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1.
Patient Educ Couns ; 105(10): 3096-3102, 2022 10.
Article in English | MEDLINE | ID: covidwho-2069547

ABSTRACT

OBJECTIVE: To prepare medical students for a rapidly changing healthcare landscape, where new means of communication emerge, innovative teaching methods are needed. We developed a project-based learning course in which medical students design audiovisual patient information in collaboration with patients and with students in Communication and Information Sciences (CIS). We studied what learning mechanisms are triggered in medical students by elements of a project-based-learning course. METHODS: In this qualitative study, twelve sixth year medical students that participated in the course were individually interviewed. Data were analyzed according to the principles of qualitative template analysis. RESULTS: We identified four learning mechanisms: Challenging assumptions about patients' information needs; Becoming aware of the origin of patients' information needs; Taking a patient's perspective; Analyzing language to adapt to patients' needs. These learning mechanisms were activated by making a knowledge clip, collaborating with patients, and collaborating with CIS students. CONCLUSION: Collaborating with patients helped students to recognize and understand patients' perspectives. Working on a tangible product in partnership with patients and CIS students, triggered students to apply their understanding in conveying information back to patients. PRACTICE IMPLICATION: Based on our findings we encourage educators to involve patients as collaborators in authentic assignments for students so they can apply what they learned from taking patients' perspectives.


Subject(s)
Education, Medical, Undergraduate , Students, Medical , Curriculum , Education, Medical, Undergraduate/methods , Humans , Learning , Surgical Instruments
2.
Nonlinear Engineering ; - (1):549-557, 2022.
Article in English | ProQuest Central | ID: covidwho-2065197

ABSTRACT

There are many factors that can lead to the transmission of coronavirus disease 2019 (COVID-19), one of which is the lack of knowledge on the virus and its prevention, notably in Indonesia. This study was focused to design and build an interactive learning app for COVID-19 education. The design of this study was research and development, and in terms of the app development, it utilized the analysis, design, development, implementation, and evaluation model. The project was carried out from July to December 2021, and it involved 25 study participants. The findings of this study confirmed that the educational app consisted of education, a symptom checker, a list of vaccine information links, the latest news, and COVID-19 statistics. The validity assessment showed that the educational app in this study was very appropriate to be utilized as a digital medium for patient education. In addition, it was also confirmed that all the functions of the app worked well, and participants strongly agreed that the educational materials and features of the app were interesting and helped them to learn COVID-19 prevention easily. It could be concluded that the app could be used as a learning medium for patient education. Further studies, however, were needed to prove its effectiveness in the real clinical world.

3.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P197, 2022.
Article in English | EMBASE | ID: covidwho-2064415

ABSTRACT

Introduction: The head and neck cancer (HNC) disease and treatment process creates highly visible disfigurement and a fundamental impact on vital functions in this anatomical region, which can lead to an emotionally traumatic illness experience. These factors make HNC patients vulnerable to significant change in quality of life (QOL). There has been little research regarding the psychosocial effects of the coronavirus disease 2019 (COVID-19) pandemic on this group, and we want to explore how their QOL has changed in this unique situation. Method(s): This is a retrospective study identifying 400 patients with newly diagnosed HNC in the time period of March 2015 to March 2021 who completed the University of Washington Quality of Life Questionnaire (UW-QOL), collected as part of routine clinical care at our institution. Patients diagnosed between March 2015 and December 2019 were classified in the pre-COVID-19 group, while those diagnosed between March 2020 and March 2021 were classified in the COVID-19 group. Only patients with newly diagnosed HNC who completed the UW-QOL were included. Patients with a diagnosis of skin, thyroid, and sinonasal cancer;those who were unwilling or unable to take part in the study;and those with recurrent HNC were excluded. Result(s): A total of 353 participants who met criteria were included. Patients diagnosed with HNC during the COVID-19 pandemic had significantly decreased scores in the chewing and speech sections of the UW-QOL (P<.01 and P<.05, respectively). More patients ranked a decreased mood as a point of concern in the COVID-19 group (29.82% vs 26.45%). There were no significant differences in global QOL scores between groups. Conclusion(s): HNC patients experienced a similar overall QOL prior to and during the COVID-19 pandemic. However, some domains of HNC-specific QOL were negatively affected during the COVID-19 pandemic. Patients had more concerns about their mood during the pandemic compared with before the pandemic. The results of this study may be used to inform patient treatment and patient education as well as to alleviate pandemic-related concerns for this vulnerable population.

