Harnessing health information technology to promote equitable care for patients with limited English proficiency and complex care needs.

BACKGROUND: Patients with language barriers encounter healthcare disparities, which may be alleviated by leveraging interpreter skills to reduce cultural, language, and literacy barriers through improved bidirectional communication. Evidence supports the use of in-person interpreters, especially for interactions involving patients with complex care needs. Unfortunately, due to interpreter shortages and clinician underuse of interpreters, patients with language barriers frequently do not get the language services they need or are entitled to. Health information technologies (HIT), including artificial intelligence (AI), have the potential to streamline processes, prompt clinicians to utilize in-person interpreters, and support prioritization. METHODS: From May 1, 2023, to June 21, 2024, a single-center stepped wedge cluster randomized trial will be conducted within 35 units of Saint Marys Hospital & Methodist Hospital at Mayo Clinic in Rochester, Minnesota. The units include medical, surgical, trauma, and mixed ICUs and hospital floors that admit acute medical and surgical care patients as well as the emergency department (ED). The transitions between study phases will be initiated at 60-day intervals resulting in a 12-month study period. Units in the control group will receive standard care and rely on clinician initiative to request interpreter services. In the intervention group, the study team will generate a daily list of adult inpatients with language barriers, order the list based on their complexity scores (from highest to lowest), and share it with interpreter services, who will send a secure chat message to the bedside nurse. This engagement will be triggered by a predictive machine-learning algorithm based on a palliative care score, supplemented by other predictors of complexity including length of stay and level of care as well as procedures, events, and clinical notes. DISCUSSION: This pragmatic clinical trial approach will integrate a predictive machine-learning algorithm into a workflow process and evaluate the effectiveness of the intervention. We will compare the use of in-person interpreters and time to first interpreter use between the control and intervention groups. TRIAL REGISTRATION: NCT05860777. May 16, 2023.

Immersive Leadership Training for Physicians: Comparing Retrospective Pre- and Post-Test Virtual vs in-Person 6-Month Follow-Up of Learning.

Purpose: Little is known about the long-term efficacy of virtual leadership training for physicians. This study compares two highly similar groups of Obstetricians-Gynecologists' (OB-GYN) 6-month post-program changes in competency and skills after experiencing equity-centered leadership training in a virtual or in-person format. Participants and Methods: Using a retrospective pre- and post-test method, we collected 6-month post-program data on 14 competencies for knowledge gains and skills use, comparing the virtual cohort (2021, n = 22) to the in-person cohort (2022, n = 33) in 55 total participants. Qualitative data from open-ended feedback questions informed on skills relevancy and professional impact since program participation. Results: Data indicate strong, statistically significant knowledge and skills retention in both cohorts, with 63% of the virtual and 85% of the in-person participants responding. Data indicate participants report the course having a positive impact on their healthcare provision and nearly all report they made changes to their communication and leadership approaches in the 6-months after the program. 59% of the virtual and 55% of the in-person cohorts report new leadership opportunities since their participation and that the course helped prepare them for those roles. Qualitative data support the need for the training, specific elements of the training these physicians found particularly helpful, and that the learning was "sticky", in that it stayed with them in the months post-program. There was a clear stated preference for in-person experiences. Conclusion: Either virtual or in-person leadership training can result in long-term (6-month) significant retention and application of knowledge and skills in physicians. While limited in size, this study suggests that in-person experiences seem to foster more effective bonds and also greater willingness to participate in post-program follow-up. Physicians find equity-centered leadership training to impact their subsequent communication and leadership practices and they report career benefits even in 6-month follow-up.

