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One constraint of Thai soybean production is the volume of seeds used for cultivation in the dry season or after the rice season. PhuPha Man district, KhonKaenprovince, in Northeast Thailand, faces the same problem and can be solved by producing seeds during the rainy season for use in the dry season. The collaborative brainstorming to participatory action development employed in this community-based soybean production project involves four steps: (1) needs assessment, (2) planning, (3) implementation, and (4) evaluation. From 2019-2020, a total of 40 farmers jointly participated in this project: 20 from the Non-Korm Sub-district and 20 from the Sawab Sub-district. They agreed to implement three missions: (1) Farmer group management. A Community-based Soybean Seed Production Center (CSSPC) was established in each area. Each CSSPC was responsible for determining the structure and role of management, including the implementation of disciplines. (2) Seed production management. During its implementation, a shortage of rainfall and drought occurred from September to October 2019, causing soybean production to decline. Moreover, product harvesting and project evaluation took place at the site during the COVID-19 pandemic from January to May 2020, influencing the ability of farmers and facilitators to work together on group activities which required delicate management of the monitoring, control, production, exchange, and learning to solve problems. (3) Seed purchasing and distribution management. Rainfall shortage and drought influenced the ability of the farmers to produce the required soybean seeds. Consequently, the CSSPC did not purchase the seeds and manage their distribution.Copyright © 2023, Anka Publishers. All rights reserved.
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The successes of YOPP from the presentations and keynote presentations included * a better understanding of the impact of key polar measurements (radiosondes and space-based instruments such as microwave radiometers), and recent advancements in the current NWP observing system, achieved through coordinated OSEs in both polar regions (e.g., Sandu et al. 2021);* enhanced understanding of the linkages between Arctic and midlatitude weather (e.g., Day et al. 2019);* advancements in the atmosphere–ocean–sea ice and atmosphere–land–cryosphere coupling in NWP, and in assessing and recognizing the added value of coupling in Earth system models (e.g., Bauer et al. 2016);* deployment of tailored polar observation campaigns to address yet-unresolved polar processes (e.g., Renfrew et al. 2019);* progress in verification and forecasting techniques for sea ice, including a novel headline score (e.g., Goessling and Jung 2018);* advances in process understanding and process-based evaluation with the establishment of the YOPPsiteMIP framework and tools (Svensson 2020);* better understanding of emerging societal and stakeholder needs in the Arctic and Antarctic (e.g., Dawson et al. 2017);and * innovative transdisciplinary methodologies for coproducing salient information services for various user groups (Jeuring and Lamers 2021). The YOPP Final Summit identified a number of areas worthy of prioritized research in the area of environmental prediction and services for the polar regions: * coupled atmosphere, sea ice, and ocean models with an emphasis on advanced parameterizations and enhanced resolution at which critical phenomena start to be resolved (e.g., ocean eddies);* improved definition and representation of stable boundary layer processes, including mixed-phase clouds and aerosols;incorporation of wave–ice–ocean interactions;* radiance assimilation over sea ice, land ice, and ice sheets;understanding of linkages between polar regions and lower latitudes from a prediction perspective;* exploring the limits of predictability of the atmosphere–cryosphere–ocean system;* an examination of the observational representativeness over land, sea ice, and ocean;better representation of the hydrological cycle;and * transdisciplinary work with the social science community around the use of forecasting services and operational decision-making to name but a few. The presentations and discussions at the YOPP Final Summit identified the major legacy elements of YOPP: the YOPPsiteMIP approach to enable easy comparison of collocated multivariate model and observational outputs with the aim of enhancing process understanding, the development of an international and multi-institutional community across many disciplines investigating aspects of polar prediction and services, the YOPP Data Portal3 (https://yopp.met.no/), and the education and training delivered to early-career polar researchers. Next steps Logistical issues, the COVID-19 pandemic, but also new scientific questions (e.g., the value of targeted observations in the Southern Hemisphere), as well as technical issues emerging toward the end of the YOPP Consolidation Phase, resulted in the decision to continue the following three YOPP activities to the end of 2023: (i) YOPP Southern Hemisphere (YOPP-SH);(ii) Model Intercomparison and Improvement Project (MIIP);of which YOPPSiteMIP is a critical element;and (iii) the Societal, Economics and Research Applications (PPP-SERA) Task Team.