4.
American Journal of Transplantation ; 22(Supplement 3):877, 2022.
Article in English | EMBASE | ID: covidwho-2063474

ABSTRACT

Purpose: SARS-CoV-2 infection in kidney transplant recipients is associated with an increased risk of severe disease and mortality relative to other patient populations, with mortality reported to be as high as 30% early in the pandemic. It has been demonstrated that vaccination against SARS-CoV-2 after transplantation is less effective as when administered prior to immunosuppression administration. To reduce the risk of poorer outcomes associated with immunosuppression, it is advisable that transplant candidates complete a SARS-CoV-2 vaccine series prior to transplantation. SARS-CoV-2 vaccine hesitancy contributes to under-vaccination in the transplant candidate population. We describe candidate perspectives associated with vaccine hesitancy in kidney transplant candidates. Method(s): Vaccination status of actively listed kidney transplant candidates at our center was reviewed in January 2022. The infectious disease nurse practitioner performed counseling telephone visits with all available candidates not vaccinated against SARS-CoV-2 to uncover their perspectives around vaccination and determine reasons for vaccine refusal/hesitancy. Result(s): Of the 233 candidates actively listed for kidney transplant, 23 (9.8%) were found to be unvaccinated against SARS-CoV-2. Of the 23 patients, 20 (87%) were successfully contacted for telephone interview. Thirteen (65%) candidates described safety concerns as their primary reason for vaccine hesitancy. The most common concerns shared by unvaccinated candidates were a lack of trust in the development of SARS-CoV-2 vaccines, speed of development and general lack of safety data. Five (38%) of the 13 candidates expressed additional concern about the effect of vaccines could have on their native kidney function. One candidate expressed fear that vaccine will increase HLA sensitization, making it more difficult for organ matching. Three candidates stated they did not need the vaccine, citing isolation, healthy diet and prior infection as protective factors. Three candidates cited medical reasons. These included recent monoclonal antibody treatment for SARS-CoV-2 infection (2) and lymphadenopathy (1). Conclusion(s): For patients awaiting kidney transplant, the primary reason contributing to vaccine hesitancy is concern regarding vaccine safety. For some, concerns are specific to diagnosis and status as a transplant candidate. Transplant centers should continue to address vaccine hesitancy in order to provide accurate information and targeted patient education around vaccine safety and benefit to aid patients in making decisions based on available scientific data.

5.
Chest ; 162(4):A2283-A2284, 2022.
Article in English | EMBASE | ID: covidwho-2060932

ABSTRACT

SESSION TITLE: Practice Management Beyond Coding and Staffing SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Despite reduced health care utilization and mortality for COPD patients participating in pulmonary rehabilitation (PR) after hospitalization, few enroll in this intervention. Reasons were explored in a post-discharge survey to inform new ways to market or restructure PR. METHODS: IRB-approved, telephone survey and record review of patients with COPD discharged from one hospital over 1-year period. Inclusion criteria for analysis: 1) Principal diagnosis of COPD or respiratory failure;2) Discharge home;3) PR indicated or not contraindicated. Inclusion criteria for survey: 1) Telephone consent;2) Fluency in English. RESULTS: 191 were studied. Of these, 51 (27%) were not in a home setting (26 died, 25 not discharged home), 32 (16%) had no indication for PR (11 had an incorrect diagnosis, 21 not medically indicated). Of the remaining, 62 could not be surveyed (38 not reachable, 8 language barrier, 16 refused consent), leaving 46 (24% of total group) surveyed at 132 ± 89 days following discharge. Of those surveyed, 89% had a primary care provider, 72% had a pulmonologist, 43% had heard of PR, but only 24% ever participated in this intervention. 28% were ever referred to PR. Pulmonologists were the most common referrers. Desirable outcomes and factors that might influence the patient’s decision to participate in PR are in the Table. Table. Survey Results, n = 46 Mean rankings of Importance to Patients: 1 = least important, 5= most important Potential Outcomes of Importance to Patient Reduced Hospitalization Risk 4.80 Improvement in Dyspnea 4.54 Learn More About Lung Disease 4.34 Increase in Ability to do Things 4.26 Fewer Flare-ups of Lung Disease 4.26 Decrease in Tiredness or Fatigue 4.09 Reduced anxiety or nervousness 3.94 Opportunity to Interact with Others 3.49 Factors that Might Positively Influence Decision for PR Likelihood of Beneficial Outcome 4.34 Low Cost 4.23 Short Travel Distance to PR 4.00 Less Concern over Excessive Dyspnea during Exercise 3.54 Convenient Transportation to PR 3.37 Fewer Weather-Related Issues 2.89 Not Having to Get Up in the AM to Go to PR 2.66 No Family Responsibility Conflicts in Attending PR 1.97 Not Too Soon After Hospitalization 1.60 No Employment Conflicts in Attending PR 1.37 CONCLUSIONS: Despite reasonably good access to medical care, uptake of PR was poor. Important factors in under-utilization include non-indication or contraindication or non-referral to PR. CLINICAL IMPLICATIONS: A major limitation of this survey is that it was conducted during the COVID-19 pandemic when PR facilities were closed. Those never participating in PR nevertheless listed desirability of outcomes typically attributed to PR. Although repeating the survey post-pandemic may yield more accurate results, current data indicates the need for improved patient education and referral to PR. This is a potential target for future interventions to increase PR usage. DISCLOSURES: No relevant relationships by Osama Elsankary No relevant relationships by Antarpreet Kaur No relevant relationships by Hnin Hnin Oo No relevant relationships by Jane Reardon No relevant relationships by Ryan Talbert No relevant relationships by Richard ZuWallack