While physicians serve in many leadership roles in healthcare, leadership training is generally not part of their medical training. The American College of Obstetricians and Gynecologists (ACOG) Robert C. Cefalo Leadership Institute has provided an annual leadership training for obstetrician and gynecologist leaders since 2006. Our previous research has repeatedly shown the program is effective, with participants experiencing significant and impressive gains in leadership learning and skills development. The COVID-19 pandemic led to the 2021 program being held virtually with a return to an in-person format possible with the 2022 program. As such, the opportunity arose to compare the 6-month post-program learning and impact of these two formats, virtual versus in-person training, in two highly similar groups experiencing nearly identical program content. Both virtual and in-person participants rated their six-month post-program skill level/ability and skills use/implementation as significantly higher than pre-program and both groups noted the learning helped them be better physicians, communicators, and leaders. Additionally, many experienced new leadership opportunities in the 6-months post-program and most of those agreed that the program prepared them to take on those new roles. This study shows that our approach to physician leadership development is highly effective and that the learning demonstrated "stickiness" in that it persisted over time. While both virtual and in-person programs were highly effective, overwhelmingly the participants prefer in-person training to virtual training.

In-person to virtual interprofessional education: Teamwork attitudes and skills among dental and dental hygiene students.

OBJECTIVES: The interruption to clinical professions' instruction due to closures from the coronavirus disease 2019 pandemic posed a significant hurdle to clinical education and presented a necessity to shift how instruction was delivered to resume educational activities. This study sought to answer the research question: did the transition from in-person to virtual instruction for interprofessional education (IPE) have an impact on students' perceptions of team attitudes and skills to learn and work in interprofessional groups? METHODS: All participating first-year dental and second-year dental hygiene students enrolled in the campus-wide IPE course were invited to complete the Team Skills Scale (TSS) assessment before and after the course for two academic years 2019-2020 and 2020-2021. Paired t-tests were utilized to assess the change in student attitudes and skills from pre- to post-course assessment, and t-tests were used to assess mean differences between student cohorts 2019-2020 and 2020-2021. RESULTS: Within the student cohort 2019-2020 students reported significant improvement in all TSS items. Within the student cohort, 2020-2021 students reported significant improvement in all but three TSS items. There were only significant differences in mean values for student reported improvement in attitudes and skills for two TSS items between the 2019-2020 and 2020-2021 cohorts. CONCLUSIONS: Dental and dental hygiene students report significant improvement in team attitudes and skills after participation in a campus-wide IPE course. The mode of administration of the course, in-person or virtual, did not have a significant impact on student-reported improvements.

Newborn readmissions and virtual primary care delivery: a population-based case-control study.

BACKGROUND: Early post-discharge assessments for newborns are recommended. Virtual care has become more prevalent during the pandemic, providing an opportunity to better understand its impact on the quality of post-discharge newborn care. The objective of this study was to understand whether primary care visit modality (in-person vs. virtual) is associated with early newborn hospital readmissions and emergency department (ED) visits. METHODS: We conducted a population-based, case-control study using linked health administrative databases between September 1, 2020 and March 31, 2022 in Ontario, Canada. We compared the modality of primary care visits among cases (hospital readmission within 14 days of life) and controls (newborns without a readmission), matched on infant sex, gestational age, and maternal parity. We included an alternative definition of cases as a composite of either a newborn hospital readmission or emergency department (ED) visit or in-hospital death within the first 14 days of life. Conditional logistic regression models were used to model odds ratios (ORs), comparing those exposed to a virtual visit versus in-person visit, adjusting for infant birth weight, birth hospitalization length of stay, neighbourhood level material deprivation, rurality and presence of active maternal comorbidities. RESULTS: Among 73,324 eligible newborns, 2,220 experienced a hospital readmission within 14 days of life and were matched to 8,880 controls. Jaundice was the primary reason for readmission (75% of readmissions). Compared to newborns who were seen in-person post-discharge, newborns who were seen virtually had higher odds of hospital readmission (adjusted odds ratio [aOR] 1.41 (95% CI 1.09, 1.83); the magnitude of effect was not different using the composite outcome (aOR 1.35, 95% CI 1.05, 1.75). CONCLUSIONS: Newborns who receive a virtual post-discharge visit are more likely than those who receive an in-person visit to require hospital readmission.

Are virtual services equivalent for mood, anxiety, and bonding? examining a perinatal intensive outpatient program.