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Objective: To evaluate practice transformation team (PTT) members' perceptions of the Flip the Pharmacy (FtP) initiative as a strategy for implementing and improving community pharmacy-based patient care. Method(s): FtP is a national 2-year practice transformation initiative for implementing enhanced patient care and medication optimization services at community pharmacies, launched in 2019 with 28 PTTs including over 500 pharmacy locations. Key informant interviews were conducted with team leads, coaches, and pharmacy champions from four PTTs that participated in the first FtP cohort. The interviews were conducted using semistructured interview guides based on the RE-AIM framework and focused on participants' experiences in the first year of FtP. Interviews were audio-recorded, transcribed, and analyzed using a rapid content analysis approach. Result(s): Four leads, 8 coaches, and 8 pharmacy champions were interviewed from 4 PTTs from May to October 2021 and resulted in 10 themes: (1) community pharmacy practice experience is important when selecting coaches;(2) team readiness supports successful pharmacy practice transformation;(3) measures of patient care quality are needed;(4) payment and practice transformation opportunities happen in parallel;(5) successful practice transformation requires strategic involvement of the entire pharmacy team;(6) FtP practice transformation domains are synergistic;(7) change packages, coaching, and performance monitoring are core practice transformation supports;(8) pharmacy teams value opportunities to share and learn from each other;(9) sustaining patient care services is continuous;and (10) COVID-19 accelerated practice transformation while creating new stress points. Conclusion(s): Participants in this study perceived the FtP initiative as a helpful strategy implementing and improving community pharmacy-based patient care. Future research should explore the sustainability of the FtP initiative and similar community pharmacy practice transformation efforts.Copyright © 2022 Pharmacotherapy Publications, Inc.
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Introduction: Antimicrobial resistance (AMR) is a global threat. The Global South has illustrated gaps and challenges in contextual interventions to tackle AMR due to economic development and existing legislation on antimicrobial use. Community pharmacists are vital healthcare professionals in primary care settings to promote Antibiotic Smart Use (ASU). Objective(s): The aim of this study was to explore their experiences and aspirations around ASU to tailor sustained interventions. Method(s): Virtual online focus group discussions (FGDS) were conducted to explore the views of part- and full-time community pharmacists in Thailand who were systematically recruited to ensure their eligibility to fit with Appreciative Inquiry (AI) theory. Out of a pool of eligible participants, those who had scored above average (> 74%) and above in the attitude questionnaire - the earlier part of the project - were quota sampled and purposively invited to take part. A specific topic guide was developed using the four domains of AI (Discovery, Dream, Design and Destiny), to provide insights into their thought processes and their recommendations for the facilitation of ASU in community pharmacies. Qualitative data were analysed using Nvivo12, using thematic framework analysis with a deductive approach. Result(s): Twenty one community pharmacists participated. Seven themes around ASU emerged in the Discovery Domain of AI. There are pharmacists' practices for non-prescribed antibiotic dispensing, professional experience, work environment, commercialisation and business, commonly used non-prescribed antibiotics, visibility of the National Plan for tackling AMR, and learning points from the COVID19 pandemic. The participants dreamed about the ideals of ASU in the community pharmacy in five themes which are establishing One Health stakeholders- regulating the supply chain, following developed countries as role models, reviewing legislation, and forming witness checks and balances in healthcare professionals. Then the participants designed interventions and strategies on five themes: insurance system, incentive intervention, re-classification of antibiotics, and organisational unity for supporting ASU. The Destiny domain consisted of five themes that would allow sustainable ASU in their settings: the need for ASU literacy, primary care, AMR attitudes and behaviour change strategies, communication of ASU progression and resource management, and trust in pharmacists as a key to building customer loyalty. Conclusion(s): Four domains of Appreciative Inquiry provided community pharmacists with the opportunity to share their experiences and aspire to desired changes to promote ASU in the pharmacy setting and broadly across the country. This framework reflected contextual interventions and strategies with bottom-up brainstorming linked to top-down approaches. The requirement of literacy, along with strategies for changing for public and healthcare providers, could elevate ASU in community pharmacies. Integration of community pharmacy into a part of government primacy care unit and communication of the ASU progression with them might promote engagement with the remaining business aspects.
