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Resumen Introduccion Uno de los momentos mas importantes en la vida de un medico ocurre cuando realiza la especializacion medica. Este periodo impone estres y exigencias academicas, lo cual, junto con el ambiente educacional, permite un mayor o menor bienestar mental. El objetivo del estudio es determinar como se relacionan el ambiente educacional y el bienestar mental de los residentes de Medicina. Metodos Estudio transversal analitico en residentes de especialidades clinico-quirurgicas. El ambiente educacional se evaluo mediante la escala Postgraduate Hospital Educational Envioroment Meassure (PHEEM) y el bienestar mental, con la escala de Warwick-Edinburgh (EBMWE). Se determino la correlacion lineal de Pearson. Se tomo el consentimiento informado y se obtuvo la aprobacion del comite de etica universitario. Resultados Integraron la poblacion de estudio 131 estudiantes, el 43,8% varones, con una mediana de edad de 28 [intervalo intercuartilico, 4] anos. El 87,9% de los residentes respondieron a la encuesta. Hubo un 65,9% de posgrados medicos y un 34,1% de quirurgicos. La puntuacion media en la PHEEM fue de 107,96 ± 18,88; en la subescala de emociones positivas, 29,32 ± 5,18 y en funcionamiento positivo, 23,61 ± 3,57, con una media total de bienestar mental de 52,96 ± 8,44. Se encontro una moderada correlacion positiva entre puntuacion total de la PHEEM y cada una de las 2 subescalas de bienestar mental (p Conclusiones Se encontro una correlacion positiva entre una mejor percepcion del ambiente educacional y el bienestar mental de los residentes de especialidades clinicas-quirurgicas con mayor bienestar mental.

Resume Position du probleme L’objectif de ce travail etait de presenter la demarche methodologique de l’education therapeutique sur cinq centres de sante de Cote d’Ivoire et son impact sur l’evolution virologique des patients inscrits dans ce processus. Methodes Cette etude a porte sur une cohorte de 739 patients adultes a charge virale non supprimee sur la periode de janvier a mars 2019. Les variables etudiees etaient le sexe des patients, le nombre de seances d’education therapeutique realisees, le statut viral et l’evolution virologique, qu’elle soit favorable ou non sur la base de la baisse de 1 log de la derniere charge virale apres l’education therapeutique. Resultats Les resultats obtenus ont presente l’education therapeutique sur ces sites comme etant un processus elabore dans lequel le patient lui-meme est un acteur majeur de la prise en charge de sa maladie et de son adaptation a celle-ci, a son mode de vie et a celui de ses proches. Neanmoins, seulement 136 patients soit 18 % de cette cohorte ont effectivement beneficie de l’education therapeutique. Cinquante et un pour cent d’entre eux connaissaient un changement de statut viral de patients a charge virale non supprimee a patients a charge virale supprimee. Sur la base de la baisse de 1 log de la derniere charge virale, ces resultats ont montre que 60 % des patients qui participent a l’education therapeutique connaissent une evolution virologique favorable. Le test d’independance de Chi-deux n’a montre aucune dependance du sexe des patients et du nombre de seances au statut viral. Conclusion Cette etude a montre l’importance de l’education therapeutique dans la prise en charge des patients vivant avec le VIH et sa prise en compte necessaire et indispensable pour l’atteinte des objectifs ONUSIDA 90-90-90.

A new veterinarian’s smooth and rapid transition from education to clinical practice is critical to their success and that of their new professional homes. Successful mentoring relationships are critical to smoothing the transition to practice, particularly when independent clinical decisions are abruptly required. A mentor acts as a personal coach and teacher, providing both career and personal guidance. While the profession has focused on training mentors, it has paid little attention to teaching mentees how to maximize the benefits of the relationship. Veterinary colleges can do more to equip their graduates with the skills they need to manage their change to working life successfully. The Western College of Veterinary Medicine’s (WCVM) substantive gap analysis revealed mentee training as an important issue to address in support of mentorship and established a mentee training program within the curriculum. The program teaches needs assessment, goal setting, identification of appropriate learning activities, and reflection skills as an iterative and cyclical process. Learning activities include working with one’s selected mentor (or mentors). These skills are important for lifelong learning and continuing professional development, as well as transition to practice.