PURPOSE: Perinatal Intensive Outpatient Programs (IOPs) address severe perinatal mood and anxiety disorders (PMADs) and mother-infant relationship concerns. Given the impact of PMADs on mothers and infants, rapid transitions to virtual services (telehealth) amid COVID-19, and service expansions to populations in need, it is critical to evaluate how effectively virtual and in-person perinatal IOP services treat PMADs and mother-infant bonding. METHODS: This quality-improvement record review examined patient records (n = 361) for a perinatal IOP from May 2016 to July 2023, amid multiple transitions between in-person and virtual services related to COVID-19, influenza, and respiratory syncytial virus. Patients in the completed measures sample (n = 115) completed depression (EPDS), anxiety (GAD-7, PASS), and mother-infant bonding (PBQ) measures over the first 3 weeks of treatment. Patients also anonymously provided program satisfaction ratings and qualitative feedback. RESULTS: While anxiety and depression symptoms improved similarly across service settings, mother-baby bonding only significantly improved with in-person treatment. Patient symptom outcomes also differed by public/private insurance, race, and number of children. Patients reported high service ratings and overall satisfaction, and available feedback indicates some preference for in-person services. CONCLUSION: As perinatal mental health services and IOPs continue to expand, virtual services can similarly address anxiety and depression symptoms and help to reach in-need populations. However, for perinatal IOPs, the core treatment target of mother-infant bonding may be uniquely addressed via in-person services.

Impact of Educational Activity Formats, Online or In-Person, on the Intention of Medical Specialists to Adopt a Clinical Behaviour: A Comparative Study.

COVID-19 accelerated continuing professional development (CPD) delivered online. We aimed to compare the impact of in-person versus online CPD courses on medical specialists' behavioural intentions and subsequent behaviour. In this comparative before-and-after study, medical specialists attended in-person courses on nine clinical topics. A second group attended an adapted online version of these courses. Behavioural intention and its psychosocial determinants were measured before and immediately after the courses. Behaviour change was measured six months later. Generalised estimating equation (GEE) models were used to compare the impact of course formats. A total of 82/206 in-person registrants (mean age: 52±10 years; 50% men) and 318/506 on-line registrants (mean age: 49±12 years; men: 63%) participated. Mean intention before in-person courses was 5.99±1.31 and 6.43±0.80 afterwards (average intention gain 0.44, CI: 0.16-0.74; p=0.003); mean intention before online courses was 5.53±1.62 and 5.98±1.40 afterwards (average intention gain of 0.45, CI: 0.30-0.58; p<0.0001). Difference in intention gain between groups was not statistically significant. Behaviour reported six months later was not significantly associated with post-course intention in either group. However, the intention difference increased significantly among those who said they had adopted the targeted behaviour (paired wilcoxon test: n = 40 and p-value=0.002) while it did not increase significantly in the group of those who had not adopted a targeted behaviour (paired wilcoxon test: n = 16 and p-value=0.223). In conclusion, the increase in intention of specialists after CPD courses was similar whether the course was in-person or online. Also, an increase in intention in both groups signalled more likelihood of adoption.

Effectiveness and safety of medication abortion via telemedicine versus in-person: A cohort of pregnant people in Colombia.

OBJECTIVE: To compare the effectiveness and safety of medication abortion (MAB) via telemedicine versus in-person in pregnant people with less than 12 gestational weeks in Colombia. STUDY DESIGN: A retrospective cohort study was conducted with 23,362 pregnant people who requested MAB service from Profamilia (a Colombian non-governmental organization) in 2021-2022. The outcomes were success and safety of MAB. We performed a descriptive and a multivariate statistical analysis using the binary regression model to obtain an adjusted Odds Ratio (aOR) to identify factors associated with abortion success. RESULTS: In comparison to in-person care (n = 20,289), individuals in telemedicine (n = 3073) were predominantly from urban areas, belonged to a lower socioeconomic stratum, single and did not identify with any ethnic group. In-person users tended to have higher levels of education and accessed the service through private insurance (p < 0,05). There were no differences in the odd of a successful abortion based on the modality of care (aOR 1.18; 95% CI=0.87-1.59). The results were also the same with sensitivity analysis stratified: pregnant people who were nine weeks gestation or less (aOR 0.86; 95% CI=0.63-1.17) or more (aOR 0.87; 95% CI=0.28-2.65). CONCLUSION: Telemedicine is an effective and safe option for MAB, as in-person care. Telemedicine has the potential to increase abortion access by extending the availability of providers and offering people a new option for obtaining care conveniently and privately, especially for women with disadvantaged socioeconomic and educational background. IMPLICATIONS: This study demonstrates that medication abortion (MAB) administered via telemedicine produces outcomes akin to those of in-person care, providing a compelling rationale for its adoption, particularly in underserved regions. This approach can be replicated in other countries in Latin America and the Caribbean.

