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This paper analyses the organization of ‘openings’ in Skype video-mediated conversation. It uncovers order in their apparent complexity by showing the relevance of a particular sequential adjacent pair organization, the appearing/noticing sequence, and its particular instantiation as an appearance-for-the-first-time greeting. The paper shows how this is a crucial resource in establishing a joint video interactional frame for the parties involved. This accounts for the occurrence of some specific phenomena in Skype openings, such as multiple greetings, and for the use of greetings which reflexively index their being occasioned by an appearance and related greeting, such as the French ‘coucou’, even when these do not occur at the start of Skype calls. When analysed this way, Skype openings, though complex, can be seen as an accomplished ‘dance of appearances and multiple greetings’.

So far, the synergistic relationship between learning design and learning analytics and its impact on learners’ educational practices have been investigated. However, little work has been done to show how integrated learning design based on constructivism learning theory and learning analytics can affect learners’ engagement and self-regulation. Thus, this study aimed to investigate the effect of the Constructivist Learning Design and Learning Analytics (CLDLA) Model on learners’ engagement and self-regulation. In this experimental study, 50 graduate students at Iranian’ Allameh Tabataba’i University were asked to participate in a Moodle course called “Teaching Skills” and fill out Agentic Engagement Scale and Self-Regulation Questionnaires in two steps as a pre-test and post-test measurements. Analysis of the data indicated that the CLDLA model has a positive impact on learners’ engagement and self-regulation. Based on the results, recommendations for further research and educational practices are suggested.

Background: This literature review sets out to increase the knowledge on patient safety within the telehealth modality of care, to inform the relevant local health service departments on the key co...

Background: Training of South African anaesthesiologists is based on the Canadian Medical Education Directives for Specialists (CanMEDS). However, the applicability of CanMEDS in this context has not been assessed. An expert panel participated in a Delphi process to create an appropriate expanded list of CanMEDS competencies that may be used in the future to assess fitness for purpose of local graduates. Methods: This descriptive study comprised a representative panel of 16 experts surveyed electronically over three rounds to assess the importance of the existing CanMEDS roles and enabling competencies and suggested additions deemed applicable locally. The primary outcome was the creation of a list of competencies applicable to South Africa. Results: There was a 100% response rate for all three rounds. Based on the existing seven CanMEDS meta-competencies (Medical Expert, Collaborator, Communicator, Leader, Scholar, Professional and Health Advocate), respondents scored the importance of 89 enabling competencies and 19 additional competencies. Seven CanMEDS enabling competencies did not achieve consensus and were excluded. Nineteen new enabling competencies and two new meta-competencies (Humaneness, Context Awareness) achieved consensus and were added. Median ratings of importance of meta-competencies showed highest scores for Medical Expert and Collaborator and lowest scores for Health Advocate. Weighting of meta-competencies revealed highest scores for Medical Expert and Professional with all others equally weighted. Conclusion: This study has formulated an adapted CanMEDS list of enabling competencies with the addition of the two new metacompetencies of Context Awareness and Humaneness for use in South African anaesthesiology. This provides a means with which future graduates may be assessed for fitness for purpose.

Resumen La pandemia COVID-19 ha supuesto un cambio cualitativo en el modo de atender a los pacientes en consultas ambulatorias. La necesidad de toma de medidas de aislamiento social como prevencion para el contagio por el SARS-CoV-2 ha obligado al uso de consultas telematicas y telefonicas en la mayoria de unidades medicas y quirurgicas. La especialidad de Aparato Digestivo, por las caracteristicas de sus pacientes y el apoyo frecuente en tecnicas complementarias para el diagnostico, es especialmente adecuada para realizar consultas no presenciales. En este documento se plantean una serie de recomendaciones que pueden servir como guia para el establecimiento o mejora de consultas no presenciales de Medicina Digestiva.

BACKGROUND: Many inpatients become anxious or frightened about scheduled treatment processes, and medical staff do not have sufficient time to provide emotional support. The recent advancement of information and communications technology (ICT) and the use of artificial intelligence (AI), including robots, in the health care field is being put to the test. OBJECTIVE: This study aimed to develop a bedside robot system to deliver information and provide emotional support to inpatients and to evaluate the usability and perceptions of the developed robot. METHODS: The first stage was accomplished by deriving essential functions from the results of user demand surveys on robots and by implementing a prototype by mapping each essential function to the robot’s hardware and software. For the second stage, the robot was assessed for usability and perceptions in a simulation center, a hospital-like environment, by 10 nurses, 10 inpatients, and family caregivers. Usability and perception were evaluated using the think-aloud method, a survey, and individual interviews. RESULTS: Based on the usability evaluation, the perceived usefulness, ease of use, and satisfaction were 5.28 ± 1.27 points, 5.42 ± 1.55 points, and 5.27 ± 1.46 points out of 7, respectively. It was found that overall, the robot was positively perceived by participants. As a result of the qualitative data analysis, the participants perceived the robot as an object that had the positive effect of providing emotional support through communication. CONCLUSIONS: The bedside robot in this study, which incorporated human-robot interaction (HRI) technology, is an alternative suited to the new normal era that will contribute to ensuring that patients have more self-directed hospital stays as well as emotional support through information delivery and communication.

Background: Telemedicine use became widespread at our weight management center in 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. Objectives: The objective of this study was to determ...

INTRODUCTION: Teleneurology has become widely adopted during severe acute respiratory syndrome coronavirus 2 pandemic. However, provider impressions about the teleneurology experience are not well described. METHODS: A novel questionnaire was developed to collect provider impressions about video teleneurology encounters. All providers in the University of Pennsylvania Health System (UPHS) Neurology Department (N = 162) were asked to complete a questionnaire after each video teleneurology patient encounter between April and August 2020. Individual patient and encounter-level data were extracted from the electronic medical record. RESULTS: One thousand six hundred three surveys were completed by 55 providers (response rate of 10.12%). The history obtained and the ability to connect with the patient were considered the same or better than an in-person visit in almost all encounters. The quality of the physician–patient relationship was good or excellent in 93%, while the overall experience was the same as an in-person visit in 73% of visits and better in 12%. Sixty-eight percent of respondents reported that none of the elements of the neurological examination if performed in person would have changed the assessment and plan. Assessment of the visit as the same or better increased from 83% in April to 89% in July and 95% in August. Headache (91%), multiple sclerosis and neuroimmunology (96%), and movement disorder (89%) providers had the highest proportion of ratings of same or better overall experience and neuromuscular providers the lowest (60%). CONCLUSIONS: Provider impressions about the teleneurology history, examination, and provider–patient relationship are favorable in the majority of responses. Important differences emerge between provider specialty and visit characteristics groups.

PURPOSE: To test whether technology-facilitated self-management support improves depression in primary care settings. METHODS: We randomized 204 low-income primary care patients who had at least moderate depressive symptoms to intervention or control. Intervention participants received 12 months of weekly automated interactive voice response telephone calls that assessed their symptom severity and provided self-management strategies. Their patient-nominated supporter (CarePartner) received corresponding guidance on self-management support, and their primary care team received urgent notifications. Those randomized to enhanced usual care received printed generic self-management instructions. RESULTS: One-year attrition rate was 14%. By month 6, symptom severity on the Patient Health Questionnaire-9 (PHQ-9) decreased 2.5 points more in the intervention arm than in the control arm (95% CI −4.2 to −0.8, p = 0.003). This benefit was similar at month 12 (p = 0.004). Intervention was also over twice as likely to lead to ≥50% reduction in symptom severity by month 6 (OR = 2.2 (1.1, 4.7)) and a decrease of ≥5 PHQ-9 points by month 12 (OR = 2.3 (1.2, 4.4)). CONCLUSIONS: Technology-facilitated self-management guidance with lay support and clinician notifications improves depression for primary care patients. Subsequent research should examine implementation and generalization to other chronic conditions. clinicaltrials.gov, identifier NCT01834534.

