Patient Satisfaction With Telehealth Visits for New Patient Appointments for Pelvic Floor Disorders: A Randomized Trial of Telehealth Versus Standard In-Person Office Visits.

IMPORTANCE: The acceptability and safety of telehealth have been reported in urogynecology for preoperative and postoperative care but not new patient consultation. OBJECTIVES: This study aimed to determine if new patient telehealth encounters are noninferior to in-person encounters for women presenting to a urogynecology clinic using a satisfaction questionnaire. Secondary objectives were to describe patient experiences and follow-up. STUDY DESIGN: A randomized controlled trial of telehealth versus in-person consults for new patients with any urogynecologic condition was conducted. Patients completed the validated Patient Satisfaction Questionnaire 18 (PSQ-18) after the visit. The primary outcome was composite PSQ-18 score. Using a noninferiority margin of 5 points on the PSQ-18, 25 patients per arm were required with a power of 80% and an α of 0.05. RESULTS: From March to September 2021, 133 patients were screened, 71 were randomized, and 58 were included in the final analysis (30 telehealth and 28 in-person). Demographic characteristics were similar between groups. Patient Satisfaction Questionnaire 18 composite scores were high for both groups but higher for in-person versus telehealth visits (75.68 ± 8.55 vs 66.60 ± 11.80; P = 0.001; difference, 9.08); results were inconclusive with respect to noninferiority. Women in the telehealth group expressed uncertainty regarding the telehealth format. There were no differences in short-term follow-up, communication with the office, or treatment chosen between groups. CONCLUSIONS: Women seen by urogynecologic providers for a new consult both via in-person or telehealth visits demonstrated high satisfaction with their first visit. We were unable to determine if telehealth is noninferior to in-person visits. Our study adds to the literature that telehealth is safe, effective, and acceptable to patients.

The shortfalls of online learning catalyzed by COVID-19: Pre-health students’ perspective

Due to the COVID-19 pandemic, the pivot to distance learning left many higher education institutions scrambling to find the resources to shift materials online and instructors making significant modifications to their courses to adapt. This study is the critical initial step in explaining any relationships between the responsive move to remote learning and academic performance and stress, anxiety, and depression. An eight-month longitudinal cohort study design with an action research methodology was conducted over four waves from June 2020 to January 2021. Participants had the option to be involved with semi-structured, in-depth interviews via Zoom. The qualitative results from the in-depth themes include: health & wellness, relationships & connectedness, transition home, classroom changes, learning & participation, extra-curriculars, COVID-19, virtual challenges, academic performance, and self-regulation. Thus, through thoughtful and intentional accommodations, instructors and students may create a new digital space for learning to improve upon motivational barriers and retaining content.

'We stick people in a house and say okay, you're housed. The problem is solved': A qualitative study of service provider and organisational leader perspectives on thriving following homelessness.

Research aimed at identifying and evaluating approaches to homelessness has predominately focused on strategies for supporting tenancy sustainment. Fewer studies focus on strategies for enabling thriving following homelessness, and the perspectives of service providers and organisational leaders (SPOL) on this topic are rare. We conducted this study in the context of a community-based participatory research project in two cities in Ontario, Canada. This research was aimed at identifying the strengths and challenges of existing supports in enabling thriving following homelessness, followed by co-designing a novel intervention alongside persons with lived experience of homelessness (PWLEH) and SPOL. The current study presents the findings of interviews conducted in 2020-2021 with SPOL in organisations serving PWLEH. We interviewed 60 individuals including service providers (n = 38; 63.3%) and organisational leaders (n = 22; 36.7%) using semi-structured qualitative interviews. Interviews were conducted and recorded on Zoom to align with physical distancing protocols associated with the COVID-19 pandemic. Recordings were transcribed verbatim and analysed abductively informed by the lenses of social justice and health equity. The essence of our findings is represented by a quote from a research participant: 'We stick people in a house and say okay, you're housed. The problem is solved'. This essence was expressed through five themes: (1) stuck in a system that prevents thriving, (2) substance use as an important coping strategy that prevents tenancy sustainment and thriving, (3) the critical importance of targeting community integration following homelessness, (4) incorporating peer expertise as imperative and (5) people need to be afforded options in selecting housing and services following homelessness. Our findings indicate that SPOL envision possibilities of thriving following homelessness yet are embedded within a system that often prevents them from supporting individuals who are leaving homelessness to do so. Research, practice and policy implications are discussed.