Property, Materiality, Proximity: The Analytic Frame and In-Person Work.

In-person meeting offers psychologically usable material-signifiers that serve as day's residue-that cannot be duplicated or substituted for in remote ways of working. Questions of materiality, the history and specificity of location, and bodily proximity all are key aspects of the psychoanalytic frame, as Bleger's classic formulations attest. The COVID-19 pandemic has changed the choreography of engagement between analyst and patient: the ghostly dust in the frame enters the room. As Bleger says, with ghosts so rustled, nonprocess has a chance to become process. Two clinical examples highlight these points about materiality and in-person working. The final section of the paper extends Bleger's description to tackle the perplexing situation of patients who hesitate to return to the office. Issues of "ghosting," vanishing, disappearing are discussed, and linked to the constitutive absence that grounds any meaningfully structured presence. This constitutive absence is evoked by the prospect of the return to in-person analytic work. A final clinical example is used to illustrate this disturbing and irreducible fact about human interaction when two bodies are together in a room to discuss, over time, the life of one of the participants.

Control de diabetes y consultas al médico de familia durante la pandemia de COVID-19: estudio multicéntrico en atención primaria / Diabetes control and visits to the family doctor during the COVID-19 pandemic: a multicenter study in primary care

Objetivos: Determinar los cambios de frecuentación de consultas presenciales (CP) y telemáticas (CT) a su médico de familia en pacientes con diabetes tipo 2 (DM2) durante la pandemia de COVID-19 y su relación con el control de su enfermedad. Diseño: Estudio multicéntrico de seguimiento retrospectivo. Emplazamiento: Siete centros de salud en Tenerife, España. Participantes: Un total de 3.543 pacientes con DM2. Mediciones: Sexo, edad, CP, CT y control de DM2 mediante hemoglobina glicosilada (A1c) durante el periodo 2019-2021. Se ajustaron modelos de regresión logística con el control de DM2 como efecto, y con las demás mediciones como variables independientes. Resultados: El 50% eran mujeres. El 38% tenía 65 años o menos. Se midió la A1c al 84% de los pacientes en 2019, 68% en 2020, y 77% en 2021. Presentaron buen control el 58,4% en 2019, 46,1% en 2020 y 50,3% en 2021. Las CP fueron 7 en 2019, 4 en 2020 y 5 en 2021 (p<0,001). Las razones de ventaja (IC95%) de buen control en 2019 fueron 1,04 (1,04-1,05) por cada año más de edad y 1,03 (1,01-1,04) por cada CP más; en 2020 fueron 1,04 (1,03-1,05) por cada año más de edad, 1,05 (1,04-1,07) por cada CP más y 1,04 (1,02-1,07) por cada CT más; en 2021 fueron 1,04 (1,04-1,05) por cada año más de edad, 1,05 (1,03-1,06) por cada CP más y 1,02 (1,00-1,04) por cada CT más. Conclusiones: El control de pacientes con DM2 durante 2019-2021 tuvo una relación directa con el cambio de frecuentación al centro de salud, con diferencias según el tipo de consulta y la edad.(AU)