Clinical practice-based training/work-integrated learning is an applied, social, and high-impact element of the veterinary curriculum. Within this context, students are learning on the job with clinician–educators who are carrying out their professional duties at the same time as supporting learning. To equip clinician–educators with role awareness and general teaching skills, it is recommended that all have access to basic teacher training. However, delivering this training can be challenging to organize and potentially costly when busy, time-poor clinician–educators are distributed across many geographical locations. This Teaching Tip shares our insights about developing and delivering a set of novel clinical teacher resources for veterinarians and veterinary nurses/technologists new to clinical teaching. The resources, underpinned by the principles of participatory design, integrate contemporary clinical educational theories with practical strategies and are interwoven with video clips capturing staff and student perspectives on key topics. While initially focused on creating just an online resource, we ultimately produced an A6 ring-bound booklet version and face-to-face workshops. In this article, we unpack considerations involved in committing to such a project and designing and creating the resources. We hope that this information may be of use to others when developing similar resources.

The aim of this study is to discover medical students’ ideas on the phenomenon of death; produce information on how these students interpret the value-related problems regarding death that they come across in different units of hospitals; and assess this data in ethical terms. This study included a qualitative research in which 12 focus group interviews were conducted with 92 fifth- and sixth-year medical students. Data obtained from interviews were assessed using a thematic content secondary analysis. The main themes were specified according to the medical students’ statements and were reviewed under the contexts of the “dying process”; “effects of death”; “attitude and behavior of health professionals”; “seeing a dead body/looking at a dead body”; “accepting death”; and “forms of expressions of death.” Medical students’ encounters with death in different units of hospitals leads them to question their values and familiarize themselves with the borders of their areas of profession.

[para. 1]: "As the second wave of the pandemic sees case numbers rise to dangerous levels across the country, it has become clear that Indigenous people are particularly vulnerable to coronavirus disease 2019 (COVID-19). The figures released by the Manitoba First Nations COVID-19 Pandemic Response Coordination Team reflect this vulnerability. Despite making up just over 10% of the total population of the province, First Nations people make up 71% of active cases with COVID-19 and 50% of patients in the intensive care unit; the median age of death from COVID-19 for First Nations people is 66 compared with the provincial median of 83 for Manitobans, overall."

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 research studies a medical staff scheduling problem, which includes government regulations and hospital regulations (hard constraints) and the medical staff’s preferences (soft constraints). OBJECTIVE: The objective function is to minimize the violations (or dissatisfaction) of medical staff’s preferences. METHODS: This study develops three variants of the three-phase modified bat algorithms (BAs), named BA1, BA2, and BA3, in order to satisfy the hard constraints, minimize the dissatisfaction of the medical staff and balance the workload of the medical staff. To ensure workload balance, this study balances the workload among medical staff without increasing the objective function values. RESULTS: Based on the numerical results, the BA3 outperforms the BA1, BA2, and particle swarm optimization (PSO). The robustness of the BA1, BA2, and BA3 is verified. Finally, conclusions are drawn, and directions for future research are highlighted. CONCLUSIONS: The framework of this research can be used as a reference for other hospitals seeking to determine their future medical staff schedule.

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: Effective intern training is essential for safe delivery of anaesthesia during community service. Interns are trained using both tutorials and clinical exposure. E-learning platforms using video tutorials may address millennial learner needs better, but feasibility is unknown in a particular local setting. This study aimed to explore the feasibility of using a video tutorial to facilitate intern training. Perceptions of the value of tutorials were also assessed. Methods: A cross-sectional survey was conducted amongst interns who rotated through anaesthesia at a regional hospital in KwaZulu-Natal. The interns had been exposed to face-to-face tutorials previously and provided with a video-based tutorial. Results: Thirty-seven of the interns consented (88%), watched the video and answered the questionnaire. All interns indicated a need for tutorials during internship. A majority of respondents (71%) felt underprepared by undergraduate training programmes. Most interns were prepared to watch the video tutorial outside of working hours; however, they were divided over the fairness of using internet access for tutorials. There was a preference for video tutorials over reading a textbook or lecture notes. A total of 88% watched the video from the Internet. One intern did not have Internet access or a computer but the video was watched using a free Wi-Fi hotspot. Conclusion: A video-based tutorial system is feasible but current infrastructure needs to be considered. Interns continue to feel underprepared for internship and request that tutorials continue in internship.