Background The “I COUGH” protocol is associated with improved postoperative pulmonary outcomes, and ambulation is an essential component. I COUGH is an acronym for Incentive spirometry, Coughing, Oral care, Understanding (patient and staff education), Getting-out-of-bed, and Head-of-bed elevation. This trial sought to enhance one component, specifically ambulation after operations. Methods Randomized trial of inpatients in a safety-net, academic medical center. The intervention group received standard I COUGH education along with text message reminders to ambulate postoperatively, whereas the control group received standard education alone. Postoperative walking frequency was compared to each participant’s ambulation on the day prior to enrollment. Results The intervention group had an average improvement of 1.8 ± 1.8 walks per day per patient, while the average change for the control group was 0.2 ± 1.0 walks per day per patient. This represents a 9-fold increase in ambulation for the intervention group (p = 0.03). Conclusions Implementation of text message reminders increased ambulation and improved adherence to the I COUGH protocol following operations. This system should be further investigated as an adjunct to postoperative care.

Background: Coronavirus disease 2019 (COVID-19) struck Pakistan with a magnitude that required micro- and macro-level adjustments at national and provincial levels. Access to medical consultation became a challenge; hospitals were flooded with cases beyond their capacity and transport was halted due to lockdown. Global Health Directorate of The Indus Health Network supported the provincial government by rolling out several walk-in community-based testing initiatives across Karachi. Results were conveyed to the patients through each district government. With a disproportionate rise in cases, an increasing delay in reporting results was observed. Methods: To help the district government bridge this gap, two physicians were engaged to convey timely results to patients who tested positive, through a helpline. Subsequently, proactive teleconsultation was initiated. We present a retrospective review of data collected during teleconsultation for COVID-19 cases identified through community-based testing between April 5 and June 10, 2020. Results: A total of 4,279 tests were conducted, revealing a 28% positivity rate (1,196 cases). Out of these, 752 (62.9%) baseline positive patients were contactable. Most patients identified either a close contact (46.8%) or a household contact (30.1%) as the source of infection. 41.8% patients were asymptomatic, 52.9% had mild to moderate illness, and 1.1% needed referral to the emergency department. 82.7% patients reported no comorbidities. Conclusion: The rapid surge of cases could not be handled by a small team and an institutional strategy of integration into an existing call center service was adopted. We share our insights to help develop evidence-based policies to effectively tackle current or future threats in similar settings.

Purpose: To determine the magnitude, determinants, and public health issues related to diabetic retinopathy (DR) in India using 2019 data from a for-profit telescreening program. Methods: Digital retinal images were captured using a nonmydriatic fundus camera and transferred via the telescreening program to a reading center. Ophthalmologists trained in DR image reading created the DR status reports. Age/sex-adjusted rates of DR, sight-threatening DR (STDR), and diabetic macular edema (DME) were calculated and correlated with known risk factors. Results: Images of 51,760 Indian diabetic patients (103,520 eyes) were reviewed. The prevalence of DR, STDR, and DME was 19.1% (95% confidence interval [CI]: 18.9-19.5), 5.1% (95% CI: 4.9-5.3), and 3.9% (95% CI: 3.7-4.1), respectively. Based on these data, we projected 14.7 million cases of DR, 3.9 million with STDR, and 3.0 million DME cases in India. Statistically significant risk factors for DR were male gender (odds ratio [OR] = 1.19, p < 0.001), older age (χ2 = 270, df = 3, p < 0.001), history of cataract surgery (OR = 2.0, p < 0.001), longer duration of diabetes (χ2 = 1084, p < 0.001), and type 1 diabetes (OR = 3.9, p = 0.01). There was a statistically significant variation of DR by geographic zones (χ2 = 310, p < 0.001). Laser treatment coverage for STDR was 22%. Duration of diabetes (p < 0.001), cataract surgery in the past (p = 0.02), and females (p = 0.001) were predictors of STDR. Conclusion: This model of telescreening for DR provides an additional pathway for screening and preventing diabetes-related visual morbidity in India. The data from this study can be used for epidemiologic and ophthalmic health policies related to diabetes.

Background: Telehealth, especially the use of real-time video and phone visits in ambulatory care, is increasingly important in the wake of the COVID-19 pandemic. The current state of internal medicine (IM) interns' telehealth training at the start of residency is unknown. Objective: To characterize the attitudes, training, and preparedness of IM interns regarding the use of telehealth video and phone visits in ambulatory care. Methods: We conducted a cross-sectional survey of IM interns at four IM residency programs in the United States in 2020. Results: One hundred fifty-six surveys were analyzed (response rate 82%). Seventy-five percent of interns rated training in the use of real-time video and phone visits for ambulatory care as important or very important. The vast majority received no training (74%) or clinical experience (90% no prior video visits, 81% no prior phone visits) during medical school. More interns believed that primary care may be effectively delivered via video visits compared with phone visits (77% vs. 35%). Most interns (69%) missed clinical time during medical school due to the COVID-19 pandemic; 41% felt that the pandemic negatively affected their ambulatory care preparation. Overall, the majority of interns (58%) felt prepared for primary care; only 12% felt prepared to deliver primary care using either video or phone visits. Conclusions: Although IM interns had favorable attitudes toward video and phone visits, few had training or clinical experience; most felt unprepared. Residency programs may need to close training gaps for current interns in conducting telehealth video and phone visits.

Background: During the COVID-19 pandemic telemedicine was rapidly expanded and incorporated into day-to-day practice by primary care providers to allow continued access to care for patients during this time. The quick adoption of telemedicine occurred out of necessity for social distancing, and evidence-based approaches are needed to determine the future utility of this approach to delivering care. The objective of this study was to identify factors associated with both provider and patient satisfaction with telemedicine visits in a primary care setting during the COVID-19 pandemic. Method: This survey-based study was conducted in 2020. Surveys were distributed electronically by e-mail to providers and patients. Participants: Surveys related to satisfaction levels with telemedicine were distributed to 73 primary care providers and 6,626 patients. Main Outcomes and Measures: The primary measures of this study were satisfaction level with telemedicine in primary care. Results: Studies were completed by 23 primary care providers and 1,692 patients. Most patient participants were female (70.8%), white (89.7%), non-Hispanic or non-Latino (96.6%), and Massachusetts residents (96.9%). Variables that were found to be significantly associated with higher levels of satisfaction with telemedicine visits included: travel time saved >30 min (odds ratio [OR] 1.8), having an easy visit connection (OR = 3.2), use of Zoom© video visit over telephone only (OR = 2.8), and identifying as female (OR 1.8). Conclusions and Relevance: Patients and providers reported high levels of satisfaction with telemedicine visits in a primary care setting. Providers felt that telemedicine visits usually take the same amount or less time than in-person visits. Both providers and patients reported a desire to see telemedicine visits continued after the pandemic. Patients who saved more than 30 min of travel time found it easy to connect or those who were female were more likely to be satisfied with telemedicine visits, while those that had telephone visits were less likely to be satisfied than those that had Zoom© visits.

Digital trails, data collections of individuals' traceable digital activities online or on digital devices, have been utilized by many industries to provide valuable insights to enhance customer experience, improve operation efficiency, and increase revenues. Despite the abundance of digital trails among health care data, health care has lagged behind other industries in extracting their values. Recently, telehealth's accelerated adoption due to the COVID-19 pandemic provides an unprecedented opportunity for health care providers to take advantage of digital trails. In this study, we describe digital trails generated from the telehealth workflow and discuss a few use cases to demonstrate how telehealth digital trails can be used to improve clinical service quality, streamline patient care workflow, and enhance the patient experience.

Aims: The COVID-19 pandemic has caused strain on hospital systems and potential delay in diagnosis of type 1 diabetes (T1D). Outpatient diagnosis and treatment of metabolically stable young persons with new-onset T1D have been shown to be equivalent to inpatient. We describe an approach to outpatient management of newly diagnosed T1D during the COVID-19 pandemic using an interdisciplinary team, telemedicine, and diabetes technologies including rapid implementation of continuous glucose monitoring (CGM). Methods: Following the onset of the COVID-19 pandemic, new-onset cases of T1D were tracked. After laboratory confirmation of diagnosis and metabolic stability, patients and families were referred for ambulatory initiation of insulin therapy and diabetes education. These cases were reviewed using data extracted from the electronic health record, comments from multidisciplinary team members, and cloud-based glucose data. Results: We report on seven young people with new-onset T1D without diabetic ketoacidosis from April to June 2020, during the COVID-19 pandemic. Ages ranged 9–23 years with presenting hemoglobin A1c (HbA1c) values 10–14.5%. Initial evaluation was generally face-to-face, followed by frequent telemedicine visits. Five patients had a family history of T1D. Two patients had access to at-home HbA1c kits prompting evaluation in the absence of symptoms. Four patients required emergency department evaluation. Five patients presented with ketosis. All patients were prescribed CGM at the first visit, most starting within 1 month. Conclusions: Technology is extraordinarily useful for the care of young persons with new-onset T1D in the ambulatory setting during the COVID-19 pandemic. Large observational studies are needed to better understand outcomes of an outpatient, technology-focused approach.