Objectives: To determine whether in patients with type 2 diabetes (DM2) the changes in their relationship with family doctors during the COVID-19 pandemic, in-person (iPC) and telematic (TC) consultations, were associated with control of their disease. Design: Multicentric study of retrospective follow-up. Setting: Seven health centers in Tenerife, Spain. Participants: 3543 patients with DM2. Main measurements: Sex, age, iPC, TC and DM2 control using glycosylated hemoglobin (A1c) during the period 2019-2021. Logistic regression models were fitted with DM2 control as an effect, and with the other measurements as independent variables. Results: 50% were women. 38% were less than 65 years old. A1c was measured in 84% of patients in 2019, 68% in 2020, and 77% in 2021. 58.4% had good control in 2019, 46.1% in 2020, and 50.3% in 2021. Median iPC were 7 in 2019, 4 in 2020 and 5 in 2021 (p<0.001). The OR(95%CI) of good control in 2019 were 1.04(1.04-1.05) per year of age and 1.03(1.01-1.04) for each iPC; In 2020 they were 1.04 (1.03-1.05) per year of age, 1.05 (1.04-1.07) for each iPC and 1.04 (1.02-1.07) for each TC; in 2021 they were 1.04 (1.04-1.05) per year of age, 1.05 (1.03-1.06) for each iPC and 1.02 (1.00-1.04) for each TC. Conclusions: The control of patients with DM2 during the period 2019-2021 had a direct relationship with the change in the frequency of consultations at the health center, with differences depending on the type of consultation and the age of the patient.(AU)

Online versus in-person gatekeeper suicide prevention training: comparison in a community sample.

BACKGROUND: Suicide prevention gatekeeper Training (GKT) is a frequently used suicide prevention intervention, however, there is still limited information about its long-term impact and effectiveness of online delivery. AIMS: The current study aimed to test the effectiveness of online GKT compared to in-person GKT in improving participant training outcomes. METHODS: A non-randomised comparison of pre-, post- and six-month follow-up data was conducted. In total 545 people participated in GKT, 317 in SafeTALK in-person sessions and 228 in online "Start" GKT by LivingWorks. Main outcome measures included: perceived knowledge; perceived preparedness; gatekeeper efficacy; and gatekeeper reluctance to intervene. RESULTS: Linear mixed model analysis demonstrated a significant effect for time for both modes of delivery for all four outcome measures. Post-hoc testing revealed that significant improvement in all outcomes were maintained above baseline at six-months following online and in-person training. CONCLUSIONS: Online training performed as good, or better than in-person GKT, on measured outcomes demonstrating utility and effectiveness of the modality for use in suicide prevention training practices. Findings additionally indicate that online training may reach participants that in-person programs do not. This study provides evidence that Online GKT has significant utility in addressing a crucial need for online alternatives to evidence-based suicide prevention training.

The efficacy of a virtual and in-person mindfulness-based intervention course on university students' during COVID-19 pandemic.

Objective: The purpose of this research was to evaluate the impact of a mindfulness-based intervention (MBI) on university students during the COVID-19 pandemic. Methods and participants: There were 53 participants who voluntarily enrolled in a mindfulness course at a regional state university (24 virtual and 29 in-person) and 56 in the control group. Participants completed surveys at the beginning and end of the course on mindfulness, life satisfaction, and resilience. Results: Results revealed that the in-person group showed significantly higher mindfulness, life satisfaction, and resilience over the course of the semester. The virtual group showed increases across all three variables as well, but only significantly improved on resilience. Conclusion: Results indicate that the inclusion of MBIs in university courses may be a cost-effective and proactive means to support the mental health and well-being of college students, and that in-person delivery may be a more effective modality.

Three-part scoring system (tripartite) for teledermatology versus International Contact Dermatitis Research Group criteria to interpret patch test readings: A comparative, observational study.