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.

Purpose: The primary purpose of this systematic review was to investigate the ability of admission measures to predict clinical skills in graduate students from a variety of health sciences fields. Method: Online databases were searched for research using application measures to make predictions regarding clinical skill development in graduate students in health sciences fields. Twenty-eight studies were included. Articles were analyzed to determine what, if any, admissions measures predicted academic and clinical success in those graduate health care sciences students as well as the generalizability of various authors' findings and consistency of results across the body of research reviewed. Results: Cognitive measures such as undergraduate grade point averages and standardized test scores, including the Graduate Record Examination, more consistently predicted academic outcomes than clinical outcomes in graduate health care students. Noncognitive measures such as essays, interviews, personality tests, and letters of recommendation were slightly better than cognitive measures at predicting clinical skills. Conclusions: Clinical skills are not well defined, leading to difficulty in developing targeted admission and outcome measures. In addition, it was difficult to compare outcomes of the research due to the wide variety of measures used to assess student potential at the time of admission and the wide variety of outcome measures used to assess academic and clinical proficiency.

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.

To help educators deliver their physiology laboratory courses remotely, we developed an inexpensive, customizable hardware kit along with freely available teaching resources. We based the course design on four principles that should allow students to conduct insightful experiments on different physiological systems. First, the experimental setup should not be constrained to laboratory environments. Second, students should be able to take this course without prior coding and electronics experience. Third, the hardware kit should be relatively inexpensive, and all other resources should be freely available. Fourth, all resources should be customizable for educators. The hardware kit consists of commercially available electronic components, with a microcontroller as its hub (Arduino friendly). All measurement systems can be assembled without soldering. The hardware kit is cost-effective (approximately the cost of a textbook) and can be customized depending upon instructional needs. All software is freely available, and we share all necessary codes in open-access online repositories for simple use and customizability. All lab manuals and additional video tutorials are also freely available online and customizable. In our particular course, we have weekly asynchronous physiology lectures and one synchronous laboratory session, where students can get help with their equipment. In this article, we only focus on the novel and open-source laboratory part of the course. The laboratory includes four units [data acquisition, ECG, electromyography (EMG), activity classification] and one final project. It is our intent that these resources will allow other educators to rapidly implement their own remote physiology laboratories or to extend our work into other pedagogical applications of wearable technology.

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.

PURPOSE:COVID-19 challenged medical practice and graduate medical education. Building on previous initiatives, we describe and reflect on the formative process and goals of the Hematology-Oncology Collaborative Videoconferencing Learning Initiative, a trainee-led multi-institutional virtual COVID-19 learning model.METHODS:Clinical fellows and faculty from 13 US training institutions developed consensus needs, goals, and objectives, recruited presenters, and generated a multidisciplinary COVID-19 curriculum. Weekly Zoom conferences consisted of two trainee-led instructional segments and a trainee-moderated faculty Q&A panel. Hematology-oncology training program faculty and trainees were the targeted audience. Leadership evaluations consisted of anonymized baseline and concluding mixed methods surveys. Presenter evaluations consisted of session debriefs and two structured focus groups. Conference evaluations consisted of attendance, demographics, and pre- or postmultiple-choice questions on topic learning objectives.RESULTS:In 6 weeks, the initiative produced five conferences: antivirals, anticoagulation, pulmonology, provider resilience, and resource scarcity ethics. The average attendance was 100 (range 57-185). Among attendees providing both pre- and postconference data, group-level knowledge appeared to increase: antiviral (n = 46) pre-/postcorrect 82.6%/97.8% and incorrect 10.9%/2.2%, anticoagulation (n = 60) pre-/postcorrect 75%/93.3% and incorrect 15%/6.7%, and pulmonary (n = 21) pre-/postcorrect 66.7%/95.2% and incorrect 33.3%/4.8%. Although pulmonary management comfort appeared to increase, comfort managing of antivirals and anticoagulation was unchanged. At the conclusion of the pilot, leadership trainees reported improved self-confidence organizing multi-institutional collaborations, median (interquartile range) 58.5 (50-64) compared with baseline 34 (26-39), but did not report improved confidence in other educational or leadership skills.CONCLUSION:During crisis, trainees built a multi-institutional virtual education platform for the purposes of sharing pandemic experiences and knowledge. Accomplishment of initiative goals was mixed. Lessons learned from the process and goals may improve future disaster educational initiatives.