Introduction In today's complex healthcare setting nurses need Emotional Intelligence abilities. Emotional intelligence competencies are not typically included as part of the curricula in most professional nursing programs. Pre-licensure BSN students and RN to BSN students have different characteristics and enter nursing school with different levels of clinical experience. The purpose of this study is to understand the differences in measured Emotional Intelligence between traditional BSN students (pre-licensure) and RN to BSN students. Method The researchers used a quantitative two-group between-subjects design to measure the differences in EI scores of pre-licensure students and RN to BSN students. Results The findings from this study indicate differences exist in EI abilities between pre-licensure and RN to BSN students. Total EI was significantly higher for pre-licensure BSN students compared to RN to BSN students. Additional branch score findings are found in the full manuscript. Discussion Based on the findings of this study, the integration of EI content throughout the associate degree, traditional BSN, and RN to BSN program curricula should be a priority.

Background Attrition rates are high for nursing programs. Attrition must be addressed to ensure nursing programs are financially sustainable and healthcare has an adequate supply of nurses. Purpose Identify factors impacting the success of students enrolled in the fundamental nursing course. Methods Retrospective file review of the previous seven cohorts (n = 351). Fifteen factors were investigated to determine their impact on successful completion of the fundamentals nursing course. Results Successful completion was significantly associated with race identified by the participants (χ2 = 10.84, p = 0.01) as participants who identified as white demonstrated higher success rates. Increasing ACT composite score (b = 0.95, p = 0.00) positively correlated with the student's success completion (CI = 1.26-5.38). Higher grade in General Psychology (b = 0.36, p = 0.02) positively correlated with successful completion (CI = 0.50-0.96). Recommendations and Conclusions Data can be used to evaluate current admission criteria and to develop support programs for students who may be at risk for not progressing well.

Objective To assess and analyze the impact of clinical simulation as a training tool in healthcare teams ability to resolve and manage conflicts, through an exploratory systematic review. Methods A structured literature review was performed with the terms [Clinical Simulation OR Patient Simulation OR Simulation Training OR High Fidelity simulation Training] AND [Conflict OR Conflict Resolution] in the following databases: MEDLINE, LILACS, Cochrane, Scielo, PubMed, CINHAL, ScienceDirect, MEDES, IBECS y DOCUMED. Articles were considered if they involved clinical simulation oriented to training of healthcare professionals or trainees in conflict management, using clinical scenarios, and excluding those studies older than 20 years. Absence of debriefing was not considered an exclusion criterion, neither the use of simulation along with other methodologies. A quantitative analysis was performed. Results 10 articles were retrieved, mostly with quasi-experimental designs, in which clinical simulation was designed as an interprofessional training and was used with multiple other methodologies like roleplay, reflexive practice and audiovisual aids, strategy that suggest an increase its effectivity. Different scenarios have been recreated, like decision-making divergences and management of medical errors, in order to apply the competences of mediation, communication, emotional skills among others, and followed by debriefing. The use of validated scales and conventional assessment methods reveal a positive impact on satisfaction, perception and learning of students, as well as transfer to clinical practice and decrease in errors. Conclusion Multiple studies describe and support the use of clinical simulation for training in management and resolution of conflicts among healthcare professionals. Simulation is accepted by participants, developing transfer of skills and competences and impact at the organizational level. Nonetheless, studies are recent and limited in number, making this area a developing field that promotes future research.

Background: Tele-critical care (TCC) adoption has been slow since its emergence in the early 2000s. The COVID-19 pandemic has renewed interest in telemedicine and may spur expansion or development of new TCC programs. This narrative addresses the Cleveland Clinic TCC service, (eHospital) to promote exchange of ideas to continually optimize the practice for current and future users. Methods: A descriptive narrative methodology is used in this report. Results: Cleveland Clinic's eHospital was established in 2014 to support nighttime critical care across system hospitals. It encompasses a tiered system of two-way audiovisual communication, telemetry, software platform that integrates the electronic health record, and a proprietary risk stratification algorithm for targeted electronic surveillance. The TCC team includes intensivists, advanced care providers, and registered nurses. Three coverage models evolved depending on onsite clinician availability. More than 133,000 patients have been served by eHospital to date, and span the typical spectrum of critical illness. Along with universal monitoring, ∼18% of patients received active interventions, the most common of which are categorized. Patterns of activity, typical workflows, and adaptations of bedside best practices are also described. Bookending the work shift are sign outs focused on pending critical issues, unstable patients, and those who can be triaged out of the intensive care unit. In between, TCC teams round periodically and interact with bedside teams. Conclusions: TCC adoption has proceeded slowly. Some acceleration is anticipated in a post-COVID-19 pandemic world. Our experience highlights operational practices that can facilitate successful TCC practice.

Background: Mobile medical devices for self-patient use are a rapidly evolving section of telehealth. We examined the INSTINCT® ultrasound system, a portable, self-operated ultrasound device attach...

MicroRNAs (miRNAs) have been proved to play critical roles in diverse biological processes, including the human disease development process. Exploring the potential associations between miRNAs and diseases can help us better understand complex disease mechanisms. Given that traditional biological experiments are expensive and time-consuming, computational models can serve as efficient means to uncover potential miRNA-disease associations. This study presents a new computational model based on variational graph auto-encoder with matrix factorization (VGAMF) for miRNA-disease association prediction. More specifically, VGAMF first integrates four different types of information about miRNAs into an miRNA comprehensive similarity network and two types of information about diseases into a disease comprehensive similarity network, respectively. Then, VGAMF gets the non-linear representations of miRNAs and diseases, respectively, from those two comprehensive similarity networks with variational graph auto-encoders. Simultaneously, a non-negative matrix factorization is conducted on the miRNA-disease association matrix to get the linear representations of miRNAs and diseases. Finally, a fully connected neural network combines linear and non-linear representations of miRNAs and diseases to get the final predicted association score for all miRNA-disease pairs. In the 10-fold cross-validation experiments, VGAMF achieves an average AUC of 0.9280 on HMDD v2.0 and 0.9470 on HMDD v3.2, which outperforms other competing methods. Besides, the case studies on colon cancer and esophageal cancer further demonstrate the effectiveness of VGAMF in predicting novel miRNA-disease associations.

Background: Women with insulin-treated gestational diabetes mellitus (GDM) require close monitoring and support to manage their diabetes. Recent changes to the diagnostic criteria have implications for service provision stemming from increased prevalence, suggesting an increased burden on health services in the future. Telemedicine may augment usual care and mitigate service burdens without compromising clinical outcomes but evidence in GDM is limited. Objective: The Telemedicine for Gestational Diabetes Mellitus (TeleGDM) trial aims to explore the use of telemedicine in supporting care and management of women with GDM treated with insulin. Methods: The TeleGDM is a mixed-methods study comprising an exploratory randomized controlled trial (RCT) and a qualitative evaluation using semistructured interviews. It involves women with insulin-treated GDM who are up to 35 weeks gestation. Participating patients (n=100) are recruited face-to-face in outpatient GDM clinics at an outer metropolitan tertiary hospital with a culturally diverse catchment and a regional tertiary hospital. The second group of participants (n=8) comprises Credentialed Diabetes Educator Registered Nurses involved in routine care of the women with GDM at the participating clinics. The RCT involves use of a Web-based patient-controlled personal health record for GDM data sharing between patients and clinicians compared to usual care. Outcomes include service utilization, maternal and fetal outcomes (eg, glycemic control, 2nd and 3rd trimester fetal size, type of delivery, baby birth weight), diabetes self-efficacy, satisfaction, and costs. Semistructured interviews will be used to examine user experiences and acceptability of telemedicine. Results: The trial recruitment is currently underway. Results are expected by the end of 2016 and will be reported in a follow-up paper. Conclusions: Innovative use of technology in supporting usual care delivery in women with GDM may facilitate timely access to GDM monitoring data and mitigate care burdens without compromising maternal and fetal outcomes. The intervention may potentially reduce health service utilization. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614000934640; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366740 (Archived by WebCite® at http://www.webcitation.org/6jRiqzjSv).