6.
Chest ; 162(4):A2282, 2022.
Article in English | EMBASE | ID: covidwho-2060931

ABSTRACT

SESSION TITLE: Respiratory Care: Oxygen, Rehabilitation, and Inhalers SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: 1.To educate patients about the severity of their disease process while inpatient. 2.To educate about and offer Pulmonary rehabilitation before they are discharged from the hospital. METHODS: 1.Education of care team regarding importance of pulmonary rehabilitation. 2.Forming a report in EPIC (EMR) enlisting current COPD exacerbation inpatients. 3.Approaching patients in a multidisciplinary fashion regarding pulmonary rehabilitation. RESULTS: There was an average of 3-5 inpatient COPD exacerbation patients per week who were approached from the begining of our QI. We saw less than 5% of patients actually enrolling and coming through pulmonary rehabilitation. CONCLUSIONS: In a rural setting there are a lot of factors that play a role in healthcare disparities. Taking an example of COPD patients in our community, despite having a functional pulmonary rehabilitation program and innovative approach to education and enrollment regarding pulmonary rehabilitation, we still faced a lot of obstacles in having the COPD patients to be able to follow and get help through outpatient pulmonary rehabilitation. The main reasons stated are as follows - lack of transportation, high fall risk, no insurance/inability to afford pulmonary rehabilitation, baseline poor functional status. CLINICAL IMPLICATIONS: Despite numerous benefits, traditional Pulmonary Rehabilitation (PR) as a resource remains underutilized in chronic lung disease.Less than 3% of eligible candidates for PR attend one or more sessions after hospitalization due to many barriers, including the ongoing COVID-19 pandemic. Our QI project is an effort to educate COPD patients on the importance of pulmonary rehabilitation while they are admitted inpatient for an exacerbation. Going through the project, we identified several valid reasons on why Pulmonary rehabilitation still remains an underutilized tool in this disease. We hope to establish reasons and work on approaching different hurdles that are faced. Accessibility in terms of higher number of rehabilitation programs and functional transport to and from, better insurance coverage on the part of insurance companies, better understanding of the disease process and patient education are all the different factors that can be worked on. DISCLOSURES: No relevant relationships by Parul Dutta No relevant relationships by Gaurav Dutta

7.
Chest ; 162(4):A840, 2022.
Article in English | EMBASE | ID: covidwho-2060703

ABSTRACT

SESSION TITLE: Sepsis: Beyond 30cc/kg and Antibiotics SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Sepsis is the leading cause of hospitalization and mortality in the United States. In addition, sepsis is, by volume, the leading cause of 30 day readmissions across all payer mix in the United States. The risk factors for 30 day readmissions are multifactorial and often portends poor outcomes and increase hospitalization costs. We trialed a pilot program of enhanced sepsis discharge education which consisted of direct patient education prior to discharge, providing a Sepsis Education brochure with tips on self management at home as well as a QR code to direct patients to institutional website in case they needed further assistance, and finally a disposable thermometer to maintain an accurate temperature log to aid in monitoring for signs and symptoms of sepsis. Our primary goal was educate patients about their diagnosis and reduce sepsis readmissions in all non-medicare patients being discharged home. METHODS: The pilot was implemented at on one med/surg unit in our 550-bed tertiary, academic medical center starting in March 2021 and progressively expanded hospital wide over the next six months. The sepsis administrative coordinator screens new in-patient admissions for sepsis (non-Medicare) patients daily and informs medical/surgical unit coordinators of potential candidates. Med/surg coordinators will confirm if patients meet criteria for follow-up (non-Medicare, being discharged to home), provide discharge education and enter the patient in a log for continued surveillance. Subsequently, the administrative coordinator then follows up with a phone call 7-10 days after discharge during which, they assess the patient for worrisome symptoms, confirms follow up appointments, medication compliance and review of temperature log. If the patient needs clinical assistance, they will refer to the patient to the hospital sepsis clinical coordinator or patient’s outpatient physicians. RESULTS: We compared sepsis discharges and 30day readmissions (all excluding COVID-19 cases) from March 1, 2019 – Dec 31, 2019 to March 1, 2021 – Dec 31, 2021. Readmissions amongst Medicare patients discharged home was 15.9 % (110 / 962) in 2019 vs 11.9% (83 / 696) in 2021. For non-medicare patients, the rate was 13.2% (41/311) in 2019 vs 13.1% (51/390) in 2021. In our pilot program, the readmission rate in medicare patients was 17.2% (28/163) versus 5.6% (5/90) in non-medicare patients. CONCLUSIONS: This program captures a patient population which may have been lost to follow-up. Implementation of the enhanced Sepsis Discharge Education led to at least a 30 patient reduction in readmissions yielding an approximate cost savings of $594,000. CLINICAL IMPLICATIONS: Providing educational support, instructions, and follow up calls upon discharge improves medication adherence, compliance, and maintains patient follow up thus reducing readmissions and improving hospital resource utilization and overall cost. DISCLOSURES: No relevant relationships by Laura Freire No relevant relationships by Nirav Mistry No relevant relationships by Caitlin Tauro

