Remote Synchronous Delivery (RSD): Lessons learned from teaching during COVID-19

The start of a new decade, 2020, was filled with many global issues but none as profound as the COVID-19 pandemic. North America watched the crisis unfold half the world away with little inkling that in a matter of weeks it would impact how we live, work, and educate. This chapter focuses on how the COVID-19 pandemic affected the way undergraduate programing is delivered at a private for-profit university. The new adapted model mimics the face-to-face classroom experience via video-conferencing live online sessions platform. This model is called remote synchronous delivery (RSD). This narrative vignette describes the RSD model in hopes of making sense and learning from this rapid development of a third space. The vignette considers the impact of the RSD model on students, faculty, curriculum, and the live online sessions platform. Evaluating the implications of RSD creates the space for reflection of other delivery models such as online courses, hybrid, and even the traditional face-to-face classroom experience. The chapter concludes with lessons learned and future implications. © Springer Nature Switzerland AG 2021. All rights reserved.

Assessing Health Care Professionals' Mindset in Adopting Telemedicine Post COVID-19: Pilot Questionnaire Study.

BACKGROUND: Amidst the COVID-19 pandemic, the traditional health care model has evolved toward a more patient-centric model. In relation to this trend, digital health services have seen an acceleration, which may have significant implications for the health care model. Due to the impact of COVID-19 on health care facilities, it is important to explore health professionals' willingness to adopt a patient-centric digital health delivery model for medicine and health care. OBJECTIVE: The aim of this study was to pilot a survey that assesses the impact and implementation of telehealth in view of health care providers prior to and post COVID-19. METHODS: A total of 26 volunteer health care professionals participated in the pilot study, of which 19/26 (73%) completed the general demographics portion. Among these respondents, 9/26 (35%) completed the entirety of the survey. The questionnaire included questions relating to general demographics, accessibility and benefits, usability, and engagements with telemedicine. Participants were randomly assigned to 1 of the 4 questionnaire designs (A-D) based on their expertise in telehealth. Of the 9 total participants who completed their randomly assigned questionnaire, 1 (11%) was randomly assigned to A, 3 (33%) were randomly assigned to B, 2 (22%) were randomly assigned to C, and 3 (33%) were randomly assigned to D. RESULTS: Responses and data from the study questionnaire were collected from Qualtrics. Microsoft Excel was used for data organization. Due to limited responses and data, no advanced statistical software was implemented. From the 9 participants who completed the entirety of the survey, responses from those with telehealth experience (n=4) showed that telehealth was preferred for follow-ups, lab results, and consultations, and that with telehealth, there was greater flexibility with appointment times and a decrease in the number of patients seen. Among the 4 health care providers with telehealth experience, all of them believed it improved accessibility and reduced physical barriers; health care professionals believed telehealth reduced translational barriers with patients. Among health care professionals without telehealth experience (n=5), 60% (3/5) reported a decrease in appointments for in-office visits post COVID-19 and strongly agreed or agreed that telehealth could influence the quality of care for patients. All 5 participants also reported no general concerns about telehealth prior to the pandemic and agreed that it would provide accessibility for patients. CONCLUSIONS: Preliminary findings of our pilot study showed initial support of a dynamical shift within the health care model due to the rise in the use of telehealth services between health care providers and patients but no statistically significant results. Further research and investigation with a larger sample size is warranted to better understand the mindset of health care professionals in adopting telemedicine post COVID-19.

A Pro Bono Physical Therapy Clinic's Pandemic Pivot to Telehealth and Its Impact on Student Readiness for a First Full- Time Clinic Experience

Purpose: The COVID-19 pandemic of 2020 led to a multitude of adjustments in physical therapist education. This article will describe the delivery model pivot that a student-run pro bono clinic made to sustain client care and student experience. The change in delivery model also led to a change in care model. The purpose of this study is to explore the impact that the change in delivery and care model within the student-run pro bono clinic had on student readiness for a first formal clinical education experience. Methods: This qualitative investigation utilized participant journals and a focus group to capture participants' reflections and experiences in the first four weeks of their full-time clinical experience. Content analysis guided the research team in the data analysis. Triangulation, an audit trail, reflexivity, and member checking further enhanced confirmability of findings. Results: Seven participants kept journals and participated in the focus group. Six categories of impact emerged, three because of the change in delivery to telehealth and three due to the change in care model which led to increased continuity of care. The three categories related to telehealth included 1) impact on clinical skills, 2) facilitating communication, and 3) window into their home. The three categories specific to increased continuity of care included 1) clinical reasoning skills, 2) documentation, and 3) client rapport. Conclusions: Telehealth and the increased continuity of care presented advantages and disadvantages to student readiness. Post pandemic, student leaders should consider ways in which they might retain the positive outcomes of the switch in delivery and care model while resuming care in-person.