INTRODUCTION This paper argues that particular experiences in the workplace are more important than others and can lead to transformational learning. This may enable practitioners to cross ‘vocational thresholds’ to new ways of being. AIM A notion of ‘vocational thresholds’ is developed, aiming to help build an understanding of the most powerful learning experiences of general practitioners (GPs). Vocational thresholds takes its cue from the idea of ‘threshold concepts’ - concepts that transform perspectives and integrate previously disconnected or hidden knowledge, sometimes in ways that are ‘troublesome’ to previously held beliefs. METHODS The paper is based on a thematic analysis of 57 GPs’ brief written accounts of a particularly powerful learning experience during their development. Accounts were provided in a conference session about an ongoing study of workplace-based structured learning arrangements in the fields of general practice medicine, engineering, and building. FINDINGS Most GPs’ accounts focused on development of dispositional attributes that moved them to a new understanding of themselves in relation to their work and patients. Just under two-thirds picked out informal and formal collegial relationships within purposeful learning arrangements as pivotal. A third picked out direct experiences with patients as shifting their perspective. CONCLUSION The emergent idea of vocational thresholds is offered as a way to frame the most important learning experiences identified by GPs. It supports a focus in early and ongoing development beyond accumulating clinical expertise and skills (knowing and doing), to dispositional capability (being) - vital for practitioners negotiating inherent and daily uncertainty. KEYWORDS General practitioners; Medical education; Vocational education; Identity; Learning experiences; Threshold concepts

Background: Diabetes distress is underrecognized and associated with poor outcomes. This study tested whether a 12-month collaborative, goal-setting, and behavioral telehealth intervention reduced diabetes distress levels. Methods: This is a secondary analysis of the Healthy Outcomes through Patient Empowerment (HOPE) study that included individuals (N = 225) with uncontrolled diabetes and depression living at least 20 miles from a Veteran's Affairs medical center. Participants were randomized to HOPE (intervention) or Enhanced Usual Care (EUC) with education. We evaluated diabetes distress levels as measured by the Problem Areas in Diabetes (PAID) Questionnaire and its four subscales (emotional, diabetes management, social, and treatment distress) at baseline, 6, and 12 months. Results: Between-group analysis revealed greater improvements in HOPE versus EUC for: 6-month PAID total score (p = 0.04), emotional (p = 0.03), and social (p = 0.04) subscales; 12-month PAID total score (p = 0.07) and emotional subscale (p = 0.07). Within-group comparisons showed larger effect sizes for HOPE compared with EUC: 12-month PAID total scores (0.82 vs. 0.54), 6-month emotional burden (0.54 vs. 0.31), and 6-month (0.32 vs. 0.08) and 12-month (0.41 vs. 0.12) social burdens. Repeated-measures analysis evaluating treatment group and time trended toward improvement in PAID overall for HOPE compared with EUC participants, but was not statistically significant (β = 6.96; SE = 4.35; p = 0.13). Discussion: Clinically meaningful reductions in PAID overall and the emotional and social subscales were observed in HOPE compared with EUC participants. Conclusion: Further evaluation of diabetes telehealth interventions that include other facets related to diabetes distress, including treatment, diabetes management, social, and emotional burdens, is warranted. Clinical Trial Number. NCT01572389; Clinical Trial Registry. https://clinicaltrials.gov/ct2/show/NCT01572389.

Background: Although mobile apps are readily available for speech sound disorders (SSD), their validity has not been systematically evaluated. This evidence-based appraisal will critically review and synthesize current evidence on available therapy apps for use by children with SSD. Objective: The main aims are to (1) identify the types of apps currently available for Android and iOS mobile phones and tablets, and (2) to critique their design features and content using a structured quality appraisal tool. Methods: This protocol paper presents and justifies the methods used for a systematic review of mobile apps that provide intervention for use by children with SSD. The primary outcomes of interest are (1) engagement, (2) functionality, (3) aesthetics, (4) information quality, (5) subjective quality, and (6) perceived impact. Quality will be assessed by 2 certified practicing speech-language pathologists using a structured quality appraisal tool. Two app stores will be searched from the 2 largest operating platforms, Android and iOS. Systematic methods of knowledge synthesis shall include searching the app stores using a defined procedure, data extraction, and quality analysis. Results: This search strategy shall enable us to determine how many SSD apps are available for Android and for iOS compatible mobile phones and tablets. It shall also identify the regions of the world responsible for the apps’ development, the content and the quality of offerings. Recommendations will be made for speech-language pathologists seeking to use mobile apps in their clinical practice. Conclusions: This protocol provides a structured process for locating apps and appraising the quality, as the basis for evaluating their use in speech pathology for children in English-speaking nations. [JMIR Res Protoc 2016;5(4):e233]

In this paper, for the Chinese automatic question answering technology in open domain, in addition to considering the traditional association between questions and questions, the correlation between questions and answers is added. The cosine similarity between questions and answers is used as the semantic similarity between them. A bi-directional long short-term memory network (BiLSTM) is added between the question and question, answer and the answer to seek the association between the contexts. and an attention mechanism is added to make question and answer related. Finally, the experimental verification shows that the accuracy of automatic question answering by the proposed method reaches 70%.

Background . Despite the promotion of international osteopathic recommendations and registration guidelines, relational competencies and patient education practices present a challenge in the clinical setting due to lack of training. In France, the latest national osteopathic standards for education and practice defined a relational competency that includes patient education. Little is known about its integration in curricula and how French osteopathic practitioners are subsequently trained for relational competency. Objective . To determine teaching, learning, and assessment methods related to relational competency in French initial osteopathic training programs and identify the role of patient education in this relational competency. Methods . An online questionnaire was designed and sent to all initial training institutes in France (n = 28). Eight institutes answered the survey. Results . The relational competency appeared in various courses, enhanced by clinical learning. However, the courses were not specific to this competency and the volume of hours was relatively low. Patient education was seen as part of the relational competency but was poorly implemented. This competency-based approach is still considered an emerging practice in these institutes. Conclusions . There is a misalignment among intended learning outcomes, teaching, and assessment. The current educational practices are not sufficient to support relational competency, specifically regarding patient education. Further research is needed on how French standards are understood, how they are assimilated by educators, and how they are translated into educational practice. In addition, the adequacy of educators training for effective implementation of the competency-based approach should be questioned.

The cancer registrar reports accurate, complete, and timely abstracted cancer data to various healthcare agencies. The data are used for understanding the incidence of cancer, evaluating the effectiveness of public health efforts in the prevention of new cases and improving patient care outcomes and survival. There are increasing demands placed on registrars for additional data points with real-time submission to reporting agencies. To that end, registrars are increasing the use of informatics to meet the demand. The purpose of this article is the role of the registrar in the collection and reporting of critical cancer data and how registrars are currently using informatics to enhance their work. This article describes how informatics can be leveraged in the future and how registrars play a vital role in meeting the increasing demands placed on them to provide timely, meaningful, and accurate data for the cancer community.