8.
Annals of Oncology ; 33:S1379, 2022.
Article in English | EMBASE | ID: covidwho-2060391

ABSTRACT

Background: Anaemia and iron deficiency affect a high proportion of patients with cancer, especially when undergoing treatment with systemic anti-cancer therapies (SACT) and are associated with fatigue, reduced quality of life & reduced performance status. Over the past 4 years, the Oncology DTU has continuously reviewed the managment of patients with anaemia and in particular the need to diagnose iron deficiency at time of starting SACT and recently the same guidance were introduced for Haemato-Oncology patients. Routine blood testing of Transferrin Saturation (TSAT) and serum ferritin is performed on all patients at time of starting SACT, those diagnosed with iron deficiency anaemia are treated with an intravenous iron infusion. During this time, various logistical challenges, learning and updates to local guidance has led to a more robust process, now in place to manage this patient group. Methods: Cancer patients attending for cycle 1 day 1 SACT have their TSAT and serum ferritin levels measured, if diagnosed with iron deficiency (ie TSAT <20% and serum ferritin <100ug/L, patients will receive an intravenous iron infusion. In March 2022, an audit of 141 new oncology referrals for SACT and 11 patients who received a blood transfusion was conducted for compliance to local guidance. Results: Logistical challenges included: update and approval of local guidelines, education of all members of the Health Care Team re: prescribing, contraindications and side-effects of iron infusions, patient education. Wider issues, include: COVID, staffing. 129/141 patients had TSAT and serum ferritin levels checked, of these 57 patients were diagnosed as iron deficient, with 54 patients then receiving an iron infusion. Analysis of further results is still underway. Conclusions: Whilst this is a very small audit, it demonstrates the importance of considering iron deficiency as an underlying cause of anaemia in patients with cancer, who are starting SACT and can ensure patients receive the most appropriate supportive treatment for their needs. Through our experiences, with the support of our haematology consultant, this service is predominantly nurse led and continues to develop. Legal entity responsible for the study: The author. Funding: Has not received any funding. Disclosure: The author has declared no conflicts of interest.

9.
Investigative Ophthalmology and Visual Science ; 63(7):1396-A0092, 2022.
Article in English | EMBASE | ID: covidwho-2058548

ABSTRACT

Purpose : To gauge the impact of healthcare technology in the management of diabetic retinopathy during the COVID-19 pandemic. Methods : The study was conducted at EyeCare Consultants of New Jersey's in their two locations in NJ, Woodland Park and Edison. Eye care professionals (ECPs-two ophthalmologists, one optometrist) surveyed 400 diabetic patients during the first year of the pandemic (March 2020- February 2021). The patients all received previous instructions with CheckedUp, a patient education digital platform utilizing audiovisual and touchscreen to further educate patients, during in-office visits. The 400 diabetic patients were divided equally into two groups. To ensure the adherence of dietary and behavioral modifications related to diabetes mellitus, Group 1 received traditional phone calls while Group 2 received video calls and supplementary education with CheckedUp. Both groups had a follow-up in person in September 2021. Surveys elicited responses to gauge consistency of HbA1C management. Results : Adherence was defined as HbA1C values which remained within a target value lower than or equal to their baseline and/or <7.0% as well as compliance with medications, dietary restrictions, regular physical activity and follow-up visits. The results found a significant difference between educating the patient with a phone call versus a video call and CheckedUp. At the next follow-up visit in person: Group 1 had an adherence of 48% (96 patients) and had several patients with HbA1C values exceeding the targeted value. Group 2 had an adherence of 69% (138 patients) and were more compliant with a healthier lifestyle. They also stated that their telehealth appointment with CheckedUp helped reinforce the importance of maintaining a normal HbA1C value. Conclusions : This study illustrates the ability of digital medicine platforms to supplement virtual and in-person consultations to manage diabetic retinopathy, especially during the pandemic. Compliance is an important matter in the management and preventing progression of diabetic retinopathy. Digital tools like CheckedUp assist with optimizing patient care in these unprecedented times.

10.
Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S153-S155, 2022.
Article in English | EMBASE | ID: covidwho-2058304

ABSTRACT

Background Foreign body ingestion among children is a well-known, potentially hazardous injury that can prove fatal. We recently reported on trends in foreign body ingestions during the first year of the pandemic. This study aims to investigate whether the trends seen during the first year of the pandemic in the setting of stay-at-home orders, including decreases in foreign body ingestions at school and increase in danger foreign body ingestions (button batteries and magnets) continued into the second year of the pandemic. Methods We used the National Electronic Injury Surveillance System (NEISS) database to evaluate the frequency of suspected-foreign body ingestions (FBI) in children ages 0-17 years of age for years 2017-2021. For the purposes of our analyses, we identified 2017-2019 and 2020-2021 as the pre-COVID-19 and COVID-19 periods, respectively. FBI frequencies were then annualized based on the number of years contained within each period. We used the NEISS coding manual to assign classes to the consumer products implicated in FBI including: electronics (including cylindrical and button batteries), magnets, coins, toys, desk supplies, bathroom items, jewelry, fasteners (screws, nails, etc.) and holiday items (Christmas ornaments, holiday decor, etc.). Escalation of care was defined as hospital admission or transfer. All reported values are populations national estimates generated from actual FBI encounters at NEISS sampled emergency rooms and were calculated using the NEISS-supplied weights and variance variables. Rao-Scott Chi-square was used for all categorical comparisons. Logistic regression modeling was used for comparison of continuous variables. Results The majority of FBI occurred in children age 0-5 years. During the COVID period, 56% of ingestions occurred in males. There was no significant increase in estimated total FBI between the pre-COVID-19 and COVID period (55,175 (95% confidence intervals (95% CI) 39,329-71,020) vs 54,325 (95% CI 37,880-70,769), P=0.06). The estimated number of ingestions occurring in school decreased from pre-COVID-19 (2,306 (95% CI 1,635-2,976)) compared to COVID-19 (1,327(95% CI 640-2,015), P=0.07). The estimated number of children requiring escalation of care due to FBI increased between the two time periods (6,375 (95% CI 4,167-8,583) vs 7,508 (95% CI 4,673-10,343);p=0.8) (table 1). The estimated frequency of magnet ingestions increased significantly between the two time periods (2,603 (95% CI 1,627-3,579) vs 4,481 (95% CI 2,982-5,890), P<0.0001). The number of multiple magnet ingestions also increased (738 (95% CI 371-1,106) vs 1,355 (95% CI 841-1,869), P<0.0001). The number of estimated button battery ingestions also increased (300 (95% CI 101-498) vs 510 (95% CI 283-738), P<0.01) (figure 1). Conclusion While there was no significant increase in the frequency of total foreign body ingestions during the pandemic, the proportion of the most dangerous ingestion subtypes (magnets and button batteries) and the need for care escalation increased significantly. The injury patterns described in this analysis, provides an opportunity for targeted advocacy and education of patients, parents, educators, caregivers, and policymakers. This should guide future pandemic public health campaigns to increase home safety and prevent harmful FBI.