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Learning Objectives: We sought to develop a research escape-hunt to teach EM residents: 1) predictive statistics and diagnostic test characteristics, 2) interpretation of data and statistical analysis, 3) study design, 4) informed consent for research, and 8) the ethical principles guiding research. Introduction: Research and evidence-based medicine are important parts of residency training and the ACGME identifies scholarly activity as a core requirement for EM. EM training programs take a variety of approaches to addressing these requirements and there is not a standard, widely accepted curriculum available. Curricular Design: We considered ways to incorporate active, participatory learning experiences that effectively engage adult learners. Within the CORD community, escape- hunts have demonstrated efficacy for other EM content. An escape-hunt was developed with each station focused on one topic and requiring participants to solve a series of puzzles. Prior to the event, participants reviewed materials covering the content including summary sheets and podcast links. The escape-hunt served as an opportunity to further explore and reinforce the asynchronous content. Faculty members were present to help guide teams through the stations and to answer questions about the content. Teams worked to solve each station with the first team to successfully complete all nine stations winning a prize. A subsequent COVID-impacted event was held the following year utilizing Zoom breakout rooms, demonstrating that this innovation can be successfully implemented both in-person and virtually. Impact: Participants reported high levels of satisfaction (100% (21/21)) and engagement (95% (20/21)) with the activity, increased comfort with the content (91% (19/21)), and demonstrated improvements in knowledge across content areas (91% (19/21)). Participants reported using skills relevant to clinical practice such as 'working as a team,' 'task switching,' 'task delegation,' 'brainstorming,' and 'solving complex problems together.' Challenges exist related to props cost and the time for development;however, we now have a materials bank that can be used in the future and we have successfully implemented a COVID-safe virtual event, demonstrating the adaptability of this format.
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Background: Despite a marked decline in worldwide under-five mortality over the past 30 years, the largest proportion of these deaths remain neonates. In 2018, 4 million (75% of all under-five deaths) infants died worldwide [1]. The neonatal mortality rate in Ethiopia was 28.1 per 100 live births, compared to 17.7 globally and 27.2 in Africa, ranking 23rd for highest neonatal mortality [2]. The Ethiopian Pediatric Society (EPS), entered a virtual partnership with the American Academy of Pediatrics (AAP) in 2020 to provide educational and practical support to clinicians in Ethiopia to perform quality improvement (QI) research. QI training for clinicians at eight Ethiopian sites is modeled on Project ECHO (Extension for Community Healthcare Outcomes) [3]. ECHO improves capacity for specialists to deliver care to underserved communities via collaboration with local clinicians using video teleconferencing, which has been a particularly advantageous tool to continue global health work during the COVID-19 pandemic. The goal of this project is to support local Ethiopian providers in designing, implementing, and assessing a QI intervention. Methods: We adapt the Project ECHO model to have U.S. neonatology faculty-fellow teams mentor clinicians from 8 hospitals in Ethiopia. Using video conferencing and regular contact through mobile devices, teams work to identify gaps in care, create SMART aim statements, identify key stakeholders and barriers to change, and implement interventions. Interventions are measured with a phone application, Liveborn, which allows instant transmission of data internationally. Sites provide monthly progress updates to the EPS. AAP/EPS leadership, U.S.-based faculty-fellow teams, and QI team leaders meet monthly via video conference for didactic sessions on QI methodology followed by teams presenting their progress, which promotes discussion and collaboration between the sites, AAP/EPS leadership, and U.S. mentorship teams to address any barriers. Results: Teams identified compliance with delayed cord clamping (DCC) and skin-to-skin (STS) after delivery as a gap by independently collecting local data. QI teams are currently still implementing interventions and measuring improvement. Teams have identified several barriers, the most common cited being stakeholder buy-in and logistic challenges in implementation. During monthly meetings, teams continually discuss and brainstorm ways to address barriers overall and among individual sites. Conclusion: Via the ECHO model, the AAP and EPS are supporting Ethiopian QI teams in designing and implementing QI interventions despite the limitations imposed by the COVID-19 pandemic. Challenges to this mentorship process include communication barriers (language, internet network) and perception of lack of need by Ethiopian clinicians for U.S. mentorship. Using the ECHO model, all teams have defined SMART aims, begun to implement interventions, and are now collecting compliance data.
