[The specificities of the online focal group: an integrative review]. / Especificidades| |do| |grupo| |focal| ||on-line:| |uma| |revisão| |integrativa|.

The scope of this study is to analyze the specificities of conception and execution of the different modalities of online focus groups (OFGs), a qualitative technique that is an alternative to a traditional focus group, due to the social distancing required by the COVID-19 pandemic. An integrative literature review was conducted in PubMed Central and BVS. National and international studies published in the last 10 years that describe and discuss OFGs were included. A total of 291 articles were identified and 24 were included after evaluation in stages. Four OFG modalities were found: synchronous or asynchronous by writing; synchronous by video/audio or audio. The OFG was used to research different health topics. The same platform can be used for realizing different OFG modalities, guaranteeing the participants' security and anonymity. The lack of a real-life atmosphere can impact participant engagement, but it can be resolved. An OFG can produce quality data, save time and expense, expand the participation of people who are geographically dispersed, but limit those with restricted internet access. This study can help researchers who intend to choose anOFG modality. Studies that assess the limits of OFGs in Brazil are suggested, as well those which address the asynchronous OFG by audio.

Objetiva-se analisar especificidades da concepção e realização das modalidades de grupo focal on-line (GFO), técnica qualitativa alternativa ao grupo focal tradicional frente ao distanciamento físico imposto pela pandemia de COVID-19. Realizou-se uma revisão integrativa da literatura nas bases PubMed Central e BVS. Foram identificados 291 artigos, a inclusão de 24 após avaliação por etapas. Foram identificados 291 artigos. Após avaliação por etapas, foram incluídos 24 artigos nacionais e internacionais dos últimos dez anos que descrevem e discutem a realização do GFO. As modalidades de GFO encontradas foram: síncrono ou assíncrono por escrito; síncrono por vídeo/áudio ou áudio. O GFO foi realizado em variadas pesquisas do campo da saúde. Uma mesma ferramenta pode ser usada para diferentes modalidades, garantindo a segurança dos participantes e o anonimato. A falta de atmosfera de vida real pode impactar o engajamento dos participantes, uma limitação manejável. As modalidades de GFO podem produzir dados de qualidade, economizar tempo e custo, ampliar a participação de sujeitos dispersos geograficamente, mas limitar em relação aos que têm dificuldades de acesso à internet. Este estudo auxilia pesquisadores na escolha de uma modalidade de GFO. Sugere-se pesquisas que avaliem os limites do GFO no Brasil e que abordem a modalidade assíncrona por áudio.

Slack in the infrastructure of intensive care units: resilience management in the post-pandemic era.

BACKGROUND: Although slack is an asset to resilient hospitals, it is usually explicitly discussed only in terms of the quantity and quality of beds and staff. This paper expands this view by addressing slack in four infrastructures of intensive care units (ICUs) (physical space, electricity supply, oxygen supply, and air treatment) during the COVID pandemic. METHODS: The study occurred in a leading private hospital in Brazil, aiming at the identification of slack in four units originally designed as ICUs and two units adapted as ICUs. Data collection was based on 12 interviews with healthcare professionals, documents, and comparison between infrastructures and regulatory requirements. RESULTS: Twenty-seven instantiations of slack were identified, with several indications that the adapted ICUs did not provide infrastructure conditions as good as the designed ones. Findings gave rise to five propositions addressing: relationships intra and inter infrastructures; the need for adapted ICUs that match as closely as possible the designed ICUs; the consideration of both clinical and engineering perspectives in design; and the need for the revision of some requirements of the Brazilian regulations. CONCLUSIONS: Results are relevant to both the designers of the infrastructures and to the designers of clinical activities as these must take place in fit-for-purpose workspaces. Top management might also benefit as they are the ultimate responsible for decision-making on whether or not to invest in slack. The pandemic dramatically demonstrated the value of investing in slack resources, creating momentum for this discussion in health services.

Impacts, Learner Diversity, and Curricular Framework of a Virtual Global Health Elective Catalyzed by the COVID-19 Pandemic.