PURPOSE Health care priorities of individuals may change during a pandemic, which may, in turn, affect health services utilization. We examined Canadians' online relative search interest in five common solid tumors (breast, colon, lung, prostate, and thyroid) during the COVID-19 pandemic to that observed in the same months in the prior 5 years. METHODS We conducted a cross-sectional retrospective study using Google Trends aggregate anonymous online search data from Canada. We compared the respective relative search volumes for breast, colon, lung, prostate, and thyroid cancers for the months March-November 2020 with the mean for the same months in 2015-2019. Welch's two-sample t tests were performed and the raw P values were then adjusted using Benjamini-Hochberg procedure to correct for multiple comparisons. The level of statistical significance was defined by choosing false discovery rate at .05 for the primary analysis. RESULTS We observed temporary statistically significant reductions in Canadians' relative search volumes for various cancers, largely early in the pandemic, in the spring of 2020. Specifically, significant reductions (after adjustment for multiple comparisons) were observed for breast cancer in April, May, and October 2020; colon cancer in March and April of 2020; lung cancer in April and September 2020; and prostate cancer in April and May 2020. Thyroid cancer relative search volumes were not significantly different from those observed prior to the pandemic. CONCLUSION Although Canadians' online interest in various cancers temporarily waned early in the COVID-19 pandemic, recent relative search volumes for various cancers are largely not significantly different from prior to the pandemic.

Since the emergence of digital and smart healthcare, the world has hastened to apply various technologies in this field to promote better health operation and patients’ well being, increase life expectancy, and reduce healthcare costs. One promising technology and game changer in this domain is digital twin (DT). DT is expected to change the concept of digital healthcare and take this field to another level that has never been seen before. DT is a virtual replica of a physical asset that reflects the current status through real-time transformed data. This article proposes and implements an intelligent context-aware healthcare system using the DT framework. This framework is a beneficial contribution to digital healthcare and to improve healthcare operations. Accordingly, an electrocardiogram (ECG) heart rhythms classifier model was built using machine learning to diagnose heart disease and detect heart problems. The implemented models successfully predicted a particular heart condition with high accuracy in different algorithms. The collected results have shown that integrating DT with the healthcare field would improve healthcare processes by bringing patients and healthcare professionals together in an intelligent, comprehensive, and scalable health ecosystem. Also, implementing an ECG classifier that detects heart conditions gives the inspiration for applying ML and artificial intelligence with different human body metrics for continuous monitoring and abnormalities detection. Finally, neural-network-based algorithms deal better with ECG data than traditional ML algorithms.

Background: To examine clinician perspectives on the acceptability, appropriateness/suitability, and feasibility of video telehealth as a way to deliver mental health services during the COVID-19 pandemic. Materials and Methods: Mental health clinicians were surveyed with 27 Likert questions, using previously validated measures, on satisfaction and implementation experience with video telehealth visits between March and June 2020. Results: A total of 112 of 193 clinicians completed the survey (58.0%), including psychiatrists, psychologists, trainees (i.e., residents and fellows), advanced practice providers, and licensed mental health counselors. Clinicians reported high levels of acceptability, feasibility, and appropriateness of video telehealth; they also reported high levels of satisfaction with video telehealth visits. Seventy-nine and a half (79.5%) reported that their patients seemed highly satisfied with video telehealth visits, and 107 (95.5%) of clinicians responded that they would like video telehealth visits to represent at least 25% of their practice in the future. Discussion: Mental health clinicians showed positive attitudes toward the implementation of video telehealth visits, high levels of satisfaction with this care, and indicated strong interest in continuing this modality as a significant portion of clinical practice. Conclusion: This study demonstrates the ability of mental health clinicians to embrace new technology to expand access to care during the COVID-19 pandemic. Results indicate that telemental health is likely to be an integral part of clinic practice in the future.

Purpose There is only limited data on the application of virtual reality (VR) for the evaluation of temporal bone anatomy. The aim of the present study was to compare the VR environment to traditional cross-sectional viewing of computed tomography images in a simulated preoperative planning setting in novice and expert surgeons. Methods A novice (n = 5) and an expert group (n = 5), based on their otosurgery experience, were created. The participants were asked to identify 24 anatomical landmarks, perform 11 distance measurements between surgically relevant anatomical structures and 10 fiducial markers on five cadaver temporal bones in both VR environment and cross-sectional viewings in PACS interface. The data on performance time and user-experience (i.e., subjective validation) were collected. Results The novice group made significantly more errors (p p = 0.001) in cross-sectional viewing than the expert group. In the VR environment, there was no significant differences (errors and time) between the groups. The performance of novices improved faster in the VR. The novices showed significantly faster task performance (p = 0.003) and a trend towards fewer errors (p = 0.054) in VR compared to cross-sectional viewing. No such difference between the methods were observed in the expert group. The mean overall scores of user-experience were significantly higher for VR than cross-sectional viewing in both groups (p Conclusion In the VR environment, novices performed the anatomical evaluation of temporal bone faster and with fewer errors than in the traditional cross-sectional viewing, which supports its efficiency for the evaluation of complex anatomy.

Background: Orthopedic specialties have begun to embrace telehealth as an alternative to in-person visits. We have not found studies assessing telehealth in sports medicine. Our goal is to evaluate...

To explore the impact of a prescribing feedback intervention on insulin prescribing.This was a mixed-methods study in a hospital setting. An insulin prescribing feedback intervention was delivered verbally and in writing to twelve doctors. Insulin prescribing error frequency was compared to ten doctors who had not received the feedback intervention. Insulin prescribing was audited over four weeks at the start and end of the intervention period. Semi-structured interviews were conducted with participating doctors who had received feedback, and qualitative data analysed thematically to explore the impact of the intervention on their prescribing practice.Prescribing data were collected on 370 insulin prescriptions with 241 errors identified. A significant reduction (χ2 = 22.6, p=0.05) in insulin prescribing error frequency was observed in the intervention group, with a non-significant increase reported in the control group. Feedback was received positively and considered valuable by doctors, supporting development of their knowledge and skills and encouraging reflection on their prescribing performance. Doctors described enhanced confidence in insulin prescribing and a desire to improve as a prescriber and avoid harm, with feedback raising awareness of their development needs. Prescribers also described enhanced team work, with greater information and feedback seeking behavior to inform future prescribing decisions.Feedback has potential to improve insulin prescribing and is a valued and acceptable process intervention for doctors. The impact on insulin prescribing practice is varied and complex influencing the capability, opportunity and motivation of prescribers to adapt and evolve their behavior in response to ongoing feedback.

BACKGROUND: Nowadays, smart healthcare minimizes medical facilities costs, ease staff burden, achieve unified control of materials and records, and enhance patients’ medical experience. Smart healthcare treatments have critical barriers to improving patient outcomes, reducing the regulatory burden, and promoting the transition from volume to benefit. OBJECTIVE: In this paper, the Internet of Things-assisted Intelligent Monitoring Model (IoT-IMM) has been proposed to improve patient health and maintain health records. METHOD: The advanced IoT sensors can monitor patient health and insert into the patients’ bodies. Information collected can be analyzed, aggregated, and mined to predict diseases at an early stage. For that, an enhanced deep learning network using Bayes theorem (EDLN-BT) benefits to obtain and verify various patient health data in a specific aspect, making it easy to supervise the patient’s activities. RESULTS: The IoT-IMM-based EDLN-BT results show the smart health care monitoring has undergone substantial growth, improving patient satisfaction for the quality of the healthcare services offered in hospitals and many other healthcare facilities. It helps predict health diseases with increased accuracy, prediction rate with minimal residual error delay, and energy consumption.

Background: There has been a rapid rise in the use of smart devices amongst medical practitioners throughout the world. This study aimed to identify how smart devices were being used by medical practitioners at the Universitas Academic Hospital (UAH), Bloemfontein, and the associated factors thereof. We also identified the views of medical practitioners regarding the usage of smart devices at their workplace.Methods: A prospective cross-sectional study was conducted. Anonymous questionnaires were distributed to medical practitioners working at UAH during weekly departmental meetings or monthly morbidity and mortality meetings. The following largest departments were included: Surgery, Anaesthetics, Paediatrics, Internal Medicine, Family Medicine, and Obstetrics and Gynaecology.Results: The response rate was 82.7% of those attending the meetings. All the respondents owned a smart device and brought it to their workplace. The most common applications used on these smart devices were that for drug references (65.9%), medical textbooks (63.6%) and medical calculators (58.1%). Significantly larger percentages of doctors aged 21–39 years compared with those aged 40–65 years used drug reference applications and medical calculators. A quarter (24.8%) of respondents communicated with patients through a smart device, 21.7% used an online storage platform to backup patient data, whilst 56.6% used their devices to store and view patient information. More than one-third (36.7%) agreed that smart devices threatened patient confidentiality, but the majority (58.8%) did not agree that these devices hinder patient communication. The majority felt that these devices improved both personal performance (69.2%) and patient care (79.0%).Conclusion: Smart devices usage is common in this setting. Hence, integration of such usage in medical curricula, discussion on professionalism, ethics and confidentiality in this context, and guidance from institutions and professional bodies become necessary.