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Introduction: Inadequate sleep habits can compromise the quality of sleep and performance in activities of daily living of the individual, even more, considering the COVID-19 pandemic, which significantly interfered in the sleep and mental health of the population. Objective: To encourage the perception of habits that negatively influence the sleep quality of young people during social isolation in times of COVID-19. Methods: A workshop was proposed through the Youtube platform, during a scientific event on “Mental Health”. Two speech therapists organized a workshop with the theme “Sleep care practices”. The theme was divided into three parts. First, the basic concepts in sleep, the notion of sleep phase distribution, and consequences of sleep deprivation were addressed. The second part included the explanation and stimulation for self-application of the Mini Sleep Questionnaire (MSQ) from the Epworth Sleepiness Scale (ESS). This MSQ questionnaire was selected because, in addition to being self-administered, it assesses the frequency of sleep-related complaints and the ESS Scale subjectively assesses excessive daytime sleepiness. Finally, the third and last part consisted of reflections on sleep hygiene, with tips on how to improve these behaviors and habits. Results: The interactive proposal based on practice in brainstorming, aimed to generate reflections to participants, seeking to highlight inappropriate points in their routines, in order to enable a new planning of behaviors related to habits that influence the various aspects of sleep hygiene. In eight days of making the video available on the aforementioned platform, 3,624 views and 388 likes were achieved. The total video time was 22 minutes and 20 seconds, with the first part having 5 minutes and 21 seconds, the second part with 6 minutes and 6 seconds and the third with 11 minutes. Conclusion: Through information and communication technologies it was possible to encourage and raise awareness of a considerable population with regard to practices favorable to quality sleep, in a short period of time.
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The need for online meetings increased drastically during the COVID-19 pandemic. Wearing headphones for this purpose makes it difficult to know when a headphone wearing person is available or in a meeting. In this work, we explore the design possibilities of headphones as wearable public displays to show the current status or additional information of the wearer to people nearby. After two brainstorming sessions and specifying the design considerations, we conducted an online survey with 63 participants to collect opinions of potential users. Besides the preference of the colors red and green as well as using text to indicate availability, we found that only 54 % of our participants would actually wear headphones with public displays attached. The benefit of seeing the current availability status of a headphone-wearing person in an online meeting or phone call scenario were nonetheless mentioned even by participants that would not use such headphones. © 2022 ACM.
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Brainstorming is a well-known technique for fostering student creativity. Due to the COVID-19 pandemic, brainstorming sessions were recently held online, using web-based tools and video calls. Virtual Reality (VR) can also be an alternative for brainstorming sessions. However, there is currently limited research on brainstorming sessions using VR, and its impact on students’ creative thinking is still unknown. We conducted a preliminary study that compares brainstorming in VR and brainstorming with a web-based online whiteboard to study how each communication method affects students’ creative thinking. Given that students had the same amount of time for both VR and web sessions, the results reveal that there is no significant difference in the quality or quantity of ideas. Even though participants said VR was difficult to use, the results of VR and web sessions were similar. We believe that if the students become familiar with VR, they will be able to develop more ideas in the virtual space. © 2021 29th International Conference on Computers in Education Conference, ICCE 2021 - Proceedings. All rights reserved
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Innovation has the potential to propel organizations to unprecedented levels of performance and to strengthen their competitive advantage. Collaboration plays a significant role in boosting the innovation capabilities and reaching performance goals. Improving collaboration brings substantial overall benefits ranging from faster internal decision making, reduced costs through shared resources, and the development of more innovative products. The COViD-10 outbreak has radically altered traditional collaboration and teamwork patterns, requiring new approaches that would nurture creativity, engagement, and motivation at team level, and that would also streamline decision-making processes. This paper investigates the use of a collaborative platform that can enhance teamwork achievements and decision-making capabilities and presents an analysis of experiments carried out within software research projects. The approach considers key challenges in today's global and fast-changing research and business environments that demand improvements in collaboration among functions ranging from R&D to distribution. The authors explore techniques for improving the effectiveness of teams, capitalizing on the promises of cutting-edge software and the applicability of the Design Thinking methodology and its potential to boost collaboration. This research probes the capacity of technology to support team performance and better decision-making processes. © 2021 The Authors. Published by Elsevier B.V.