Background: Place-based international electives that build global health competencies have existed for decades. However, these electives require travel and are infeasible for many trainees around the world, particularly those with insufficient financial resources, logistical complexities, or visa limitations. The emergence of virtual approaches to global health electives, catalyzed by the travel pause related to the COVID-19 pandemic, necessitates the exploration of learner impacts, participant diversity, and curricular frameworks. Child Family Health International (CFHI), a non-profit global health education organization that partners with universities to expand immersive educational offerings, launched a virtual global health elective in 2021. The elective drew on faculty from Bolivia, Ecuador, Ghana, Mexico, the Philippines, Uganda, and the United States. Objective: This study aimed to describe a newly developed virtual global health elective curriculum and evaluate the demographics of and impacts on trainee participants. Methods: Eighty-two trainees who were enrolled in the virtual global health elective from January to May 2021 completed both 1) pre- and post-elective self-assessments of domains of competency mapped to the elective curriculum and 2) free text responses to standardized questions. Data were analyzed through descriptive statistical analysis, paired t-testing, and qualitative thematic analysis. Findings: The virtual global health elective had 40% of its participants hail from countries other than the United States. Self-reported competency in global health broadly, planetary health, low resource clinical reasoning, and overall composite competency significantly increased. Qualitative analysis revealed learner development in health systems, social determinants of health, critical thinking, planetary health, cultural humility, and professional practice. Conclusion: Virtual global health electives effectively develop key competencies in global health. This virtual elective had a 40-fold increase in the proportion of trainees from outside the United States, compared to pre-pandemic place-based electives. The virtual platform facilitates accessibility for learners from a variety of health professions and a wide range of geographic and socioeconomic environments. Further research is needed to confirm and expand on self-reported data, and to pursue approaches to greater diversity, equity, and inclusion in virtual frameworks.

Defining estimands in clinical trials: A unified procedure.

The ICH E9 (R1) addendum proposes five strategies to define estimands by addressing intercurrent events. However, mathematical forms of these targeted quantities are lacking, which might lead to discordance between statisticians who estimate these quantities and clinicians, drug sponsors, and regulators who interpret them. To improve the concordance, we provide a unified four-step procedure for constructing the mathematical estimands. We apply the procedure for each strategy to derive the mathematical estimands and compare the five strategies in practical interpretations, data collection, and analytical methods. Finally, we show that the procedure can help ease tasks of defining estimands in settings with multiple types of intercurrent events using two real clinical trials.

Clinical research resource support for off-site research coordinators in intensive and specialty care units.

Clinical Research Coordinators (CRCs) are vital collaborators in a clinical research project. They often are the primary liaisons between investigators and human participants in studies and are involved in every aspect of many protocols, including participant recruitment, care (both usual medical care and specific study-related monitoring and procedures), data collection, specimen processing, and follow-up. The Clinical Translational Science Award program, which was created by the National Institutes of Health in 2006, has significantly expanded the venues in which Clinical Research Resource (CRR) - based CRCs are embedded. CRCs functioning in these areas, outside of the research-focused in-patient environment of the CRR, are designated as "off-site" CRCs. Many of these locations, such as intensive care units and emergency departments, require that CRCs interact regularly with healthcare providers whose primary functions are focused on providing optimal patient care rather than research and often involving very complex patients. These off-site CRCs require additional training and support outside of the usual research-oriented environment of the CRR. They are required to function within the context of the patient-care team while fostering implementation of collaborative research. This is a description of such a program specifically geared to off-site CRCs with the goal of enhancing the quality of research and experiences of CRCs.

Using automated active infrared counters to estimate footfall on urban park footpaths: behavioural stability and validity testing.

BACKGROUND: Using infrared counters is a promising unobtrusive method of assessing footfall in urban parks. However, infrared counters are susceptible to reliability and validity issues, and there is limited guidance for their use. The aims of this study were to (1) determine how many weeks of automated active infrared count data would provide behaviourally stable estimates of urban park footfall for each meteorological season, and (2) determine the validity of automated active infrared count estimates of footfall in comparison to direct manual observation counts. METHODS: Three automated active infrared counters collected daily footfall counts for 365 days on three footpaths in an urban park within Northampton, England, between May 2021 - May 2022. Intraclass correlation coefficients were used to compare the behavioural stability of abbreviated data collection schedules with total median footfall within each meteorological season (Spring, Summer, Autumn, Winter). Public holidays, events, and extreme outliers were removed. Ten one-hour manual observations were conducted at the site of an infrared counter to determine the validity of the infrared counter. RESULTS: At least four-weeks (28 days) of infrared counts are required to provide 'good' to 'excellent' (Intraclass correlation > 0.75, > 0.9, respectively) estimates of median daily footfall per meteorological season in an urban park. Infrared counters had, on average, -4.65 counts per hour (95% LoA -12.4, 3.14; Mean absolute percentage error 13.7%) lower counts compared to manual observation counts during one-hour observation periods (23.2 ± 15.6, 27.9 ± 18.9 counts per hour, respectively). Infrared counts explained 98% of the variance in manual observation counts. The number of groups during an observation period explained 78% of the variance in the difference between infrared and manual counts. CONCLUSIONS: Abbreviated data collection schedules can still obtain estimates of urban park footfall. Automated active infrared counts are strongly associated with manual counts; however, they tend to underestimate footfall, often due to people in groups. Methodological and practical recommendations are provided.