Poor adherence to prescription medication can compromise treatment effectiveness and cost the billions of dollars in unnecessary health care expenses. Though various interventions have been proposed for estimating adherence rates, few have been shown to be effective. Digital systems are capable of estimating adherence without extensive user involvement and can potentially provide higher accuracy with lower user burden than manual methods. In this paper, we propose a smartwatch-based system for detecting several motions that may be predictors of medication adherence, using built-in triaxial accelerometers and gyroscopes. The efficacy of the proposed technique is confirmed through a survey of medication ingestion habits and experimental results on movement classification.

Adherence and compliance to oral anticancer medications (OAMs) can be challenging for patients due to their complex regimens. The goal of this research project was to design an effective and engaging user interface (UI), based on user-centered design (UCD) and incorporate animations, to reinforce and improve patient's understanding of the key aspects of taking OAMs. This current paper encompasses the development process and describes the initial phase of the project, which focused on the design and development of the tablet-based educational application (app). A UCD approach was implemented by consulting with oncology clinicians and patients at an early stage of development. Animations were developed and incorporated to convey complex medical concepts and information. An iterative design process will help ensure that the tool is customized for patient engagement.

Phenomenon: In South Africa, as with many other developing countries, a call has been made for institutions of higher learning to participate in more research and set the pace for societal transformation. At the Faculty of Health Sciences (FoHS), University of the Free State (UFS), numerous strategic efforts are focused on supporting and stimulating research. An essential prerequisite for the success of these vital efforts is to be aware of the research culture within the academic faculties. A peculiarity of medical colleges in South Africa is that medical faculties are in partnership with the government through the academic training hospitals; hence, staff appointment occurs through a joint structure with both the provincial Department of Health and the National Health Laboratory Services. So far, no known study has investigated research culture in this context (joint staff appointment). Approach: This study included elements of case study evaluation and improvement-oriented evaluation. We distributed to 242 educators a structured questionnaire to obtain perceptions of aspects of research, research processes, and existing research culture in the FoHS, UFS. Suggestions on how to improve the research culture also were obtained. The structured questionnaire was self-administered, consisted of closed and open-ended questions grouped into five main sections, and was distributed electronically and manually (hard copy) to participants. Findings: One-hundred-eleven questionnaires were returned (46% response rate). Motivation to do research varied by school and included career advancement (77%, School of Allied Health Professions); change the situation (80%, Academic support); develop individual skillset (67%, School of Nursing) and improve patient care (62%, School of Medicine). Perceived factors affecting research culture included limited funding and allocated time for research, minimal leadership support for research, and absence of research-related support structures as well as minimal teamwork/collaboration. Frustration was the most reported (negative) emotion (25%). Participants suggested that encouraging teamwork among staff, reducing workload to allow time for research, establishing a mentorship program, providing training on deficient skills, and more support from leadership would improve research culture. Insights: This present study reveals some of the factors that impact negatively on research, research culture, and productivity in a medical college in a resource-limited setting. While the benefits of joint staff appointment cannot be overemphasized, our findings highlight that the complex interplay between employers/stakeholders result in poorly executed joint appointment scheme/models (i.e., competitive approach) and creates numerous challenges that negatively impact research productivity and research culture. Recommendations suggested herein can be implemented by the FoHS and other medical colleges in similar contexts to improve research productivity and foster an enabling research culture.

Introduction The medical education research field operates at the crossroads of two distinct academic worlds: higher education and medicine. As such, this field provides a unique opportunity to explore new forms of cross-disciplinary knowledge exchange. Methods Cross-disciplinary knowledge flow in medical education research was examined by looking at citation patterns in the five journals with the highest impact factor in 2017. To grasp the specificities of the knowledge flow in medical education, the field of higher education was used as a comparator. In total, 2031 citations from 64 medical education and 41 higher education articles published in 2017 were examined. Results Medical education researchers draw on a narrower range of knowledge communities than their peers in higher education. Medical education researchers predominantly cite articles published in health and medical education journals (80% of all citations), and to a lesser extent, articles published in education and social science journals. In higher education, while the largest share of the cited literature is internal to the domain (36%), researchers cite literature from across the social science spectrum. Findings suggest that higher education scholars engage in conversations with academics from a broader range of communities and perspectives than their medical education colleagues. Discussion Using Pierre Bourdieu’s concepts of doxa and field, it is argued that the variety of epistemic cultures entering the higher education research space contributes to its interdisciplinary nature. Conversely, the existence of a relatively homogeneous epistemic culture in medicine potentially impedes cross-disciplinary knowledge exchange.

Objectives Antibiotic resistance is indeed a global concern. It is of significant concern especially in the low-middle income countries because of the ease of accessibility, affordability, and absence of regulations pertaining to the dispensing of non-prescription antibiotics. This study aims to estimate the frequency and factors associated with the self-medication of antibiotics found among the practicing nurses. Methods We conducted a descriptive cross-sectional study at a tertiary care hospital in Karachi, Pakistan from July 2016 to August 2016. Results Of the 48 recruited nurses, 60.4% (29/48) were practicing self-medication of antibiotics. There were slightly more male nurses (17/29) than their female counterparts. The most frequently used antibiotics were Amoxicillin/Clavulanic acid, which was reported by 72.4% (21/29) of the nurses. The most prominent factor urging the nurses for practicing self-medication of antibiotics was their perceived knowledge of antibiotics, as was the case with 72.4% (21/29) of the nurses. Fever (79.3%) and sore throat (65.5%) were the two most frequent health problems that prompted the nurses to practice antibiotics self-medication. An earlier experience of the use of antibiotics was reported by 51.7% (15/29) of the nurses. Only 20.7% (6/29) of the nurses completed the entire antibiotic course. The adverse effects of antibiotics were encountered by 41.4% (12/29) of the nurses, which included diarrhoea, nausea, and vomiting. Conclusions The self-medication of antibiotics is a frequent practice found among the practicing nurses in Karachi. It is a pressing concern and needs considerable attention from the healthcare authorities.

الملخص: هذا التقرير عن مريض في ٦٢ من عمره يعاني من ورم الغدد الصم العصبية للأمعاء الدقيقة منذ فترة طويلة مع انتشار ثابت إلى الكبد. حضر يشكو من آلام حادة في الجهة اليمنى من بطنه يصاحبها غثيان وقيء. بالاستناد إلى الفحوصات الشعاعية، تم تشخيص المريض بالتهاب المرارة المتزامن والتهاب الزائدة الدودية.تم إجراء جراحة لاستئصال كل من الزائدة الدودية والحوصلة المرارية بالمنظار سويا حيث أكد فحص الأنسجة للعضوين المستأصلين لاحقا التهابهما أوليا دون وجود أي أثر سرطاني. تعافى المريض بعدها بسلاسة وتركزت الخطة العلاجية ما بعد العملية على متابعة علاج ورم الغدد الصم العصبية في الأمعاء الدقيقة وتقييم العلاج التلطيفي المتبع منذ سنوات.من النادر جدا تزامن كلا الالتهابين، حيث لا يوجد سبب مؤكد خلفه. بناء على المراجعة التي أجريناها للمنشورات العلمية، تم تسجيل ١١ حالة التهاب متزامن في كلا العضوين (الزائدة الدودية والحوصلة المرارية) حتى العام ٢٠١٩، ويعتقد أن تكون هذه الحالة بين أيديكم الأولى حيث يصاحب هذا التزامن ورم الغدد الصم العصبية. نهدف في هذا التقرير إلى سرد الصورة المرضية، وتحدياتها التشخيصية والخطة العلاجية المتبعة مع بعض التفاصيل من داخل العملية الجراحية المجراة. Abstract: We report the case of a 62-year-old retired man with a long-standing small bowel neuroendocrine tumour. He presented with right-sided abdominal pain associated with nausea and vomiting. Radiographic imaging confirmed acute appendicitis and cholecystitis. We performed a synchronous laparoscopic appendectomy and cholecystectomy in the same setting. Histopathological examination of specimens confirmed the preoperative diagnoses in both organs. Our patient recovered uneventfully. The postoperative management plan focused on continuation of the follow-up for the small bowel neuroendocrine tumour. The synchronicity of both acute cholecystitis and appendicitis is extremely uncommon. We believe that our case report is the first of its kind with synchronous inflammation of the gallbladder and appendix in a patient with neuroendocrine tumour. In this report, we aim to provide insights on managing such a condition in the background of other intra-abdominal tumours.