Background: The current coronavirus disease 2019 (COVID-19) pandemic has forced dermatology practices to rapidly adopt or expand teledermatology services. To date, teledermatology clinical practice guidelines (CPGs) have not been evaluated for quality. This may hinder the implementation and sustainability of high-quality teledermatology services. The objective of this study is to evaluate teledermatology CPGs by using a comprehensive, validated appraisal tool and provide actionable recommendations for improvement for future guideline developers. Materials and Methods: A systematic literature search was performed to identify all CPGs published in teledermatology. Identified guidelines meeting inclusion criteria were scored for guideline quality by three researchers using the Appraisal of Guidelines and Research and Evaluation tool (AGREE II). Results: Three guidelines met inclusion criteria, including guidelines published by the American Telemedicine Association, the British Association of Dermatologists, and the Australian College of Dermatologists and the University of Queensland. Each of these guidelines exhibited unique strengths and areas for improvement. Areas of strength include clear objective statements, stakeholder involvement, and clarity of presentation. Areas for improvement include rigor of guideline development, applicability, and editorial independence. Conclusions: All guidelines were determined to be of sufficient quality for adoption based on AGREE scoring. Adoption of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence appraisal framework would improve the rigor of development of each guideline. Administering and publishing questionnaires to assess financial competing interests and external review processes would shed more light on the presence and/or extent of author bias. One inherent limitation of CPG selection criteria is that large providers of teledermatology services, such as the United States Veterans Affairs, were not examined in this review. However, the results of this study provide actionable targets to improve the quality of the teledermatology CPGs examined in this study.

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.

Resumen Objetivo Determinar las propiedades psicometricas de la version en espanol del cuestionario de Jeffries para evaluar la percepcion, satisfaccion y resultados de aprendizaje en simulacion clinica (QJSC) para estudiantes de titulaciones de Ciencia de la Salud. Metodo Para la adaptacion transcultural a lengua castellana del cuestionario QJSC, se aplico el metodo inverso con una traduccion-retraduccion. Se efectuo el analisis de consistencia interna para evaluar la fiabilidad, analizada con el alfa de Cronbach, se considero aceptable un valor entre 0,90 y 0,95. Para establecer la validez de contenido se efectuo un analisis factorial, solo se consideraron para la interpretacion los items con saturaciones factoriales mayores a 0,60. Los analisis estadisticos se realizaron con el programa SPSS 19. La administracion del cuestionario se llevo a cabo en 10 a 12 sesiones formativas de simulacion clinica de acuerdo con el programa de asignatura con 10 a 12 estudiantes por sesion, para simulacion clinica de alta fidelidad entre 2017 y 2018, en una muestra de 443 estudiantes de pregrado de las titulaciones de Ciencias de la Salud correspondientes a Enfermeria, Nutricion y Dietetica, Tecnologia Medica y Kinesiologia en los Centros de Simulacion Clinica de la region de Coquimbo, La Serena, Chile. Resultados El nivel de consistencia interna para QJSC fue de un alfa de Cronbach= 0,963. Los datos cumplieron con los criterios de Kaiser-Meyer-Olkin para muestra adecuada (measure of sampling adequacy) de 0,981 con un minimo aceptable de 0,500. Los datos tambien cumplieron los requisitos de la prueba de esfericidad de Batlett (χ2 = 53971, df = 561, P Conclusiones Se concluyo que la evidencia acerca de la validez y confiabilidad de las puntuaciones para la version en lengua castellana del QJSC indica que es una herramienta adecuada para evaluar la percepcion, satisfaccion y resultados de aprendizajes de los estudiantes en esta metodologia de ensenanza y aprendizaje.