Consumer risk perception of online food delivery during the COVID-19 Movement Control Order (MCO) in Malaysia

Malaysia's online food delivery (OFD) has developed into a vibrant scene. Urban dwellers are slowly getting used to the idea of OFD services as the new normal for eating out at the times of COVID-19. During the movement control order (MCO), government initiatives and movement restrictions propelled OFD services into the limelight, allowing locals the opportunity to support their favorite local businesses. Using model goal-directed behavior (MGB), this study investigated the effect of consumers' perceived risk (e.g., performance risk, privacy risk, financial risk, physical risk, and COVID-19 risk) on their use of OFD services. The results of the partial least squares-structural equation modeling (PLS-SEM) analysis of 339 responses indicates that perceived risk negatively affects consumers' desire to use OFD services, while perceived physical risk and COVID-19 risk negatively affect their intention to use OFD services. Further, the study uncovers the moderating role of perceived risk in the relationship between desire and intention. This study offers insights to OFD service providers in formulating new business strategies and propositions for business growth and consumer retention in the post-pandemic world.

THE FUTURE OF TEACHING AND LEARNING: FACE TO FACE, HYBRID, AND ONLINE INSTRUCTIONAL DELIVERY MODELS

This research study explores nuances to instructional delivery models beyond the COVID-19 pandemic. A case study that examines the redesign and reimagining of a graduate course to fit the diverse needs and preferences of students. This research was intended to provide insight into the possibilities of redesigning and reimagining graduate level courses for a master of education in educational leadership program at a state university in Louisiana. The research team engaged this case study in order to address the needs of current and prospective students regarding face to face, hybrid models, and online options for course delivery. This case study documents efforts to redesign and reimagine courses using instructional delivery models that meet the diverse needs and preferences of students and potential graduate candidates. While this case study has implications for instructional delivery at every level of education it is a work in progress. It begins to shed light on how graduate programs and course delivery will continue to evolve beyond the Covid-19 pandemic and well into the future. © 2022 Proceedings of the 19th International Conference on Cognition and Exploratory Learning in the Digital Age, CELDA 2022. All rights reserved.

An evidence-based practice guideline of the National Society of Genetic Counselors for telehealth genetic counseling.

There are currently no practice guidelines available for genetic counseling using telehealth modalities. This evidence-based practice guideline was developed in response to increasing use of alternative service delivery models for genetic counseling, specifically telephone and video-based genetic counseling (telehealth genetic counseling or THGC). A recent systematic evidence review (SER) compared outcomes of THGC with in-person genetic counseling and found that for the majority of studied outcomes, THGC was a non-inferior and comparable service delivery model. The SER results were used to develop this guideline. The current and anticipated future use of THGC, including the influence of the COVID-19 pandemic, provides the context for this guideline. Recommendation: The Telehealth Practice Guideline author workgroup conditionally recommends telehealth genetic counseling, either via telephone or video, as a delivery method for genetic counseling. Depending on factors unique to individual healthcare systems and provider and patient populations, THGC may be the only service delivery model available or may be utilized in addition to other service delivery models including in-person genetic counseling. The evidence shows large desirable effects, minor undesirable effects, and increased equity for patients when THGC is available. THGC may reduce or remove existing barriers to patient access to genetic counseling, such as medical conditions and/or disabilities that may affect a patient's ability to travel, inflexible work or school schedules, and lack of reliable transportation, finances, or dependent care. THGC is likely acceptable to key groups impacted by its use and is feasible to implement. Certain patient populations may require additional resources or encounter more barriers in using telemedicine services in general. For these populations, THGC can still be a valuable option if solutions are available.

(The shift to) online delivery of a rural faculty development program in research skills: lessons learned.