The social value of a SARS-CoV-2 vaccine: Willingness to pay estimates from four western countries.

SARS-CoV-2 vaccines give rise to positive externalities on population health, society and the economy in addition to protecting the health of vaccinated individuals. Hence, the social value of such a vaccine exceeds its market value. This paper estimates the willingness to pay (WTP) for a hypothetical SARS-CoV-2 vaccine (or shadow prices), in four countries, namely the United States (US), the United Kingdom, Spain and Italy during the first wave of the pandemic when COVID-19 vaccines were in development but not yet approved. WTP estimates are elicited using a payment card method to avoid "yea saying" biases, and we study the effect of protest responses, sample selection bias, as well as the influence of trust in government and risk exposure when estimating the WTP. Our estimates suggest evidence of an average value of a hypothetical vaccine of 100-200 US dollars once adjusted for purchasing power parity. Estimates are robust to a number of checks.

What data collection methods work best for COVID19 outbreak surveillance for people with end stage kidney disease? An observational cohort study using the UK Renal Registry.

BACKGROUND: Patients on kidney replacement therapy (KRT) are vulnerable to severe illness from COVID-19. Timely, accurate surveillance is essential for planning and implementing infection control at local, regional and national levels. Our aim was to compare two methods of data collection for COVID-19 infections amongst KRT patients in England. METHODS: Adults receiving KRT in England were linked to two sources of data on positive COVID-19 tests recorded March-August 2020: (1) submissions from renal centres to the UK Renal Registry (UKRR) and (2) Public Health England (PHE) laboratory data. Patient characteristics, cumulative incidence by modality (in-centre haemodialysis (ICHD), home HD, peritoneal dialysis (PD) and transplant), and 28-day survival were compared between the two sources. RESULTS: 2,783/54,795 patients (5.1%) had a positive test in the combined UKRR-PHE dataset. Of these 2,783, 87% had positive tests in both datasets. Capture was consistently high for PHE (> 95% across modalities) but varied for UKRR (ranging from ICHD 95% to transplant 78%, p < 0.0001). Patients captured only by PHE were more likely to be on transplant or home therapies (OR 3.5 95% CI [2.3-5.2] vs. ICHD) and to be infected in later months (OR 3.3 95%CI [2.4-4.6] for May-June, OR 6.5 95%CI [3.8-11.3] for July-August, vs. March-April), compared to patients in both datasets. Stratified by modality, patient characteristics and 28-day survival were similar between datasets. CONCLUSIONS: For patients undergoing ICHD treatment the collection of data submitted directly by renal centres allows constant monitoring in real time. For other KRT modalities, using a national swab test dataset through frequent linkage may be the most effective method. Optimising central surveillance can improve patient care by informing interventions and assisting planning at local, regional and national levels.

Five tips for conducting remote qualitative data collection in COVID times: theoretical and pragmatic considerations.

OBJECTIVE: To provide five methodological and pragmatic tips for conducting remote qualitative data collection during the context of the COVID-19 pandemic. METHOD: The tips presented in this article are drawn from insights of our own experiences as researchers conducting remote qualitative research and from the evidence from the literature on qualitative methods. The relevant literature was identified through searches using relevant keywords in the following databases: CINAHL, PubMed, SCOPUS, and Web of Science. Searches were limited to articles in English and Portuguese, published from 2010 to 2021, to ensure a current understanding of the phenomenon. RESULTS: Five tips are provided: 1) Pay attention to ethical issues; 2) Identify and select potential participants; 3) Choose the type of remote interview; 4) Be prepared to conduct the remote interview; and 5) Build rapport with the participant. CONCLUSION: Despite the challenges in conducting remote data collection, strengths are also acknowledged and our experience has shown that it is feasible to recruit and interview participants remotely. The discussions presented in this article will benefit, now and in the future, other research teams who may consider collecting data for their qualitative studies remotely.

End of COVID-19 emergencies sparks debate.

Moves by WHO and U.S. dial back data collection, reporting mandates.

A Method for Stress Detection Using Empatica E4 Bracelet and Machine-Learning Techniques.