Background The International Contact Dermatitis Research Group (ICDRG) grading is the gold standard and is used to interpret patch test results in allergic contact dermatitis (ACD). The ICDRG readings include a combination of visual and palpation findings. Digital photography limits palpation. An alternative scoring system exists to analyse 2D images and interpret patch test readings in teledermatology (TD). Aims To compare tri-partite scoring system (TPSS) (TD) with ICDRG (face-to-face) and to assess the feasibility of TPSS by TD. Methods In this observational study, two investigators each scored the patch test readings for 78 patients at the 48th h, 96th h and on the 7th day. Results The TPSS has a sensitivity of 100%, specificity of 93.34%, positive predictive value of 91.67% and negative predictive value of 100%. At a confidence interval of 95%, Cohen's kappa (0.90) indicated excellent agreement between both investigators. The concordance between both scoring systems was at 93.2% for agreement and 6.82% for disagreement. Polysensitisation (6 patients with 16 allergens) was detected equally in both methods. Limitations A single centre study. Conclusion The readings obtained by TPSS were in agreement with ICDRG. TPSS can reduce the number of patient visits by 50% and may be used during COVID-19 times and beyond.

Impact of COVID-19 on essential healthcare services at the primary healthcare level in Armenia: a qualitative study.

BACKGROUND: The COVID-19 pandemic has presented significant global healthcare challenges, particularly impacting the continuity of essential health services in low- and middle-income countries. This study investigates the impact of the COVID-19 pandemic on the utilization and provision of essential health services in Armenia. METHODS: We employed a conventional qualitative study design, conducting semi-structured in-depth interviews (n = 17) within public and private primary healthcare (PHC) facilities in Armenia in 2021. Our study participants encompassed physicians providing specialty services in PHC facilities (e.g. endocrinologists, gynecologists/obstetricians, and pediatricians), regular visitors to PHC facilities (e.g. adults with chronic diseases, parents of children), and policymakers. Thematic analysis was conducted, yielding five emergent categories: mobilization and organization of PHC services during COVID-19; PHC visits during COVID-19; worsening of chronic conditions due to the decline in PHC visits; problems with routine childhood vaccinations; and patient-provider communication challenges. RESULTS: The number of in-person visits to PHC facilities declined due to adaptations in service delivery, imposed lockdown measures, and the public's fear of visiting healthcare facilities. Maternal and child health services continued with no major disruptions. PHC providers deliberately limited the number of maternal and child visits to essential antenatal care, newborn screenings, and routine childhood immunizations. Still, children experienced some delays in vaccination administration. The pandemic resulted in a notable reduction in follow-up visits and monitoring of patients with chronic conditions, thereby exacerbating their chronic conditions. Phone calls were the primary method of patient-provider communication during the pandemic. CONCLUSIONS: The COVID-19 pandemic has had a profound impact on the delivery and utilization of essential healthcare services at PHC facilities, especially for those with chronic conditions who needed continuous care. Unified national-level guidance and technical capacity are needed to direct the provision of essential services at the PHC level, promote effective health communication, and implement digital platforms for the uninterrupted provision of essential care during public health emergencies.

Effectiveness of Online vs. In-Person Periodontal Health Workshops for Public Awareness.

Background: Periodontal health is a critical aspect of overall oral health, yet public awareness and education on this topic remain limited. With the increasing prevalence of online health education platforms, it is essential to evaluate the effectiveness of online periodontal health workshops compared with traditional in-person workshops on improving public awareness. Materials and Methods: Study Design: This randomized controlled trial (RCT) aimed to assess the impact of online and in-person periodontal health workshops on public awareness. Participants (N = 500) were randomly assigned to one of two groups: the online workshop group or the in-person workshop group. Online Workshop: Participants in this group accessed an interactive online periodontal health workshop, consisting of video presentations, animations, and quizzes. The workshop covered topics, such as gum disease prevention, oral hygiene, and the importance of regular dental checkups. In-Person Workshop: Participants in this group attended a traditional in-person periodontal health workshop conducted by dental professionals. The content and duration of this workshop mirrored the online version. Pre- and Postworkshop Assessments: Both groups completed pre-workshop and postworkshop assessments, including a knowledge questionnaire and a self-assessment of oral health habits. Arbitrary scores were assigned to quantify knowledge gain (0-100%). Results: Participants in the online workshop group showed a mean knowledge gain of 30% (standard deviation (SD) = 5.2), while those in the in-person workshop group exhibited a mean knowledge gain of 35% (SD = 4.7). The self-assessment of oral health habits indicated an improvement in both groups, with 60% of participants reporting better oral hygiene practices. Conclusion: Both online and in-person periodontal health workshops demonstrated effectiveness in improving public awareness and promoting better oral health habits. Combining both modalities could be an effective strategy for comprehensive public education on periodontal health.