BACKGROUND: While rural physicians are the ideal candidates to investigate health and healthcare issues in rural communities, they often lack the required skills, competencies, and resources. As a result, research skills development programs are crucial to help ensure communities receive the quality of care they deserve. Memorial University of Newfoundland created a research skills development program called 6for6 to empower and enable rural physicians to research solutions to community-specific health needs. 6for6 program delivery was exclusively in-person until 2019. However, with limitations introduced due to the COVID-19 pandemic, organizations around the globe needed to respond quickly. As we work to return to a post-pandemic environment, program administrators and educators worldwide are unsure whether to retain or remove the changes made to programs to adapt to the pandemic restrictions. Therefore, this work addresses the impact of the online delivery model in two areas: 1) attainment of competencies (specifically research skills, knowledge, and attitudes); and 2) participant experiences, defined as the ease of attendance, the capacity to interact with team members and peers, and challenges or barriers associated with navigating program resources. METHODS: We compared the effect of an online delivery model pivoted to adapt pandemic restrictions with the original model (primarily face-to-face) on the acquisition of learning competencies and participant experience using a mixed-methods study. Various data collection methods, such as a pre-post program survey, post-program focus group, and structured observation, were utilized. RESULTS: From 2014 to 2021, 35 physicians attended the program (30 face-to-face and five online). The Wilcoxon-sign-rank test did not show any significant differences in the participants' median change of research competency scores who attended face-to-face and online learning, respectively: knowledge (32.6, 26.8), attitudes (3.8, 3.5), and skills (32.4, 20.0). Flexibility and accessibility were key aspects of participants' experiences during the online model. Comparison with previous years demonstrated no significant challenges with the virtual delivery model, yet participants struggled with mentorship challenges and learning-life balance. CONCLUSIONS: Although presenting some unique challenges, the online model did not negatively affect learner competencies. Likewise, it provided opportunities for rural physicians to attend learning sessions and interact with experts and peers while remaining in their communities.

Effectiveness of a community-integrated intermediary care (CIIC) service model to enhance family-based long-term care for Thai older adults in Chiang Mai, Thailand: a cluster-randomized controlled trial TCTR20190412004.

BACKGROUND: Populations around the world are ageing faster, with the majority living in low- and middle-income countries where health and social care are yet to be universal and inclusive for the ageing population. This community-integrated intermediary care (CIIC) model is a novel prevention-based, long-term care model enhancing the family-based care system traditionally practised in Thailand and neighbouring Asian countries, and many low-and middle-income countries globally. This study assessed the effectiveness of the CIIC model in Chiang Mai, Thailand. METHODS: The two-arm parallel intervention study was designed as a cluster-randomized controlled trial. The study population at randomization and analysis was 2788 participants: 1509 in six intervention clusters and 1279 in six control clusters. The research protocol was approved by the WHO Research Ethics Review Committee (WHO/ERC ID; ERC.0003064). The CIIC service intervention model is a combination of formal care and informal care in a subdistrict setting consisting of three components: (1) care prevention delivered as community group exercise and home exercise; (2) care capacity-building of the family caregiver; and (3) community respite service. The primary outcome was family caregivers' burden at 6-month follow-up, and secondary outcome was activities of daily living. Analysis applied the intention-to-treat approach using cluster-level analysis via STATA 16 SE. RESULTS: Baseline characteristics did not differ between the two arms. Loss of follow up was 3.7%. Mean age of the participants was 69.53 years. Women constituted 60%. The COVID-19 pandemic caused delayed implementation. The proportion of families with reduced caregiver burden at 6-month follow-up was higher among the intervention clusters (mean 39.4%) than control clusters (mean 28.62%). The intervention clusters experienced less functional decline and fewer people with depression. CONCLUSIONS: When communities are integrated for preventing care, and families are empowered for giving care, it is possible to secure universal access to health and social care for the older persons, with basic resources mobilized from communities. This study had shown the CIIC model as an effective and potential step to the realization of universal health and long-term care coverage being inclusive of ageing populations in Thailand and globally. TRIAL REGISTRATION: This trial was registered at the Thailand Clinical Trial Registry-Trial registration number TCTR20190412004, https://www.thaiclinicaltrials.org/.

Continuum of care through patient relationship management approach in Indian public healthcare system

Patient relationship management is a system-designed strategy for healthcare that has the potential to improve patient satisfaction while also lowering healthcare costs. The main goals of this concept are to create an effective referral model that provides a continuum of care while managing patient relationships with a cutting-edge digital healthcare system that manages a patient's healthcare data, to keep track of people's healthcare needs and develop a healthcare referral model, to provide effective and timely care by continuous follow-up, involving patient relationship management in the public healthcare system, and to develop a new healthcare delivery model. The application of digital solutions to health systems can help address constraints that have hindered the optimal delivery of equitable and high-quality care. © 2022 Elsevier Inc. All rights reserved.

Implementing mixed nursing care teams in intensive care units during COVID-19: A rapid qualitative descriptive study.