Resumen Objetivo Explorar y analizar el uso de la simulacion clinica para la formacion y/o capacitacion de equipos clinicos en el manejo y resolucion de conflictos en salud, mediante una revision sistematica exploratoria. Metodo Se realizo una busqueda con los terminos: clinical simulation OR patient simulation OR simulation training OR high fidelity simulation training AND conflict OR conflict resolution en las bases de datos MEDLINE, LILACS, Cochrane, Scielo, PubMed, CINHAL, ScienceDirect, MEDES, IBECS y DOCUMED. Los limites fueron el uso de la simulacion clinica orientado a la formacion en el manejo de conflictos en estudiantes o profesionales de la salud, con uso de escenarios clinicos, excluyendo aquellos con mas de 20 anos. No se considero excluyente el uso o no de debriefing, ni el uso de simulacion junto a otras metodologias. Se realizo un analisis cualitativo. Resultados Se obtuvieron diez articulos, mayoritariamente cuasi-experimentales, en los cuales la simulacion clinica se utiliza prioritariamente de forma interprofesional para la capacitacion en manejo de conflictos clinicos, en conjunto con otras metodologias tales como role play, practica reflexiva y uso de recursos audiovisuales, lo cual sugiere aumentar su efectividad. Se han recreado situaciones como discrepancia en la toma de decisiones y manejo de errores medicos, buscando aplicar competencias de mediacion, comunicacion y habilidades emocionales, entre otras, seguidas de debriefing. La aplicacion de escalas validadas y metodos convencionales revelan un impacto positivo en la satisfaccion, percepcion y aprendizaje de los participantes, asi como en la transferencia y disminucion de errores atribuidos a la atencion. Conclusion Los estudios utilizan y apoyan el uso de la simulacion clinica para la formacion en el manejo y resolucion de conflictos en salud, siendo aceptada por los participantes, generando transferencia e impacto a nivel organizacional. Sin embargo, los estudios son limitados y recientes, siendo un campo aun en desarrollo que invita a futuras investigaciones.

Resume Le College national des enseignants d’anesthesie et de reanimation (CNEAR) reunit les 181 professionnels hospitalo-universitaires de l’anesthesie-reanimation impliques dans l’enseignement et la recherche en anesthesie, reanimation et medecine perioperatoire. Les objectifs du CNEAR pour la discipline anesthesie-reanimation & medecine peri-operatoire sont avant tout pedagogiques, a destination des etudiants du troisieme et du deuxieme cycle des etudes medicales. Le CNEAR intervient ainsi dans l’organisation, l’evaluation et la validation de l’enseignement du troisieme cycle des specialites medicales. Il realise la publication d’un referentiel actualise de connaissances a destination des etudiants du deuxieme cycle des etudes medicales. Grâce a un partenariat fort avec l’universite numerique en sante et sport (UNESS), le CNEAR assure la mise en ligne de contenus pedagogiques sur la plateforme SIDES NG, la mise en place du livret electronique de l’interne et le suivi regulier du curriculum des internes. Les membres du CNEAR participent egalement a la representation de la discipline aupres des pouvoirs publics et des tutelles au sein du Conseil national professionnel d’anesthesie-reanimation et medecine peri-operatoire (CNP-ARMPO). Pour atteindre ces objectifs, le CNEAR travaille en etroite collaboration avec la sous-section 48-01 (Anesthesie-reanimation et medecine peri-operatoire) du Conseil national des universites et la Societe francaise d’anesthesie et de reanimation (SFAR). Il est par ailleurs membre de droit du CNP-ARMPO et de la Coordination nationale des colleges d’enseignants en medecine (CNCEM) et etend ses collaborations internationales grâce a un partenariat prometteur avec UNESS-International.