Voices of conference attendees: how should future hybrid conferences be designed?

BACKGROUND: With conference attendees having expressed preference for hybrid meeting formats (containing both in-person and virtual components), organisers are challenged to find the best combination of events for academic meetings. Better understanding what attendees prioritise in a hybrid conference should allow better planning and need fulfilment. METHODS: An online survey with closed and open-ended questions was distributed to registrants of an international virtual conference. Responses were then submitted to descriptive statistical analysis and directed content analysis. RESULTS: 823 surveys (Response Rate = 4.9%) were received. Of the 813 who expressed a preference, 56.9% (N = 463) desired hybrid conference formats in the future, 32.0% (N = 260) preferred in-person conferences and 11.1% (N = 90) preferred virtual conferences. Presuming a hybrid meeting could be adopted, 67.4% (461/684) preferred that virtual sessions take place both during the in-person conference and be spread throughout the year. To optimise in-person components of hybrid conferences, recommendations received from 503 respondents included: prioritising clinical skills sessions (26.2%, N = 132), live international expert presentations and discussions (15.7%, N = 79) and interaction between delegates (13.5%, N = 68). To optimise virtual components, recommendations received from 486 respondents included: prioritising a live streaming platform with international experts' presentations and discussions (24.3%, N = 118), clinical case discussions (19.8%, N = 96) and clinical update sessions (10.1%, N = 49). CONCLUSIONS: Attendees envision hybrid conferences in which organisers can enable the vital interaction between individuals during an in-person component (e.g., networking, viewing and improving clinical skills) while accessing virtual content at their convenience (e.g., online expert presentations with latest advancements, clinical case discussions and debates). Having accessible virtual sessions throughout the year, as well as live streaming during the in-person component of hybrid conferences, allows for opportunity to prolong learning beyond the conference days.

Virtual Learning Decreases the Carbon Footprint of Medical Education.

INTRODUCTION: The environmental impact of holding in-person academic conferences and continuing medical education (CME) programs can be significant. In-person conferences provide a unique social and professional platform to engage in networking and foster professional development; however, there is an opportunity for hybrid and virtual platforms to provide CME for broader audiences looking to improve their clinical skills and strengthen their knowledge base. This study seeks to describe the reduction in carbon emissions associated with a webinar hosted by an online dermatology-focused medical education platform. METHODS: This cross-sectional study used the location of deidentified virtual attendees of a webinar to predict the carbon emissions produced if attendees had instead traveled to the location of the most recent Integrative Dermatology Symposium (Sacramento, CA). Following collection of each virtual attendee's location, the mode of transportation was predicted on the basis of each participant's distance to the conference. RESULTS: The estimated carbon emissions were calculated for 576 participants. The total estimated, unadjusted carbon emissions for both attendees predicted to fly or drive was 370,100 kg CO2. The emissions produced per participant from those expected to fly to an in-person CME after adjusting for all additional passengers on every flight were 4.5 kg CO2. The emissions produced per participant from those expected to drive were 42.7 kg CO2. CONCLUSION: The use of a virtual CME webinar led to a significant reduction in travel-related carbon dioxide emissions when compared to running the same program in-person event. When accounting for all passengers traveling via plane on any flight, driving to an event produced more emissions per participant than flying.

A Pilot Survey on the Perceptions of Pediatric Subspecialty Fellows and Program Directors on Virtual Compared with In-Person Interview Experiences.

Pediatric fellowship programs have conducted virtual interviews since the start of the COVID-19 pandemic in 2020. In this national survey of fellowship program directors and fellows interviewed in-person and virtually, fellowship program directors and fellows formed accurate impressions, regardless of format, but our data did not clearly support one interview format over another.

Comparison of Telemedicine versus In-Person Visit for Control of Asthma in Children aged 7-17 years: A Randomized Controlled Trial.