11.
Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S324, 2022.
Article in English | EMBASE | ID: covidwho-2057806

ABSTRACT

In 2020, telehealth (TH) in pediatric gastroenterology (GI) practice experienced unprecedented, meteoric growth, despite undefined best practices for the subspecialty. Use of synchronous video for TH first occurred in 1964, it was increasingly described in the literature from the 1970s to 1990s, and then catapulted to the forefront during the COVID-19 Public Health Emergency (PHE) beginning March 2020. Due to the sudden need for increased TH utilization by nearly all health care providers TH became essential to clinical practice. TH broadly encompasses most remote activities of clinical care, provider and patient education, and general health services. Prior to the COVID-19 PHE, surveys indicate that only 50% of North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) membership had any experience with telehealth. Although experience has grown dramatically, best practices for TH in pediatric GI, hepatology, and nutrition remain undefined and non-standardized. Key areas for review include: historical perspective, general and subspeciality usage, health care disparities, quality of the provider-patient interaction, modes of health care delivery, logistics and operations, licensure and liability, reimbursement and insurance coverage, research and quality improvement priorities, and future use of telehealth in pediatric GI with a call for advocacy. This present position paper from the Telehealth Special Interest Group of NASPGHAN provides recommendations for pediatric GI-focused telehealth best practices, reviews areas for research and quality improvement growth, and presents advocacy opportunities. Summary of Recommendations * The decision of when and how to use telehealth should be shared between patients-families and providers with the goals to achieve quality medical care and excellent patient experience * Telehealth is convenient for patients-families, affords a high degree of satisfaction and may improve access to high-value subspecialty care * Digital disparities exist for telehealth and providers need to be mindful of inequity in telehealth access and healthcare delivery * Individual providers carry the responsibility of licensed, secure, and HIPAA-compliant telehealth delivery in accordance with governmental regulations * Advocacy for permanent insurance coverage, reimbursement parity and universal licensure is urgently needed.

12.
Investigative Ophthalmology and Visual Science ; 63(7):1390-A0086, 2022.
Article in English | EMBASE | ID: covidwho-2057664

ABSTRACT

Purpose : Amidst the COVID-19 pandemic, telemedicine has emerged as a safe and cost-effective alternative to traditional, in-person ophthalmology clinic visits. To better understand the implications of this technology on the patient-physician relationship, this study assessed patient perspectives about telemedicine to identify areas for improvement. Methods : A cross-sectional survey was distributed to patients at University Retina during July 2021. Responses regarding telehealth's ability to ease anxiety of contracting COVID-19, efficiency, patient education, quality of examination, and convenience were collected on a 5-point Likert scale. A positive attitude was defined as ≥ 4 average Likert rating for all questions. Frequencies of positive attitudes were compared across demographic factors by the Pearson chi-square test. Multivariate analysis was used to evaluate factors influencing patient preference for telehealth over traditional visits. Results : Of 103 respondents, most were female (53.8%), aged 65-74 (34.6%), and high school educated (46.2%). 38% of patients did not know their diagnosis and 62.1% had no prior history of telehealth usage. Overall, patients had a neutral attitude towards telehealth (mean Likert rating (SD) = 3.11/5 ± 0.82). Nearly one-third (31%) preferred telehealth over face-to-face visits. Questions regarding “patient education” had the greatest proportion of positive attitude, whereas “efficiency” had a largely negative attitude (both 63.1%). “Convenience” of telehealth yielded the highest number of responses in strong agreement or disagreement (38.9%). Patients with no history of telehealth usage more frequently reported negative attitudes compared to those with prior experience (87.5% vs. 71.8%, p = 0.046). Patients tended to respond more positively as education level increased, but this trend was not statistically significant (p = 0.18). On multivariate analysis, patients younger than 75 were more likely to prefer telehealth over in-person visits compared to patients 75 or older (odds ratio [OR] = 2.25, p = .007). Patient gender, knowledge of diagnosis, and history of past telehealth usage did not predict preference for telemedicine. Conclusions : Patients responded with a net neutral outlook on telehealth, indicating room for improvement. Efforts should focus on addressing technological inefficiencies and age-related barriers to patient satisfaction.