Lister hospital children day services quality improvement project

Aims• Initially to review the use of the Children’s Day Services at the Lister Hospital1. Reviewing the first of a three-part quality improvement project to review and improve the booking system for Children’s Day Services• To compare the expected demands of the day services unit with daily realities in services provided.• To assess how this interplays with staffing levels and safe, appropriate usage.• Eventually, to provide an overview of what services are required for the local population and to assess what changes might be required to deliver this safely.• Finally, to review changes implemented to improve day services especially the use of the booking system.Methods• Quantitative data:1. 90 days of appointment data was reviewed retrospectively between April-June 2021. A total of 842 appointments were reviewed. This was categorised into type of day service appointment e.g. blood test, jaundice clinic, allergy etc.2. Using the data from a patient and staff survey and previous phlebotomy audit, completed by the Children’s day services team.• Qualitative data: 2 weeks’ worth of qualitative data was collected. This included a written account of all informal or verbal requests including additional ‘walk-in’ patients. The qualitative data also included written accounts of staff that reflected on patient safety.ResultsOver the data collection period, blood tests accounted for 41.6% of workload, despite only 12.5% of appointments being for phlebotomy. This was reached largely through the use of designated ‘ward attender’ slots for blood tests. 20.2% of day service appointments were used to provide a prolonged jaundice clinic, which is a foundation doctor led clinic. An average of 9.3% of day services consisted of allergy clinic, while registrar reviews were 9.3% of encounters.Quantitative results overall showed a disproportionate and inappropriate number of appointments booked as blood tests, and more jaundice clinic slots than required.The qualitative data displayed a broad range of scenarios varying in complexity. Some showed foundation doctors being required to oversee difficult procedures alongside running clinic. Other scenarios included poor referrals with missing or inadequate information with demands on day services that were inappropriate and potentially unsafe.ConclusionThe day service has changed over the COVID pandemic and, with that, the demands on its staff have also changed. One key finding is that there is a high phlebotomy service demand which is currently disproportionate to expectations. The demand on prolonged jaundice clinic is lower than expected, and there is huge variety between the complexity of tasks that are indistinguishable in the current booking system. There may be opportunities to outsource phlebotomy to better use resources, while staffing should better match real demands. Patient booking must find a balance between flexibility and rigidity to ensure an efficient and safe system. Lastly, the day services unit is a bridge between the hospital service and community paediatrics and could be utilised better with the knowledge this review has shown. The next stage will be to review the changes made to the service to complete the cycle of the quality improvement project.

Virtual clinical assessment in medical education: an investigation of online conference technology.

As a result of the Covid-19 pandemic, medical education institutions were suddenly and unexpectedly faced with making significant changes in delivering their clinical assessments to comply with social distancing requirements and limited access to clinical education centres. Seeking a potential solution to these new circumstances, we designed, implemented and evaluated an online virtual OSCE, as a 'proof of concept' intervention study. Our qualitative research involved document analysis of the stages of decision-making and consultation in designing the intervention, and thematic analysis based on the perspectives and experiences of the key stakeholders (final year students, clinical examiners, simulated patients and faculty staff who acted as station assistants), gathered through surveys with Likert-scale questions and free text comments, and online discussion groups which were recorded and transcribed. From our analysis, we identified four themes: optimising assessment design for online delivery, ensuring clinical authenticity, recognising and addressing feelings and apprehensions, and anticipating challenges through incident planning and risk mitigation. Through the data gathered at each stage of the intervention, and the involvement of key stakeholders in the design and evaluation, our study highlights examples of effective practice for future applications of online technologies in assessment, provides guidance for designing and implementing online virtual assessment, and lays a foundation for comparative, longitudinal research on the significant and increasing roles played by technology in healthcare professional education and practice.