Postpartum hemorrhage (PPH) is a medical emergency that is the primary cause of nearly one-quarter of all maternal deaths worldwide. Prelicensure nursing students are often underprepared to respond to obstetrical emergencies, such as PPH, due to a lack of exposure in the clinical setting. Simulation is used to aid students in developing knowledge, skills, and attitudes in clinical learning and emergency scenarios. The purpose of this pilot study was to evaluate student knowledge before and after participation in a high-fidelity simulation of a patient experiencing PPH. Student confidence and satisfaction after the experience was also assessed. Findings demonstrated that high-fidelity simulation significantly increased student knowledge related to PPH nursing care (p = 0.001). Student perceived confidence and satisfaction were also aggregately rated at 95% after the simulation experience. The PPH scenario utilized is described, and implications of implementing simulation in prelicensure nursing programs are discussed.

الملخص: أهداف البحث: سوء استعمال الأدوية الوصفية موضوع مثير للخلاف والجدل في المملكة العربية السعودية، وذلك بسبب سهولة الحصول على الأدوية من صيدليات التجزئة. تهدف دراستنا إلى تقييم ما إذا كان السكان السعوديون، في جدة، قد استبدلوا تعاطي بريجابالين - أحد الأدوية التي تم تقييدها مؤخرا لصيدليات المستشفيات فقط - إلى جابابنتين. طرق البحث: أجريت دراسة وصفية، وتم جمع وتحليل البيانات خلال شهر واحد، من خلال استبانة تم بناؤها ذاتيا ووُزعت عبر منصات التواصل الاجتماعي. وشملت بنود الدراسة ما يلي: (١) الخصائص الديمغرافية للمشاركين؛ (٢) تاريخ الإدمان (إن وجد)؛ (٣) الاستخدام غير الطبي لجابابنتين (عدد مرات الاستخدام، الاستخدام المتزامن مع أدوية أخرى والمحفزات)؛ و(٤) طريقة اكتشاف الاستخدام غير الدوائي للجابابنتين. النتائج: تم جمع ٣٧٠ مشاركة وكان معظم المشاركين من الإناث ٢٨٩ (٧٨.١٪)، ومعظم أعمار المشاركين دون سن ٣٠ سنة وعددهم ٣٠٠ (٨١.١٪)، وكان لدى ٧٢ (١٩.٥٪) شخصا تاريخ إدمان على الأدوية الوصفية. وكانت أغلب الأدوية التي ورد ذكرها هي بريجابالين ١٧ (٤.٦٪). بالإضافة إلى عدد اللذين أساءوا استخدام جابابنتين ١٠ (٢.٧٪)، حيث أفاد نصفهم (٥) عن سوء استخدام بريجابالين في السابق. معظم مسيئي استخدام جابابنتين قد سمعوا عن تأثيره واستخدامه من الأصدقاء ٨ (٨٠٪) وكان أكثر الأسباب المحفزة للاستخدام هي ''قضاء وقت ممتع'' ٦ (٦٠٪). وبالإضافة إلى أن نصف مستخدمي جابابنتين قد أجابوا بأنهم يتعاطون الدواء بشكل أسبوعي. الاستنتاجات: سلطت هذه الدراسة الضوء على احتمالية انتقال المسيئي استخدام بريجابالين إلى الجابابنتين. ننصح بتكثيف حملات التوعية لتثقيف كل من المجتمع وصيدليات التجزئة والمجتمعية بشأن هذه المسألة. Abstract: Objective: Following the recently conducted local studies on the growing misuse of pregabalin, Pregabalin misuse has received national attention. These studies have led to the authorities restricting the availability of pregabalin to hospital pharmacies alone. While the recent epidemiological studies and case reports found gabapentin to be misused worldwide, it was previously presumed to be free of any abuse potential. This study assesses the likelihood of there being a diversion to Gabapentin abuse following the Pregabalin restriction in Jeddah, KSA. Methods: A cross sectional observational study was conducted between November 2017 and December 2017 using a self-constructed online survey via Twitter and WhatsApp. The survey items included participants’ demographics, additional history, Gabapentin for non-medical use (frequency, concurrent use with other drugs, and motivators), and how the participants knew about the Gabapentin misuse. The data was subjected to a descriptive analysis via the utilization of frequencies and percentages. The analysis was carried out by using SPSS V21. Results: Data of the 370 respondents who took the surveys were collected. Most of the respondents were women (n = 289; 78.1%) and below the age of 30 years (n = 300; 81.1%). A total of 72 respondents (19.5%) had a history of psychoactive drug abuse. Ten of the respondents reported Gabapentin misuse (2.7%). Half of the participants reported prior Pregabalin misuse, and were un-employed. Most of the misusers (n = 8; 80%) came to know about the psychotropic effects of Gabapentin from friends. The most common motives for using it were to ‘have fun’ and ‘peer pressure’ (n = 6; 60%). Half of the misusers used Gabapentin on a weekly basis. Conclusion: The findings of our study suggest a potential diversion from Pregabalin to Gabapentin misuse. Regulations and periodic reviews of the psychoactive prescription medications available in the community pharmacies are essential.

الملخص: أهداف البحث: تبحث هذه الدراسة في نوعية الحياة لطلاب الامتياز التمريضي والمتغيرات التنبئية لجودة نوعية الحياة لطلاب الامتياز التمريضي أثناء جائحة كوفيد-١٩. كما تم أيضا تقييم ارتباطات نوعية الحياة الخاصة لطلاب الامتياز التمريضي مع الجنس والعمر والخبرة التمريضية السابقة والمعدل التراكمي من الفصل الدراسي السابق. طرق البحث: استخدمت هذه الدراسة تصميم المقطع العرضي الكمي من خلال نموذج المسح الإلكتروني لجمع البيانات المطلوبة. وتم اعتماد مقياس تقييم جودة الحياة المكون من ٢٢ عنصرا كأداة للمسح. أكمل المسح ٢٨٣ طالب امتياز تمريضي من خمس جامعات حكومية في المملكة العربية السعودية. النتائج: تبين أن العمر والجنس والخبرة المتعلقة بالتمريض قبل التدريب مرتبطة بشكل كبير بدرجة مقياس تقييم جودة الحياة الإجمالية. وكان تأثير المعدل التراكمي لطلاب الامتياز التمريضي بسيطا. كما كان هناك فرق كبير في النتيجة الإجمالية لمقياس تقييم جودة الحياة على أساس العمر، والجنس، والمعدل التراكمي. أخيرا، وفقا لتقديرات تحليل الانحدار، تم العثور على أن العمر فقط هو المؤشر المهم لجودة نوعية الحياة الخاصة بطلاب الامتياز التمريضي. الاستنتاجات: في هذه الدراسة، كان هناك ارتباط إيجابي بين نوعية الحياة لطلاب الامتياز التمريضي السعوديين وبين أعمارهم وجنسهم. يتمتع الذكور من طلاب الامتياز التمريضي بجودة نوعية حياة أكبر من الإناث، بينما لوحظ وجود نوعية حياة مرتفعة بين الطلاب الحاصلين على معدل تراكمي مرتفع قبل عام التدريب. وتم العثور على أن العمر فقط لطلاب الامتياز التمريضي ليكون مؤشرا موثوقا لجودة نوعية الحياة. Abstract: Objectives: This study investigated the quality of life (QoL) of nursing internship students (NISs) and the predictive variables for the QoL of NISs during the COVID-19 pandemic. The correlates of QoL of NISs with their gender, age, prior nursing experience, and grade point average (GPA) from the previous semester are also assessed. Methods: This study used a quantitative cross-sectional design through an electronic survey form for the collection of required data. The 22-item Quality of Life Evaluation Scale (QOLES) was adopted as the survey instrument. A total of 283 NISs from five public universities in KSA completed the survey. Results: The students' age, gender, and nursing-related experience prior to their internship were all found to be significantly associated with the overall QOLES score (p values of 0.001, 0.001, and 0.01, respectively). The NISs GPA was found to be marginally significant (p = 0.08). A significant difference was identified in the overall QOLES score based on age (p = 0.02), gender (p = 0.02), and GPA (p =

Background: Telemedicine use has expanded substantially in recent years. Studies evaluating the impact of telemedicine modalities on downstream office visits have demonstrated mixed results. Introd...