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Keywords: Telehealth;Health-coaching;Behaviour change Purpose: COVID-19 has changed the face of healthcare, including student placement provision in the UK and internationally. There is a national placement capacity crisis. The Coventry University telehealth coaching clinic provided second year BSc Physiotherapy students with a placement on the University site. Telehealth enables students to work with clients to achieve their physical activity goals at a time when University staff working at home may need more well-being support. To our knowledge, on-site telehealth clinics are being used at one other UK University. Methods: Using problem-based learning, ten students used a ‘telehealth trigger scenario’ and worked collaboratively to brainstorm and search the evidence for key concepts. Students were facilitated by visiting tutors and clinical educators to replicate a practice placement. Students led the development of infrastructure (booking system, IT support), governance (record keeping, GDPR compliance, informed consent) and teamworking (weekly strategy meetings). Students modified the ‘improving health: changing health behaviour’ NHS health trainer handbook to use as an assessment tool, focussing on physical activity (removing eating, smoking and drinking habits). We evaluated the clinic using mixed methods: (i) placement capacity statistics, (ii) student satisfaction survey, (iii) student performance (pass/fail rate), (iv) client satisfaction survey, (v) student's experience (themes extracted from team debrief sessions). Results: Students saw a total of 15 clients, and 12 of those received a follow up appointment. (i) Placement capacity: 29 of the 120 second year BSc Physiotherapy students could not be placed during March–April 2021. Ten (35%) of these students were placed on the telehealth clinic. (ii) Student satisfaction survey: of 10 respondents, 90% agreed they gained new and transferable skills, 90% agreed they felt part of a community with staff and students, 40% agreed the placement was organised and running smoothly. (iii) Student performance: at the halfway evaluation, 100% of students had passed. (iv) Client satisfaction: of seven respondents, 85% were satisfied with the service, 100% agreed it was easy to schedule appointments at convenient times. (v) Student experience: key themes were learning achieved (development of clinical knowledge and skills, quality assurance skills, and emotional intelligence) and limitations of the placement (time constraints, limited learning opportunities). Conclusion(s): The Coventry University telehealth clinic is an innovative and high-quality service, which is appropriate to be managed by second- and third-year BSc physiotherapy students. However, there is room for improvements such as increasing structure and organisation of the clinic, which can be done by addressing feedback. Impact: Currently, 44 students do not have placements for May 2021, but 45% of these students will be placed by scaling up the telehealth clinic to take 20 students. This could reduce the current predictions that 50% of Coventry University Physiotherapy students will graduate late (due to sub-optimal placement hours), by at least one-third. Telehealth Students can gain new skills in organisation, administration, management, governance and communication (in virtual environments) that will impact confidence and ability to execute audits and service delivery projects after graduation. The telehealth service could be scaled up to include psychology, occupational therapy and dietetics students. Funding acknowledgements: No external funding was received.
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Introductory sentences indicating the purposes of the study: We used boot camp translation (BCT), a validated community based participatory strategy, to elicit input from diverse stakeholders (i.e., patients and clinic staff) to develop messaging and patient education materials for follow-up colonoscopy after abnormal fecal testing. BCT is a process that engages participants in translating health information into ideas, messages, and materials that are understandable and relevant to patients. Brief description of pertinent experimental procedures: Colorectal cancer is the second-leading cause of cancer death in the United States, and screening rates are disproportionately low among Latinos. Mailed fecal immunochemical test (FIT) outreach programs have been shown to improve colorectal cancer screening rates in federally qualified health centers (FQHCs), with improvements ranging from 22% - 45%. Patients with an abnormal FIT result have an increased risk of having colorectal cancer, and the risk increases if the necessary follow-up colonoscopy is delayed. Unfortunately, rates of follow-up colonoscopy among adults with an abnormal FIT result are low in FQHCs. As part of the Participatory Research to Advance Colon Cancer Prevention (PROMPT) study, a partnership with a Los Angeles-based FQHC that provides medical services to over 300,000 patients annually (82% Latino), we used BCT to gather input from patients and staff to develop messaging and materials for patients in need of a follow-up colonoscopy after abnormal FIT. Due to the COVID-19 pandemic, we conducted BCT using a digital platform. Eligible patient participants were Latino, ages 50 to 75 years, Spanish-speaking, and willing to participate in three virtual sessions. Recruitment and BCT materials were developed in English and Spanish, but all three sessions were held in Spanish consistent with patient preferences. The sessions included presentations on colorectal cancer screening, effective messaging to improve Latino screening participation, and brainstorming sessions to obtain feedback on messaging and materials. Summary of the new unpublished data: A total of 10 adults (7 patients and 3 clinic staff) participated in the BCT sessions. Key themes learned were 1) increasing awareness about the colonoscopy procedure (why it is important, what the procedure is, how to prepare), 2) using simple and clear wording, including statistics, and using family as a motivator, and 3) providing different patient outreach modalities to broaden reach, such as patient-facing fact sheets, videos in clinic or sent by text. Statement of the conclusions: Using BCT, we successfully incorporated feedback from Spanish-speaking Latino patients to design culturally relevant materials to promote follow-up colonoscopy after abnormal FIT results. Targeted efforts are needed to improve rates of follow-up colonoscopy among patients with abnormal FIT results in FQHC settings. (Final materials, including patient-facing fact sheets and screenshots from short videos, will be showcased in the poster.).