Exploration of the COVID-19 Content within a Vaccine Choice Social Media Platform: A Case Study

With the continued rise in cases of COVID-19 and the increased availability of vaccines, it is essential to recognize the drivers of vaccine uptake. A large vaccine choice organization often uses social media platforms, specifically Facebook, to communicate messages to their audience. This study examined this organization’s Facebook posts between January 1, 2020 and May 1, 2020 to determine what themes and sub-themes were most often discussed regarding COVID-19. Three independent reviewers used an inductive approach with content analysis to code and analyze 35 posts relevant to COVID-19. Ten themes and eight subthemes emerged. Personal freedoms was the most prevalent theme, followed by vaccine safety and private/government involvement. Though some of the themes and sub-themes were uniquely associated with the COVID-19 pandemic, many were similar to the vaccine uptake factors identified for other vaccines. With the increasing usage of social media for information, the investigation of online forums can provide insight into the determinants which may impact COVID-19 vaccine uptake. These findings may be generalized to guide interventions to increase vaccine acceptance and distribution of other novel vaccines within the general population.

Successful conduct of an acute stroke clinical trial during COVID.

Most clinical research stopped during COVID due to possible impact on data quality and personnel safety. We aimed to assess the impact of COVID on acute stroke clinical trial conduct at sites that continued to enroll patients during the pandemic. BEST-MSU is an ongoing study of Mobile Stroke Units (MSU) vs standard management of tPA-eligible acute stroke patients in the pre-hospital setting. MSU personnel include a vascular neurologist via telemedicine, and a nurse, CT technologist, paramedics and emergency medicine technicians on-board. During COVID, consent, 90-day modified Rankin Scale (mRS) and EQ5D were obtained by phone instead of in-person, but other aspects of management were similar to the pre-COVID period. We compared patient demographics, study metrics, and infection of study personnel during intra- vs pre-COVID eras. Five of 6 BEST-MSU sites continued to enroll during COVID. There were no differences in intra- (n = 57) vs pre- (n = 869) COVID enrolled tPA eligible patients' age, sex, race (38.6% vs 38.0% Black), ethnicity (15.8% vs 18.6% Hispanic), or NIHSS (median 11 vs 9). The percent of screened patients enrolled and adjudicated tPA eligible declined from 13.6% to 6.6% (p < .001); study enrollment correlated with local stay-at-home and reopening orders. There were no differences in alert to MSU arrival or arrival to tPA times, but MSU on-scene time was 5 min longer (p = .01). There were no differences in ED door to CT, tPA treatment or thrombectomy puncture times, hospital length of stay, discharge disposition, or remote vs in-person 90-day mRS or EQ5D. One MSU nurse tested positive but did not require hospitalization. Clinical research in the pre-hospital setting can be carried out accurately and safely during a pandemic. tPA eligibility rates declined, but otherwise there were no differences in patient demographics, deterioration of study processes, or serious infection of study staff. Trial registration: NCT02190500.

Patients' Perceptions on Surgical Care Suspension for Pelvic Floor Disorders During the COVID-19 Pandemic.

OBJECTIVES: The primary objective of the study was to evaluate patients' attitudes toward the postponement of their scheduled procedures for pelvic floor disorders (PFD) because of the COVID-19 pandemic. Secondary objectives were to identify patients who were upset with the postponement of their PFD procedures and to identify factors that are associated with being upset because of the delay in care. METHODS: This was a cross-sectional, survey-based study of women from a single urban, academic practice using a novel questionnaire. The study cohort included women whose PFD surgeries or office procedures were postponed between March 17 and April 30, 2020. RESULTS: Ninety-eight women had surgeries postponed; 68 (70%) responded to our questionnaire. Nearly half of the respondents (32/68, 47.1%) were upset about their procedures being postponed. Upset patients reported a greater impact of PFD symptoms on their mood than those who were not upset (P=0.002). Those who were upset were also more likely to report feelings of isolation (P=0.006), fear that their PFD would worsen because of delayed care (P < 0.001), and anxiety over surgery postponement (P < 0.001) than those who were not upset about the delays. When controlling for anxiety, social isolation, and impact of PFD symptom, anxiety (adjusted odds ratio = 15.7; 95% confidence interval = 3.7-66.6) and feeling of isolation (adjusted odds ratio = 9.7; 95% confidence interval = 1.5-63.7) remained associated with increased odds of being upset because of procedure delays. CONCLUSIONS: Half of women whose pelvic reconstructive procedures were postponed because of the COVID-19 pandemic were upset because of the delay in care, especially those who are emotionally and socially vulnerable during the COVID-19 pandemic.