In response to challenging circumstances, the human body can experience marked levels of anxiety and distress. To prevent stress-related complications, timely identification of stress symptoms is crucial, necessitating the need for continuous stress monitoring. Wearable devices offer a means of real-time and ongoing data collection, facilitating personalized stress monitoring. Based on our protocol for data pre-processing, this study proposes to analyze signals obtained from the Empatica E4 bracelet using machine-learning algorithms (Random Forest, SVM, and Logistic Regression) to determine the efficacy of the abovementioned techniques in differentiating between stressful and non-stressful situations. Photoplethysmographic and electrodermal activity signals were collected from 29 subjects to extract 27 features which were then fed into three different machine-learning algorithms for binary classification. Using MATLAB after applying the chi-square test and Pearson's correlation coefficient on WEKA for features' importance ranking, the results demonstrated that the Random Forest model has the highest stability (accuracy of 76.5%) using all the features. Moreover, the Random Forest applying the chi-test for feature selection reached consistent results in terms of stress evaluation based on precision, recall, and F1-measure (71%, 60%, 65%, respectively).

What are the challenges of epidemiological research during the COVID-19 pandemic?

Abstract The COVID-19 pandemic had an impact in several areas, and in scientific research was not different. Researchers are working from their homes since research facilities and universities were closed, and face-to-face interaction where limited to stop the virus spread. This brought a lot of changes in observational studies, especially in epidemiology research. Since most studies are being conducted through internet-based assessments, researchers are facing different challenges regarding data collection and participants recruitment, for example. In this paper, we share some of the challenges faced in a population-based study conducted in Southern Brazil, as well as possible alternatives to help researchers to overcome these issues.

Changing face-to-face psychological care to remote mode: facilitators and obstacles in the COVID-19 pandemic. / Cambio de la atención psicológica presencial a modalidad remota: facilitadores y obstáculos en la pandemia de COVID-19.

OBJECTIVE: to verify associations between sociodemographic variables and factors that facilitate and hinder the transition from face-to-face psychological care to remote mode in the first year of the COVID-19 pandemic. METHOD: this is an analytical, quantitative, cross-sectional study. After approval by the Research Ethics Committee, data collection was performed by applying an online form consisting of 55 questions. Data were analyzed using descriptive and inferential statistics techniques. RESULTS: the intentional sampling consisted of a total of 385 Brazilian psychologists, mostly women (67.01%), young professionals with up to five years of graduation (44.16%) most of activities in the private clinic. It was found that training time between five and 10 years was associated with a greater perception of difficulties and that previous experience with remote care facilitated adaptation in the transition from one modality to another. CONCLUSION: considering that call center can be a powerful tool in the health scenario, it is suggested the inclusion of remote care issues in the research agenda and syllabus in the curricula of health training courses.

Potential use of telemedicine in paediatrics: a single-centre retrospective review.

Recent advancements and adoption of telemedicine have affected all aspects of healthcare including paediatrics. While telemedicine has the potential to increase access to paediatric care, the limitations of this service in its current iteration bring into question its usefulness for direct replacement of in-person care, particularly in an acute or urgent care setting. This retrospective review demonstrates that only a small percentage of in-person visits to our practice would have resulted in definitive diagnosis and treatment if facilitated via telemedicine. There is a need for better and more widespread data collection techniques and tools suitable for paediatric remote care implementation before telemedicine becomes a useful diagnostic and treatment tool in an acute or urgent care setting.

How to Best Prepare Pharmacy Students for Disaster Management: A Qualitative Study.

OBJECTIVE: This study explores the opinions of academic and practicing pharmacists about ways to prepare pharmacy students for disaster management to enable them to optimize their role in disaster health management. METHODS: Semi-structured individual interviews were conducted for data collection from April through June 2021. The research participants were 9 pharmacists who were involved in disaster management. The interview guide was developed following a comprehensive literature review on disaster management. Data were analyzed using thematic analysis. RESULTS: The main themes identified are knowledge of health and disaster management, specific skills in disaster management, positive attitudes toward involvement in disaster management, and appropriate behavior in the face of a disaster, as well as personal readiness and training to achieve competence and readiness. Participants mentioned that special training in soft skills, especially communication and problem-solving, is essential for students. CONCLUSION: Disaster-specific competencies and personal readiness through training can prepare pharmacy students for disaster management. Soft skills such as communication and problem-solving must be the highest priority.

Preparing for the Future: Establishing a National Consensus on Nursing Crisis Documentation.