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Background: Because of their vulnerability, cancer patients were exposed to viral infections and especially by the spread of the COVID-19, the coronavirus pandemic. According to published scientific data, the coronavirus was spread by sneezing, coughing, or the contact of the eyes, nose, and mouth through contaminated spaces. For these reasons, the oncology center's staff needs more protection and more precaution. A multidisciplinary hospital team was assembled to define critical failures linked to cancer patient process in hospital and proposed different actions to secure them and improve this process. Methods: According to a risk management tool (Failures Modes Effect and Criticality Analysis), the cancer patient process was mapped in many steps. During the videoconference brainstorming, many ideas were expressed and were classified into an Ishikawa diagram. The criticality indices were calculated from the severity, the occurrence, and the detection probability. Results: The cancer patient process has been described;20 failures have been identified with 8029 points of the sum of critical indices. The new organization of the cancer patient process, the program of training of administrative staff and security agents of hospitals, wearing the protective resources were reduced to the criticality index of 6615 points, a mean of factor reduction of 1291, and the standard deviation was 5007.75. Conclusion: Modification of cancer patient process in oncology center resulted in an important risk reduction as shown by risk analysis. Our study illustrates the usefulness of risk analysis methods in the healthcare system. A systematic use of risk analysis was needed to improve the safety of high-risk activities in healthcare processes. © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NCND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
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Humanity is facing global and local sustainability challenges that call for the involvement of a wide range of expertise drawn from academia, civil society, the private sector, as well as funding and development agencies. The challenge will be to leverage this diversity to nurture decision making. To make such discussions successful we propose a pattern language approach. It can be used as a practical step-by-step process to guide interdisciplinary collaboration between researchers and to facilitate transdisciplinary interactions between the academic and nonacademic worlds. The patterns are documented and freely accessible online in the Sustainable Science Pattern database.
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Background With the onset of the SARS-CoV-2 pandemic, health care providers everywhere were forced to rapidly shift the way they deliver care. Within our community-based academic organization, there was variability in response to required changes among different clinical areas, with many clinics ramping down their services while they restructured. In our pediatric endocrinology clinic, we had built the infrastructure to support virtual care using a provincial platform as part of a pilot program for our diabetes population in the year preceding the pandemic. This experience set the stage for a swift pivot to virtual care. To ensure ongoing high quality consultation and follow-up services during the pandemic, our clinic required rapid restructuring to successfully and immediately shift completely to a sustainable "virtual first" approach in March 2020. Objectives In the months following the onset of the SARS-CoV-2 pandemic, we sought to quickly develop and implement innovative strategies, using a quality improvement framework, to supplement virtual care and maintain high quality care delivery. Design/Methods As soon as physical distancing measures were implemented in March 2020, our multidisciplinary team held daily 30-minute meetings to troubleshoot, brainstorm, and strategize potential adaptations in care delivery to ensure we continued to meet patient and family needs with primarily virtual care. Barriers and problems were presented and prioritized, solutions proposed, then implemented with support of operation and e-health teams. Attention to educational needs for medical students, residents and fellows helped shape solutions. Results The following innovative solutions were successfully implemented within three months: a drive thru hemoglobin A1C clinic for patients with diabetes a streamlined "low touch" Auxology Clinic to supplement virtual visits when body measurement, vital signs or physical exam assessment were required pre-visit preparation instructions for patients and families active promotion of patient portal enrolment re-design of follow-up orders content to allow providers to accurately indicate suitability of virtual care alone or with support measures a workflow to allow quick conversion from in-person to virtual visits to prevent cancellations related to isolation requirements an educational framework to ensure level-appropriate exposure to and involvement in patient care for trainees auto-faxing of medication and supplies printer mapping and workflow for external lab requisitions provider/staff scheduling and role re-assignment to facilitate minimal number of on-site staff support of the team to adopt best practices for virtual visits Conclusion While virtual care delivery existed before the pandemic, it was rarely used outside of pilot projects, or only from necessity, when travel to a health care facility was not possible. Herein we provide an overview of an innovative, primarily virtual, care delivery model to satisfy patient and family needs in a pediatric endocrinology clinic in an academic centre. Many components of our model have (and can be) applied or adapted to support care delivery in other clinical areas. The people, processes, and digital health adaptations required to support a primarily virtual mode of care were critical to its success.