13.
JMIR Form Res ; 6(9): e40001, 2022 Sep 28.
Article in English | MEDLINE | ID: covidwho-2054802

ABSTRACT

BACKGROUND: Patient awareness of chronic kidney disease (CKD) is low in part due to suboptimal testing for CKD among those at risk and lack of discussions about kidney disease between patients and clinicians. To bridge these gaps, the National Kidney Foundation developed the Kidney Score Platform, which is a web-based series of tools that includes resources for health care professionals as well as an interactive, dynamic patient-facing component that includes a brief questionnaire about risk factors for kidney disease, individualized assessment of risk for developing CKD, and self-management tools to manage one's kidney disease. OBJECTIVE: The aim of this study is to perform usability testing of the patient component of the Kidney Score platform among veterans with and at risk for kidney disease and among clinicians working as primary care providers in Veterans Affairs administration. METHODS: Think-aloud exercises were conducted, during which participants (veterans and clinicians) engaged with the platform while verbalizing their thoughts and making their perceptions, reasonings, and decision points explicit. A usability facilitator observed participants' behaviors and probed selectively to clarify their comprehension of the tool's instructions, content, and overall functionality. Thematic analysis on the audio-recording transcripts was performed, focusing on positive attributes, negative comments, and areas that required facilitator involvement. RESULTS: Veterans (N=18) were 78% (14/18) male with a mean age of 58.1 years. Two-thirds (12/18) were of non-White race/ethnicity, 28% (5/18) had laboratory evidence of CKD without a formal diagnosis, and 50% (9/18) carried a diagnosis of hypertension or diabetes. Clinicians (N=19) were 29% (5/17) male, 30% (5/17) of non-White race/ethnicity, and had a mean of 17 (range 4-32) years of experience. Veterans and clinicians easily navigated the online tool and appreciated the personalized results page as well as the inclusion of infographics to deliver key educational messages. Three major themes related to content and communication about risk for CKD emerged from the think-aloud exercises: (1) tension between lay and medical terminology when discussing kidney disease and diagnostic tests, (2) importance of linking general information to concrete self-management actions, and (3) usefulness of the tool as an adjunct to the office visit to prepare for patient-clinician communication. Importantly, these themes were consistent among interviews involving both veterans and clinicians. CONCLUSIONS: Veterans and clinicians both thought that the Kidney Score Platform would successfully promote communication and discussion about kidney disease in primary care settings. Tension between using medical terminology that is used regularly by clinicians versus lay terminology to promote CKD awareness was a key challenge, and knowledge of this can inform the development of future CKD educational materials.

14.
J Med Internet Res ; 24(9): e39800, 2022 09 23.
Article in English | MEDLINE | ID: covidwho-2054799

ABSTRACT

BACKGROUND: The COVID-19 pandemic created unprecedented shifts in the way health programs and services are delivered. A national lockdown to prevent the spread of COVID-19 in Australia was introduced in March 2020. This lockdown included the closure of exercise clinics, fitness centers, and other community spaces, which, before the pandemic, were used to deliver Beat It. Beat It is an 8-week in-person, community-based, and clinician-led group exercise and education program for adults self-managing diabetes. To continue offering Beat It, it was adapted from an in-person program to a fully web-based supervised group exercise program for adults with type 2 diabetes (T2DM). OBJECTIVE: This study aims to assess whether the Beat It Online program produced comparable health outcomes to the Beat It in-person program in terms of improving physical fitness (muscular strength and power, aerobic endurance, balance, and flexibility) and waist circumference in older adults with T2DM. METHODS: Australians with T2DM who were aged ≥60 years were included. They were enrolled in Beat It Online, a twice-weekly supervised group exercise and education program conducted via videoconference over 8 weeks. Anthropometric measurements and physical fitness parameters were assessed at baseline and completion. The adaptations to Beat It are reported using the Model for Adaptation, Design, and Impact, including the type of changes (what, where, when, and for whom), the criteria for making those changes (why and how), and the intended and unintended outcomes. The intended outcomes were comparable functional fitness as well as physical and mental health improvements across demographics and socioeconomic status. RESULTS: A total of 171 adults (mean 71, SD 5.6 years; n=54, 31.6% male) with T2DM were included in the study, with 40.4% (n=69) residing in lower socioeconomic areas. On the completion of the 8-week program, significant improvements in waist circumference, aerobic capacity, muscular strength, flexibility, and balance were observed in both male and female participants (all P<.001). The Model for Adaptation, Design, and Impact reports on 9 clinical, practical, and technical aspects of Beat It that were adapted for web-based delivery. CONCLUSIONS: This study found that Beat It Online was just as effective as the in-person program. This adapted program produced comparable health benefits across demographics and socioeconomic status. This study offers important findings for practitioners and policy makers seeking to maintain independence of older people with T2DM, reversing frailty and maximizing functional and physical fitness, while improving overall quality of life. Beat It Online offers a flexible and inclusive solution with significant physical and mental health benefits to individuals. Further evaluation of Beat It (both in-person and Online) adapted for culturally and linguistically diverse communities will provide greater insights into the efficacy of this promising program.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Aged , Australia , Communicable Disease Control , Diabetes Mellitus, Type 2/therapy , Exercise Therapy , Female , Humans , Male , Pandemics , Quality of Life
15.
J Med Internet Res ; 24(9): e39360, 2022 09 26.
Article in English | MEDLINE | ID: covidwho-2054795