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]

Telerehabilitation, or the delivery of rehabilitation using information and communication technologies, may improve timely and equitable access to rehabilitation services at home. A systematic literature review was conducted of studies that formally documented the costs and effects of home-based telerehabilitation versus in-person rehabilitation across all health conditions.Six electronic databases were searched from inception to 13 July 2021 (APA, PsycInfo, CINAHL, Embase, EmCare, Medline (Ovid), and PubMed) using a protocol developed by a medical librarian. A quality appraisal of full economic evaluation studies was conducted using the Drummond 10-point quality checklist.Thirty-five studies were included in this review covering various rehabilitation types and diverse populations. The majority were published in the last six years. Available evidence suggests that telerehabilitation may result in similar or lower costs as compared to in-person rehabilitation for the health care system and for patients. However, the impact of telerehabilitation on long-term clinical outcomes and health-related quality of life remains unclear.More high quality and robust economic evaluations exploring the short- and long-term costs and other impacts of telerehabilitation on patients, caregivers, and health care systems across all types of patient populations are still required.Implications for rehabilitationHome-based telerehabilitation may reduce barriers in access to care for individuals living in the community.Economic analyses can inform health care system decision-making by evaluating the costs and effects associated with telerehabilitation.This study found that telerehabilitation may result in similar or lower costs as in-person rehabilitation; however, its impact on health-related quality of life is unclear.

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.

Objective Measuring Saudi women's subjective happiness during the present period that has brought great transformations in gender equality in KSA is essential to gather reliable information about the present situation of women in KSA. This study intends to test the validity and reliability of the ‘Subjective Happiness Scale’ Arabic version (SHS-A) when applied to Saudi working women. This study also examines the factors that affect the subjective happiness of Saudi working women. Methods This validation study was conducted among 300 Saudi working women to test the psychometric properties of the SHS-A. Validity was evaluated using principal component analysis (PCA) and confirmatory factor analysis (CFA). Multiple regression analysis was also carried out to examine the factors affecting subjective happiness. Results The PCA identified one factor that explained approximately 66.0% of the variance of the model. The CFA revealed the following findings: normed fit index = 0.982, comparative fit index = 0.990, Tucker–Lewis index = 0.971, goodness-of-fit index = 0.986, adjusted goodness-of-fit index = 0.929, and root mean square error of approximation = 0.086. The x2/df value was 2.09 (x2 = 4.189, p = .123). The Cronbach's alpha of the SHS-A in the first and second samples was 0.824 and 0.830, respectively. Employment position, working hours, and monthly salary were found to influence the subjective happiness of Saudi working women. Conclusions This study provides evidence that supports the validity and reliability of the SHS-A when used among Saudi working women. This valid and reliable tool can open further avenues and opportunities for advancing women's research agenda in KSA and other Arabic-speaking countries for economic and societal progress., Highlights • SHS-A has acceptable validity and reliability for Saudi working women. • SHS-A can be used to measure Saudi working women's subjective happiness. • SHS-A can be used for research, policymaking, and policy evaluation related to women's happiness.

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.

As empathy gains importance within academia, we propose this review as an attempt to bring clarity upon the diverse and widely debated definitions and conceptions of empathy within the medical field. In this paper, we first evaluate the limits of the Western mainstream medical culture and discuss the origins of phenomena such asdehumanizationanddetached concernas well as their impacts on patient care. We then pass on to a structured overview of the debate surrounding the notion of clinical empathy and its taxonomy in the medical setting. In particular, we present the dichotomous conception of clinical empathy that is articulated in the debate aroundcognitive empathyandaffective empathy. We thus consider the negative impacts that this categorization brings about. Finally, we advocate for a more encompassing, holistic conception of clinical empathy; one that gives value to a genuine interest in welcoming, acknowledging and responding to the emotions of those suffering. Following this line of reasoning, we advance the notion of ‘empathic concern’, a re-conceptualization of clinical empathy that finds its source in Halpern in Med Health Care Philos (2014) 17:301–311engaged curiosity. We ultimately advance Narrative Medicine as an approach to introduce, teach and promote such an attitude among medical trainees and practitioners.

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.