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Remdesivir (GS-5734) was identified as a promising therapeutic candidate for COVID-19, at a time when no therapeutic agents had shown to be efficacious for the treatment of coronavirus disease 2019 (COVID-19). A series of rapid randomized, double-blind, placebocontrolled Adaptive COVID-19 Treatment Trials were developed, all written into one Protocol document, to evaluate the safety and efficacy of novel therapeutic agents in hospitalized adults diagnosed with COVID- 19. The first study (ACTT-1) was a multi-center trial conducted in 73 sites globally (N = 1062), that demonstrated remdesivir shortened the time to recovery in adults who were hospitalized with COVID-19 and had evidence of lower respiratory tract infection. This presentation focuses on the unique challenges presented by the high-profile Adaptive COVID-19 Treatment Trial and how the data management team ensures its success in this pandemic environment. Typically, a data management team may take several weeks or months to design and build a database upon receipt of a new protocol but due to the high priority of the Adaptive COVID-19 Treatment Trial study, the database was initially built in 2 days. Having such a short turnaround time meant the team had to focus on critical items such as randomization and forms that collected data related to safety signals. Flexibility was also important since study sites were being identified and activated on a rolling basis, and many were international which meant various formatting differences, specifically with laboratory results. For both internal and external stakeholders to ensure proper communication and organization, it was crucial to maintain a proper balance of collaboration yet still identifying clear leaders of functional groups to avoid having ''too many cooks in the kitchen.'' Scheduling frequent meetings and utilizing collaboration software, rather than relying on email communication, helped all parties to brainstorm and resolve issues efficiently. The Adaptive COVID-19 Treatment Trial was divided into multiple stages (called ACTTs) where each new Adaptive COVID-19 Treatment Trial introduced a different therapeutic combination. Each Adaptive COVID-19 Treatment Trial was designed to enroll over 1000 trial participants across 100+ sites, and it was not uncommon for the stages to overlap, creating many challenges with data management. Data queries were often sent to sites weekly or even multiple times a week, and data managers would go above and beyond by working nights and weekends to accommodate the high workload and shortened timeframe. Safety and endpoint data were the top priority during data cleaning and the volume of queries was not just a challenge for the data management team but also for the sites that had to juggle the trial in addition to clinically managing their COVID patients who had a brand new disease. Meeting deadlines was essential but doing so at the expense of the cleanliness of the data was not an acceptable option, so new processes had to be implemented in order to avoid this from occurring. It was also critical to be ''audit-ready'' at all times due to the high-profile nature of the study, so an internal team was dedicated to ensuring that all documentation was present and complete throughout the course of the study. Mock audits were held so that issues could be resolved a Food and Drug Administration audit. In this presentation, four speakers will introduce the study in more detail and demonstrate how being more adaptable and communicative enabled the data management team, in collaboration with the other study stakeholders, to successfully manage the trial. Each presentation will last approximately 20 min and they are listed below in more detail and in chronological order. The remaining 10 min will be devoted to a question and answer session with audience members. National Institutes of Health Clinical Project Manager Ms Nomicos is a Clinical Project Manager at the National Institute of Allergy and Infectious Disease who, along with several other Clinical Project Managers, was respons ble for general oversight of study conduct and contractors on the Adaptive COVID-19 Treatment Trial. Ms Nomicos will introduce the ACCT trial and provide some background information, as well as briefly explain the study objectives, design, and procedures. Ashley Bowersox, MPH (Emmes) Ms Bowersox is a Senior Data Manager in the Vaccine and Infectious Diseases group, supporting the Clinical and Epidemiological Studies in Infectious Diseases. She served as the Forms Design Lead and DM Project Manager on the Adaptive COVID-19 Treatment Trial. Ms Bowersox will discuss database design considerations and in particular the need to build the database with flexibility to accommodate rolling identification and activation of study sites as well as attention to the unique needs of the international sites participating in the study. Ashley Wegel, CCRA, MEd (Emmes) Ms Wegel is an Associate Project Leader in the Vaccine and Infectious Diseases group, supporting the Clinical and Epidemiological Studies in Infectious Diseases. She served as the Forms Design Lead and DM Project Manager on the Adaptive COVID-19 Treatment Trial. Ms Wegel will present site management and data management strategies for meeting incredibly demanding database freeze and lock timelines required by sponsor to support safety reviews and publications and continuously improve upon forms design and interface for each new stage. Kelly Clark (Duke Human Vaccine Institute) Ms Clark is a Clinical Research Coordinator in the Duke Vaccine Trials Unit at the Duke Human Vaccine Institute, one of the enrolling sites on Adaptive COVID-19 Treatment Trial. Ms Clark will discuss the challenges of working on a rapid study with tight timelines, requiring quick responses to a large volume of research data queries, while clinically managing their COVID patients who had an unfamiliar and daunting new disease.