ABSTRACT

BACKGROUND: The incidence of Takotsubo syndrome (TTS), also known as the broken heart syndrome or stress cardiomyopathy, is increasing worldwide. The understanding of its prognosis has been progressively evolving and currently appears to be poorer than previously thought, which has attracted the attention of researchers. An attempt to recognize the awareness of this condition among the general population drove us to analyze the dissemination of this topic on TikTok, a popular short-video-based social media platform. We found a considerable number of videos on TTS on TikTok; however, the quality of the presented information remains unknown. OBJECTIVE: The aim of this study was to analyze the quality and audience engagement of TTS-related videos on TikTok. METHODS: Videos on the TikTok platform were explored on August 2, 2021 to identify those related to TTS by using 6 Chinese keywords. A total of 2549 videos were found, of which 80 met our inclusion criteria and were evaluated for their characteristics, content, quality, and reliability. The quality and reliability were rated using the DISCERN instrument and the Journal of the American Medical Association (JAMA) criteria by 2 reviewers independently, and a score was assigned. Descriptive statistics were generated, and the Kruskal-Wallis test was used for statistical analysis. Multiple linear regression was performed to evaluate the association between audience engagement and other factors such as video content, video quality, and author types. RESULTS: The scores assigned to the selected video content were low with regard to the diagnosis (0.66/2) and management (0.34/2) of TTS. The evaluated videos were found to have an average score of 36.93 out of 80 on the DISCERN instrument and 1.51 out of 4 per the JAMA criteria. None of the evaluated videos met all the JAMA criteria. The quality of the relayed information varied by source (All P<.05). TTS-related videos made by health care professionals accounted for 28% (22/80) of all the evaluated videos and had the highest DISCERN scores with an average of 40.59 out of 80. Multiple linear regression analysis showed that author types that identified as health professionals (exponentiated regression coefficient 17.48, 95% CI 2.29-133.52; P=.006) and individual science communicators (exponentiated regression coefficient 13.38, 95% CI 1.83-97.88; P=.01) were significant and independent determinants of audience engagement (in terms of the number of likes). Other author types of videos, video content, and DISCERN document scores were not associated with higher likes. CONCLUSIONS: We found that the quality of videos regarding TTS for patient education on TikTok is poor. Patients should be cautious about health-related information on TikTok. The formulation of a measure for video quality review is necessary, especially when the purpose of the published content is to educate and increase awareness on a health-related topic.


Subject(s)
Social Media , Takotsubo Cardiomyopathy , Humans , Information Dissemination , Reproducibility of Results , Takotsubo Cardiomyopathy/diagnosis , Video Recording
16.
Journal of Clinical Urology ; 2022.
Article in English | Web of Science | ID: covidwho-2043079

ABSTRACT

Objective: The use of Quick Response (QR) codes has the potential to overcome some of the healthcare challenges we currently face, especially those presented by the COVID-19 pandemic. The aim of this research was to evaluate the use of QR codes poster in delivering patient information effectively in a Urology Outpatient department. Methods: A national online survey of Urologists was distributed, and leaflet costs were estimated. QR codes for the British Association of Urological Surgeons (BAUS) patient information leaflets were incorporated into a poster for the Urology Outpatient department. Feedback on the poster was sought from patients. Results: Overall, 108 Urologists responded to the initial survey;44% were consultants. However, 54% provided > 50% of patients with an information leaflet during face-to-face clinics prior to the Covid-19 pandemic, decreasing to 33% during COVID-19. Using departmental outgoings, a cost of (sic)3120 was calculated for printed leaflets per year normally. Rise in telephone clinics during the pandemic meant 47% of patients were provided an Internet link or asked to use Google in the clinical letter, up from 17% prior to the pandemic. In response to the QR codes poster, in a patient population, mostly male (82%) and older people(60% between 60 and 80 years of age), 40% were familiar with QR codes, 73% could access Internet and 53% used it to find information, 46% found the poster easy to use or follow and 61% found it informative. Conclusion: QR codes offer benefits, including capability for touch-free access, cost-effectiveness, potential to increase engagement and understanding, enable user-initiated learning and improve adherence. Patient perception varies with age group and smartphone access and usage.

17.
British Journal of Surgery ; 109:vi99, 2022.
Article in English | EMBASE | ID: covidwho-2042564

ABSTRACT

Aim: To improve education in patients with new urinary catheters on discharge from the Emergency Department (ED), decreasing the incidence and healthcare burden of subsequent catheter-associated complications. Method: Qualitative study design was employed to survey all Healthcare Professionals (HCPs) working in the ED and establish the quality and means of information currently provided. A novel trust-endorsed proforma with information leaflet was created with urology team input and uploaded to the ED website. Staff were updated via email, WhatsApp and verbally and re-surveyed after 6 months. Survey responses were evaluated with descriptive statistical analysis. Results: The majority of HCPs in the department reported nearly always/ often providing information verbally to patients, with similar findings on re-surveying. The most commonly discussed topic with patients remained: Common complications and where to seek advice. HCPs reported never/rarely offering written information (75%, 74% before and after respectively) and nearly all HCPs surveyed did not know where to find patient information resources (81%, 79% respectively). Conclusions: Written information provision remained poor despite creation of a proforma with information leaflet. A high departmental turnover of HCPs, alongside varying seasonal Covid burden may have reduced the efficacy of interventions. The findings may also be as a result of HCPs still not knowing where to locate such resources. 'Nudge theory' through placing leaflets next to catheter supplies, combined with improved education of new staff rotating through the department at individual inductions and the introduction of checklists are changes that have been since actioned and due to be re-surveyed in February 2022.