Background: At the beginning of the COVID-19 pandemic, New York City quickly became the epicenter with hospitals at full capacity needing to care for patients. At New York Presbyterian Brooklyn Methodist Hospital, we needed to develop an innovative system of how to safely discharge the massive influx of patients. Inundation of patient care with limited manpower and resources forced us to align with a third-party vendor, around-the-clock alert, to make remote patient monitoring (RPM) possible. Each patient was prescribed a pulse oximeter and nurses were assigned to monitor vital signs, speak to patients, and escalate to physicians if required. Results: We enrolled 50 patients, of whom 13 were escalated resulting in 3 emergency room visits and 1 readmission. We had a high compliance rate with high patient satisfaction in postsurveys. Discussion: Our program was unique in that it utilized telemedicine for regular patient follow-up, along with RPM through a third-party vendor. Patients were able to be safely discharged home with close follow-up through regularly obtained vitals with access to a 24/7 hotline for any emergencies, possibly preventing readmissions. Limitations include a small sample size population. Conclusions: Our experience shows that in a short period despite lack of resources, telehealth and RPM's concurrent use with a third-party vendor could be successfully utilized for safe discharges with high patient satisfaction.

الملخص: يعتبر فرط نشاط جارة الدرقية الأولي الناجم عن ورم غدد جارات الدرقية خارج مكانها المعتاد في منطقة المنصف اكتشافا نادرا. نقدم هنا حالة من فرط نشاط جارة الدرقية الأولي الناجم عن ورم غدد جارات الدرقية خارج مكانها المعتاد يقع في منطقة المنصف لرجل يبلغ من العمر ٧٥ عاما. بداية تمت إحالة هذا المريض إلى العيادة للتحقيق في ارتفاع نسبة الكالسيوم في الدم الذي تم تشخيصه صدفة. وأظهر تصويره الأولي غدتين مشبوهتين، واحدة مجاورة للغدة الدرقية والأخرى في منطقة المنصف. عند التحقق بدراسات متكررة وإضافية، تم تحديد الغدة المنصفية لوحدها فقط باعتبارها الغدة المشبوهة المحتملة لورم غدة جارة الدرقية وتم التأكيد على ذلك بعد اعتدال مستويات هرمون الغدة جارة الدرقية بعد الاستئصال الجراحي. يمكن أن يكون التشخيص الدقيق لمثل هذه الحالات أمرا صعبا؛ واستخدام دراسة أشعة واحدة مثل التصوير بالموجات فوق الصوتية أو التصوير المقطعي المحوسب أو التصوير النووي وحده قد لا يؤدي إلى نتائج قاطعة أو يمكن أن يعطي نتائج إيجابية خاطئة. توضح حالتنا أن طرق التصوير المتعددة المستخدمة مجتمعة يمكن أن تؤدي إلى تشخيص دقيق لسبب فرط نشاط جارات الدرقية الأولي. وبالتالي يؤدي ذلك إلى تجنيب المرضى إجراءات استئصال جراحية إضافية غير ضرورية أو من ناحية أخرى، تقليل فرص نسيان مصادر أخرى للإفراز خارج مكانها المعتاد. Abstract: Primary hyperparathyroidism caused by an ectopic parathyroid adenoma in the mediastinum is a rare clinical condition. We present a 75-year-old male with primary hyperparathyroidism caused by an ectopic parathyroid adenoma in the mediastinum. This patient was initially referred to the clinic for suspected incidental hypercalcemia. Initial imaging showed two suspicious lesions: one adjacent to the thyroid gland and another in the mediastinum. Further investigations identified a sole mediastinal adenoma. The diagnosis was confirmed by normalization of parathyroid hormone levels after its surgical resection. Thoroughly diagnosing such cases can prove challenging and using a single modality such as ultrasonography, computed tomography, or nuclear imaging alone may not yield conclusive findings or can give false positive results. Our case demonstrates that a combination of several imaging modalities can lead to accurate localization of the cause of primary hyperparathyroidism. This will obviate the performance of unnecessary surgical procedures. In addition, the possibility of missing additional sources of ectopic secretions of the parathyroid hormone will be reduced.

الملخص: أهداف البحث: تزايد انتشار حصى الكلى في جميع أنحاء العالم في العقد الماضي، ويُعتقد أن عوامل الخطر المتعددة تُعزى إلى التغيير في نمط الحياة، والنظام الغذائي، وحتى الاحتباس الحراري. في دولة الإمارات العربية المتحدة، لم يتم عمل الكثير من البحوث لاستكشاف انتشار حصى الكلى والمعرفة عنها. تهدف هذه الدراسة إلى قياس مدى معرفة المجتمع بحصى الكلى بين البالغين في دولة الإمارات العربية المتحدة. طرق البحث: في هذه الدراسة المقطعية، تم جمع البيانات باستخدام استبانة ذاتية الإدارة تم توزيعها علىخمسة مائة و خمسة عشر مشارك (٢٠-٤٩ عاما) من أبو ظبي ودبي وعجمان والشارقة. النتائج: من بين ٥٠٠ مشارك، بلغ متوسط مجموع درجات المعرفة ٥٦.٤٪. لم يكن هناك ارتباط بين المعرفة بين أولئك الذين عانوا من حصى الكلى والذين لم يصابوا بها. كان وجود تاريخ عائلي بتشخيص حصى الكلى يزيد من خطر الإصابة بحصى الكلى بمعدل ٢.٢٧. وأظهرت النتائج أن المشاركين الذين كان لديهم علامات وأعراض وتشخيص وعلاج حصى الكلى، كان لديهم مستوى جيد من المعرفة بعد تحليل مصدر المعرفة، ولكن كان هناك مستوى ضئيل من المعرفة بخصوص العوامل الغذائية المتعلقة بحصى الكلى. كان للإنترنت ووسائل الإعلام دور أكبر بضعفين من الأطباء في تثقيف السكّان. الاستنتاجات: استطاعت هذه الدراسة أن توضح أن سكّان الإمارات على دراية ببعض الجوانب المتعلقة بحصوات الكلى ولكن على غير دراية بشأن عوامل الخطر التبعية. وهذا يسلط الضوء على أهمية تعزيز التعليم من خلال الحملات الصحية. Abstract: Objectives: The prevalence of kidney stones is increasing worldwide. Multiple risk factors are believed to contribute to the development of kidney stones such as lifestyle, diet, and global warming. In the United Arab Emirates (UAE), there has been limited research exploring the prevalence and risk factors of kidney stones. This study attempts to assess the understanding and prevalence of kidney stones among adults in the UAE. Methods: In this cross-sectional study, data were collected using a self-administered questionnaire, distributed among 515 participants (20–49 years old) from Abu Dhabi, Dubai, Ajman, and Sharjah states. IBM SPSS version 25 was used for data analysis. Results: The mean of knowledge score was 56.4% (n = 500). There was no correlation between the knowledge of those who had experienced kidney stones and those who did not. Furthermore, a family history of kidney stones increased the risk of developing stones by 2.27 times. Among participants reporting signs, symptoms, diagnosis, and the management of kidney stones, the knowledge and understanding about kidney stones was high. However, the perceptions of the same cohort about dietary precautions were limited. While analysing the sources of knowledge, the Internet and mass media were twice as important as physicians in educating the population. Conclusion: This study shows that the study cohort from the UAE population was aware of certain aspects of kidney stones but was quite naïve about its consequential risk factors. This highlights the importance of promoting education about kidney stones through health campaigns.