Clinicians across the globe face overwhelming dissatisfaction and burden with electronic health records due to poor usability and the sheer volume of data collection requirements. In the United States, electronic health records are noted to be a principal source of distress, dissatisfaction, and endless workarounds, leading to poor clinician performance and, ultimately, poor patient outcomes. The purpose of this article is to present a detailed review of a 2020 Texas pilot study. The study's focus was the engagement of nursing informatics experts from around the state to gain consensus on nursing documentation's current status and if plans were being developed to modify or decrease documentation, specifically to alleviate burden during a time of crisis. The study consisted of subject matter expert focus groups, a high-level Delphi for instrument development, and the implementation of the statewide instrument to gain consensus. Ultimately, the research team learned that there were gaps in not only what documentation could be removed (either temporarily or permanently) but also what standards dictate the use of crisis documentation (ie, "surge" criteria). The study findings discussed in this article will inform improvement strategies and policy recommendations to increase the value and usability of crisis nursing documentation requirements.

Harmonization of maternal balanced energy-protein supplementation studies for individual participant data (IPD) meta-analyses - finding and creating similarities in variables and data collection.

BACKGROUND: Public health and clinical recommendations are established from systematic reviews and retrospective meta-analyses combining effect sizes, traditionally, from aggregate data and more recently, using individual participant data (IPD) of published studies. However, trials often have outcomes and other meta-data that are not defined and collected in a standardized way, making meta-analysis problematic. IPD meta-analysis can only partially fix the limitations of traditional, retrospective, aggregate meta-analysis; prospective meta-analysis further reduces the problems. METHODS: We developed an initiative including seven clinical intervention studies of balanced energy-protein (BEP) supplementation during pregnancy and/or lactation that are being conducted (or recently concluded) in Burkina Faso, Ethiopia, India, Nepal, and Pakistan to test the effect of BEP on infant and maternal outcomes. These studies were commissioned after an expert consultation that designed recommendations for a BEP product for use among pregnant and lactating women in low- and middle-income countries. The initiative goal is to harmonize variables across studies to facilitate IPD meta-analyses on closely aligned data, commonly called prospective meta-analysis. Our objective here is to describe the process of harmonizing variable definitions and prioritizing research questions. A two-day workshop of investigators, content experts, and advisors was held in February 2020 and harmonization activities continued thereafter. Efforts included a range of activities from examining protocols and data collection plans to discussing best practices within field constraints. Prior to harmonization, there were many similar outcomes and variables across studies, such as newborn anthropometry, gestational age, and stillbirth, however, definitions and protocols differed. As well, some measurements were being conducted in several but not all studies, such as food insecurity. Through the harmonization process, we came to consensus on important shared variables, particularly outcomes, added new measurements, and improved protocols across studies. DISCUSSION: We have fostered extensive communication between investigators from different studies, and importantly, created a large set of harmonized variable definitions within a prospective meta-analysis framework. We expect this initiative will improve reporting within each study in addition to providing opportunities for a series of IPD meta-analyses.

Effectiveness assessment of non-pharmaceutical interventions: lessons learned from the COVID-19 pandemic.

Effectiveness of non-pharmaceutical interventions (NPIs), such as school closures and stay-at-home orders, during the COVID-19 pandemic has been assessed in many studies. Such assessments can inform public health policies and contribute to evidence-based choices of NPIs during subsequent waves or future epidemics. However, methodological issues and no standardised assessment practices have restricted the practical value of the existing evidence. Here, we present and discuss lessons learned from the COVID-19 pandemic and make recommendations for standardising and improving assessment, data collection, and modelling. These recommendations could contribute to reliable and policy-relevant assessments of the effectiveness of NPIs during future epidemics.

Survey mode and nonresponse bias: A meta-analysis based on the data from the international social survey programme waves 1996-2018 and the European social survey rounds 1 to 9.

The constant increase in survey nonresponse and fieldwork costs are the reality of survey research. Together with other unpredictable events occurring in the world today, this increase poses a challenge: the necessity to accelerate a switch from face-to-face data collection to different modes, that have usually been considered to result in lower response rates. However, recent research has established that the simple response rate is a feeble measure of study quality. Therefore, this article aims to analyze the effect of survey characteristics, especially the survey mode, on the nonresponse bias. The bias measure used is the internal criteria first proposed by Sodeur and first applied by Kohler. The analysis is based on the survey documentation and results from the International Social Survey Programme waves 1996-2018 and the European Social Survey rounds 1 to 9. Random-effects three-level meta-regression models, based on data from countries from each inhabited continent, were created in order to estimate the impact of the survey mode or modes, sampling design, fieldwork experience, year of data collection, and response rate on the nonresponse bias indicator. Several ways of nesting observations within clusters were also proposed. The results suggest that using mail and some types of mixed-mode surveys were connected to lower nonresponse bias than using face-to-face mode surveys.