ABSTRACT
Introduction Maximising efficiency in endoscopy in the face of increasing service pressure, demand and complexity of endoscopy is imperative, particularly given the unparalleled impact of the COVID pandemic on service delivery and cancer pathways. Previous attempts to improve turnaround time through introduction of a turnaround nurse have been hindered by inadequate staffing. We aimed to improve list efficiency and improve turnaround time through the application of marginal gains theory and implementation of a multi-faceted improvement plan. Methods Data was collected from electronic patient records and audit entries made by endoscopy staff. List 'actual' start and stop times were audited against 'scheduled' times. Turnaround time was assessed by a Quality Improvement (QI) Fellow, observing the endoscopy list and collecting information in real time. Results were discussed at a departmental meeting and a 4-stage improvement plan was devised and implemented. Re-audit data was collected to determine effect. Results Preliminary audit data revealed 89% of list starts to be delayed. Lists ran beyond scheduled stop times in 73%. The improvement plan saw: 1) Review and re-organisation of the nursing rota. 2) Departmental commissioning of an external 'change agent' to conduct interviews with nursing and endoscopy managers and work with the QI fellow in designing a bespoke team-building day to address communication strategies and brainstorm perceived departmental issues hindering efficiency. 3) Introduction of an in-room debrief tool, to enhance situation awareness and teamwork. 4) Implementation of a multi-modal 'Nurse-led consent' training programme, combining didactic and in-situ scenariobased simulation training, measuring and recording competence using Directly-Observed-Procedural-Skills (DOPS) assessments. Re-audit data revealed improved list finish-times (49% cf. 27%) although delays in start-times remained. Median turnaround time was 10 minutes, a major improvement from a turnaround time in 20.8 minutes in 2018. Conclusions It is recognised that single improvement interventions are unlikely to result in significant, sustainable change. The aggregation of marginal gains theory dictates that small, marginal gains can add up to a remarkable improvement. Our 4-stage improvement plan saw the implementation of a revised nursing rota and a bespoke team-building day in tandem with the introduction of a 'Nurse Consent' training programme and a novel team debrief tool. In this way, we were able to implement change, whilst simultaneously assessing and addressing staff morale, engage key stakeholders and as a result significantly improve turnaround time. We plan to streamline admission and patient preparation processes to further address delayed start times in future cycles of the improvement project.
ABSTRACT
Many conferences and in-person meetings have transitioned to virtual platforms in response to the COVID-19 pandemic. Here, we share strategies and lessons learned from organizing an international virtual unconventional conference, or 'unconference'. The event focused on how early career researchers can advocate for systemic improvements in scientific publishing and research culture. The virtual unconference had three main components: (1) a virtual networking event, (2) asynchronous virtual brainstorming, and (3) a virtual open space, where participants could join or lead in-depth discussions. The unconference format was participant-driven and encouraged dialogue and collaboration between 54 attendees from 20 countries on six continents. Virtual brainstorming allowed participants to contribute to discussions at times that were convenient for them. Activity was consistently high throughout the 48 hours of virtual brainstorming and continued into the next day. The results of these discussions are collaboratively summarized in a paper entitled Empowering Early Career Researchers to Improve Science, co-authored by the unconference participants . We hope that this method report will help others to organize asynchronous virtual unconferences, while also providing new strategies for participant-driven activities that could be integrated into conventional virtual conferences.