18.
Journal of the Canadian Association of Gastroenterology ; 4, 2021.
Article in English | EMBASE | ID: covidwho-2032041

ABSTRACT

Background: In light of the COVID-19 pandemic, gastroenterologists in Alberta moved to virtual care for many clinic visits. As the public health situation evolves, it is important to evaluate provider satisfaction with virtual care during these unprecedented times. Aims: To assess healthcare provider (HCP) satisfaction with virtual care during the COVID-19 pandemic. Methods: We administered a 20-item satisfaction survey that assessed the usefulness, ease of use, interface qualities, reliability, and overall satisfaction with virtual care tools for the delivery of care to patients with gastrointestinal diseases. One hundred and twenty-five gastroenterologists in Alberta were invited to participate via email. We used a modified Telehealth Usability Questionnaire (TUQ) which was open for response from June 19-August 30, 2020. Results: The overall response rate was 19% (24/125) with 46% female respondents. Most respondents worked in an academic facility (63%) and had been in practice for a mean duration of 12.3 years. Respondents were from seven facilities within the South, Calgary, Central and Edmonton health zones. Virtual care reported was a hybrid model consisting of telephone and in-person (54%) or telephone and video consults (42%). Although 90% indicated that virtual care tools improved access to healthcare, provided location flexibility and were appropriate to meet healthcare needs, only 42% agreed that it saved time. Inconclusive virtual consultations due to the absence of physical examination and missing lab values was reported by 75% and 33% of HCPs, respectively. Ninety-five percent of HCPs who used video conferencing found it simple, easy to learn and were able to become productive quickly with it. Over 60% of HCPs reported that virtual care (irrespective of the platform used) was not the same as in-person visits. The mean overall satisfaction for HCPs who rarely or never had virtual care prior to the pandemic, was 0.57 points higher than those who often provided virtual care (4.36 vs 3.79;95% CI: 0.26-0.88, p=0.001). Overall, 88% of providers were satisfied with virtual care and all respondents were willing to use it again (Figure 1). Identified areas of concern included patient safety, patient education on best practices, adequate remuneration, additional administrative duties, and challenges with providing care for new patients on virtual platforms. Conclusions: This survey of GI providers in Alberta showed high satisfaction and acceptance with virtual care. However, the majority reported it to be less reliable than in-person visits. Access to Alberta Netcare to view investigations was deemed valuable. Areas of concern that needs to be addressed include patient education on virtual care best practices and provider resources to assist with new consultations on virtual platforms.

19.
Journal of the American Academy of Dermatology ; 87(3):AB210, 2022.
Article in English | EMBASE | ID: covidwho-2031399

ABSTRACT

Dermatology is unique in that not only are there a shortage of dermatologists in the United States but patient access care to is largely disproportionate. As a response to the chasm of access that exists, many patients have relied on the Internet to obtain information on how to address their concerns, and this often comes at the cost of non-evidence based remedies being promoted. The inception of the 2020 COVID-19 pandemic has led many physicians to restrategize their approach to patient care. Fortunately, utilization of a virtual model has been integral to this process. The purpose of this study was twofold: increase patient confidence in addressing dermatologic concerns by providing targeted education on specific dermatologic topics and define a framework that can be implemented by dermatologists looking to use social media to increase patient education and access to dermatologic care. 3 separate education sessions (webinars) were held where the topics of hair, eczema, and acne were discussed, respectively. Each session was roughly 1 hour in length. Attendees were given pre- and postwebinar surveys to assess existing patient attitude toward their knowledge of dermatologic topics and their comfort in consulting a dermatologist with their concerns. Across the 3-day series, the total number of registrants was 30. 12 registrants for the hair webinar with an overall attendance rate of 33%;12 registrants for the eczema webinar with an overall attendance rate of 33%;6 registrants for the acne webinar with an overall attendance rate of 50%.

20.
Journal of the American Academy of Dermatology ; 87(3):AB170, 2022.
Article in English | EMBASE | ID: covidwho-2031394

ABSTRACT

Introduction: Hand dermatitis causes significant physical, psychosocial, and economic burden. The internet is a major source of health education for patients. Here, we evaluate the readability, quality, and comprehensiveness of online health resources on hand dermatitis. Methods: On July 27th 2021, a Google search was conducted with terms “hand dermatitis” and “hand eczema” and the first 40 items were evaluated. Articles that were advertisements, blogs, intended for professionals, scientific papers, or irrelevant were excluded. Contents of articles were evaluated using several validated grading tools/criteria for readability and quality and Pearson’s correlation assessed the relationship between readability and quality. Results: Twenty-three articles met inclusion criteria. Average readability was at the 11th-grade level (range 7.7-15.6). University-level reading comprehension (≥13th grade) was required for 5/23 websites. The highest quality website based on the Discern instrument was Medical News Today (55.5);nearly half of the websites (48%, 11/23) rated as poor or very poor. The average JAMA benchmark score was only 1.4/4. Nineteen websites contained images (83%) and only 4 websites (21%) included images representing hand dermatitis in skin of color (SOC). Quality and readability of the articles were significantly correlated (P =.02). Conclusion: Our results demonstrate that generally, articles were too difficult to read, have low quality, and lack representation of SOC images. With increases in hand dermatitis in the setting of frequent hand-hygiene practices during the COVID-19 pandemic, it is important for online health information to improve in readability, quality, and inclusion of SOC images to optimize online patient education.

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