AIMS: The goal of this study was to gain insight into the views and experiences of an intensive care team working in a new nursing-care delivery model during the COVID-19 waves. A new model of care was implemented to augment nursing capacity and provide sufficient intensive care beds. DESIGN: A qualitative monocentric study using rapid qualitative descriptive methods was reported in line with the COREQ checklist. METHODS: Nurse, ward manager and physician participants were purposively recruited between January and March 2021 in a tertiary university-affiliated hospital in the Flemish-speaking part of Belgium. Semistructured interviews were conducted and analysed using thematic analysis methods. RESULTS: The participants were seventeen expert nurses, twelve supporting nurses, seven ward managers and four physicians. A central theme of ensuring safe, high-quality care emerged from the findings. There was a sense of losing one's grip on clinical practice when working in the mixed nursing-care teams. Different underlying experiences played a part in this sense of losing control: dealing with unknown elements, experiencing role ambiguity, struggling with responsibility and the absence of trust. Several coping mechanisms were developed by the nursing-care team to deal with those experiences, including attempts to create stability, to strike a balance between delegating and educating, to build in control and to communicate openly. CONCLUSION: In this rapid qualitative descriptive study, the implementation of a new nursing-care delivery model during a pandemic was seen to lead to several challenges for all members of the care team. Coping mechanisms were developed by the team to deal with these experienced challenges. IMPACT: When rethinking nursing-care delivery models, the findings of this study may help guide the process of implementing mixed nursing-care teams. Special attention needs to be paid to clarifying roles, sharing responsibility and clinical leadership. Other significant influences (such as moral distress) should also be taken into account.

Innovative Play-Based Strategies for Teletherapy

An accelerated need for effective and accessible therapy for children has become more evident in 2020 by the novel coronavirus SARS-CoV2 (COVID-19) pandemic. This global health crisis has exacerbated an existing mental health care crisis for children, particularly for those of color and low income who have a history of being disproportionately underserved. Teletherapy may address some of the barriers that prevent many children from receiving mental health services. Play-based strategies can be creatively integrated in teletherapy to maintain a relational, developmentally appropriate, and evidence-based approach to working with children in a virtual setting. In this article, creative ways to facilitate virtual play-based strategies are provided. Specific information about set-up, accessibility, selectability, scaffolding technology, developmental and cultural considerations, limit setting, and documentation for virtual sessions is discussed. Access to creative and theoretically informed teletherapy practices will strengthen the mental health response needed to reduce disparities in care.

An advanced self-care delivery model for leg ulcer management: a service evaluation.

BACKGROUND: Lower limb ulceration is a common cause of suffering in patients and its management poses a significant burden on the NHS, with venous leg ulcers (VLUs) being the most common hard-to-heal wound in the UK. It is estimated that over one million patients in the UK have lower limb ulceration, of which 560,000 were categorised as VLUs, with a cost burden of over £3 billion each year. OBJECTIVE: The aim of this service evaluation was to assess the effects of implementing a self-care delivery model on clinical outcomes with the intention of limiting face-to-face health professional contact to one appointment every 6 weeks. METHOD: A suitability assessment was conducted and a cohort of patients were moved to a self-care delivery model. Patient data were collected, anonymised and independently analysed, comparing time to healing against data on file from a previous report. RESULTS: This highlighted that, in 84 of the 95 patients selected, the VLUs had healed by week 24 on the pathway, a further 10 patients' VLUs had healed by week 42 and only one remaining patient reached 42 weeks without healing. CONCLUSION: These results support the hypothesis that patients with VLUs can self-care and deliver clinical effectiveness. It is recommended that all services explore the possibility of introducing a self-care model for VLU care.

The stories of eight women managed by a community rehabilitation company during the Covid-19 pandemic.

This study explores the stories of eight women supervised by probation during the first national lockdown in the United Kingdom in response to the Covid-19 pandemic. Probation quickly implemented an exceptional delivery model to protect the health and safety of staff and service users. Covid-19 has highlighted societal disparities across the world, it can be suggested that this has hugely impacted the lives of women and further extending the gender inequality gap. Although acknowledging that this is a small-scale study, it does provide a platform for women to voice and share their experiences of both problematic challenges encountered and the opportunities embraced during the first national lockdown. Firstly, the importance of supervisory relationships kept women feeling connected, emotionally supported and provided a source for practical advice. Secondly, the experiences of lockdown were felt differently dependant on the vulnerabilities and complexities of women; in short, the greater the priority need the more issues and obstacles women encountered. Thirdly, remote probation supervision was regarded as the safest and appropriate way to approach the unchartered waters of Covid-19. And finally, there was shared optimism to return to 'normal' face-to-face supervision, re-engage with services that had been paused or interrupted to aid recovery and rehabilitation.