OBJECTIVES: To compare asthma control between telemedicine and in-person visit in children aged 7 to 17 y. METHODS: A non-inferiority randomized-controlled trial was conducted at a pediatric chest clinic, involving a total of 192 patients, with 96 children in each group of telemedicine and in-person follow-up. RESULTS: There was a significant improvement in the mean asthma control test (ACT)/ Childhood asthma control test (C-ACT) scores from baseline to three months in both groups, with no significant difference in the change of means between the two groups. The mean difference in ACT/C-ACT score at three months in the telemedicine and in-person visit group was -0.35; 95% CI (-1.30 to +0.10) [p-value 0.09]. There was a significant change in the mean Pediatric Quality of Life index (PQLI) scores from 57.2 ± 10.2 to 66.82 ± 7.99 in the telemedicine group and from 56.1 ± 11.7 to 66.71 ± 4.66 in the in-person visit group, however the mean difference in PQLI score in both the groups was not significant (p = 0.91). There was no significant difference in the number of asthma exacerbations (4 vs. 1) between telemedicine and in-person visit (p = 0.10). The mean telemedicine satisfaction questionnaire score in this study was 3.8 ± 0.7, which indicates that most of the parents were satisfied with the telemedicine follow-up process. CONCLUSIONS: This study revealed that telemedicine is non-inferior to in-person visit for follow-up of children with asthma and can be used as an alternative to in-person visit for the management of asthma, especially in remote settings and pandemic situations.

A Multimethod Exploration of the COVID-Era Transition to Virtual Hearings in Child Welfare Court Cases.

To promote open and safe access to court hearings for families and professionals during the COVID-19 pandemic, juvenile and family courts across the United States shifted towards virtual hearings in child welfare cases. Drawing on findings from a four state court observation study conducted pre and post emergence of the pandemic, as well as from a national survey of court professionals and a survey of parents, we reflect on the experiences of courts and court participants with virtual hearings in child welfare cases and specific impacts on hearing quality. Findings indicate that despite stakeholder perceptions, there is little difference in the quality of hearings with respect to judicial engagement and discussion. Differences were found however, in the attendance of fathers and relatives at hearings, with less fathers and relatives attending virtual hearings. Parents had mixed experiences with the virtual hearing process. Professionals noted challenges, as well as strategies for overcoming challenges, to engage parents and ensure their access to virtual hearings.

Efficacy of in-person versus digital mental health interventions for postpartum depression: meta-analysis of randomized controlled trials.

AIM: This meta-analysis aimed to compare the efficacy of in-person and digital mental health interventions in addressing Postpartum Depression. METHODS: Following PRISMA guidelines, the protocol for this meta-analysis was registered at the Open Science Framework (Retrieved from osf.io/wy3s4). This meta analysis included Randomized Controlled Trials (RCTs) conducted between 2013 and 2023. A comprehensive literature search identified 35 eligible RCTs from various electronic databases. Inclusion criteria focused on pregnant women over 18 years old, encompassing antenatal depression and up to two years postpartum. Diagnostic interviews or Edinburgh Postnatal Depression Scale (EPDS) were used to establish PPD. Digital interventions included telephonic, app-based, or internet-based approaches, while in-person interventions involved face-to-face sessions. RESULTS: The meta-analysis revealed a moderate overall effect size of -0.69, indicating that psychological interventions are effective for PPD. Digital interventions (g = -0.86) exhibited a higher mean effect size than in-person interventions (g = -0.55). Both types of interventions displayed substantial heterogeneity (digital: I2 = 99%, in-person: I2 = 92%), suggesting variability in intervention content, delivery methods, and participant characteristics. CONCLUSION: Digital mental health interventions show promise in addressing PPD symptoms, with a potentially greater effect size compared to in-person interventions. However, the high heterogeneity observed in both modalities underscores the need for further research to identify key drivers of success and tailor interventions to diverse populations. Additionally, the choice between digital and in-person interventions should consider individual needs and preferences. Ongoing research should further investigate and optimise intervention modalities to better serve pregnant women at risk of PPD.