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Park KY, Kang YJ, Park HK, Hwang HS. Exploring effective video-review strategies of patient encounters for medical students: precepted review versus peer discussion. MEDICAL EDUCATION ONLINE 2024; 29:2392428. [PMID: 39154381 PMCID: PMC11332281 DOI: 10.1080/10872981.2024.2392428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Video-recordings review of patient encounters is reported to improve the clinical performance of medical students. However, evidence on specific remediation strategies or outcomes are lacking. We aimed to implement videorecording-based remediation of standardized patient encounters among medical students, combined with preceptor one-on-one feedback or peer group discussion, and evaluate the effectiveness of the two remediation methods using objective structured clinical examination (OSCE). METHODS Following standardized patient encounters, 107 final-year medical students were divided into two groups based on different remediation methods of video review: (1) precepted video review with preceptor feedback (N = 55) and (2) private video review and subsequent peer group discussion under supervision (N = 52). All students underwent twelve-stations of OSCE both before and after the video review. Students' pre- and post-remediation OSCE scores, self-efficacy level in patient encounters, and level of educational satisfaction with each method were assessed and compared between different video-based remediation methods to evaluate their respective effects. RESULTS After remediation, the total and subcomponent OSCE scores, such as history taking, physical examination, and patient - physician interaction (PPI), among all students increased significantly. Post-remediation OSCE scores showed no significant difference between two remediation methods (preceptor module, 79.6 ± 4.3 vs. peer module, 79.4 ± 3.8 in the total OSCE score). Students' self-efficacy levels increased after remediation in both modules (both p-value <0.001), with no difference between the two modules. However, students' satisfaction level was higher in the preceptor module than in the peer module (80.1 ± 17.7 vs. 59.2 ± 25.1, p-value <0.001). Among students with poor baseline OSCE performance, a prominent increase in PPI scores was observed in the preceptor-based module. CONCLUSION Video-based remediation of patient encounters, either through preceptor review with one-on-one feedback or through private review with peer discussion, was equally effective in improving the OSCE scores and self-efficacy levels of medical students. Underperforming students can benefit from precepted video reviews for building PPI.
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Affiliation(s)
- Kye-Yeung Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ye Ji Kang
- Department of Medical Education, Hanyang University College of Medicine, Seoul, Korea
| | - Hoon-Ki Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hwan-Sik Hwang
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
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Agarwal S, Jat KR, Gupta S, Sankar J, Lodha R, Kabra SK. Video-based direct observation physiotherapy in children with cystic fibrosis: a randomised controlled trial. Eur Respir J 2024; 64:2400826. [PMID: 38811042 DOI: 10.1183/13993003.00826-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Affiliation(s)
- Sheetal Agarwal
- Department of Pediatrics, Atal Bihari Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Kana Ram Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sumita Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Eastwood C, McCabe P, Heard R. Unpacking the black box of voice therapy: A clinical application and revision of the Motor Learning Classification Framework (MLCF). INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:68-82. [PMID: 35706389 DOI: 10.1080/17549507.2022.2079723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Voice therapy is a complex behavioural intervention. Understanding its components is integral for continued advancement of voice therapy research, translation of evidence into the clinical setting and improved client care. The Motor Learning Classification Framework (MLCF) offers an excellent opportunity for increasing such knowledge, specifically in relation to identifying variables that affect motor learning (ML), an important mechanism hypothesised to bring about voice change during voice therapy. The MLCF has shown promising results in identifying speech-language pathologists' (SLPs) use of ML variables during experimentally controlled voice therapy contexts. The purpose of this study was to test the feasibility of applying the framework in the clinical context of everyday voice therapy practice. METHOD Data consisted of two video-recorded voice therapy sessions representing usual voice therapy care. Classification of ML variables used by SLPs during the recorded sessions was attempted based on the MLCF. RESULT Several problematic features of the framework were identified. Based on deliberations between the authors of the current paper, the MLCF was revised using an iterative process. This resulted in the construction of an updated version of the framework (MLCF-V2). The MLCF-V2 organises ML strategies into two broad categories: directly observable behaviours and learning processes. The framework incorporates greater consideration of theory and empirical evidence supporting motivational, attentional focus and subjective error estimation influences on ML. Several examples of each ML variable are included as well as an attempt to provide clearer classification instruction. CONCLUSION It is anticipated that the MLCF-V2 will provide a more useful and reliable classification for use in future investigations of SLPs' use of ML variables during usual voice therapy practice.
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Affiliation(s)
- Clare Eastwood
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Patricia McCabe
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Robert Heard
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Tuden D, Secong D, Wainwright A. Nurse Practitioner Regulatory Assessment: Transitioning From an Onsite to a Virtual Format. Comput Inform Nurs 2023; 41:968-974. [PMID: 37580057 DOI: 10.1097/cin.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
The Nurse Practitioner Onsite Peer Review is an integral part of the British Columbia College of Nurses and Midwives Quality Assurance program. Traditionally an in-person assessment, Nurse Practitioner Onsite Peer Review involves a critical review of documentation by an experienced nurse practitioner assessor against regulatory standards and entry-level competencies. The onset of the COVID-19 pandemic and resulting environmental limitations required the college to rethink its approach to onsite reviews, resulting in the quality assurance program embarking on a pilot project to explore the feasibility of conducting reviews virtually. As there are many factors that can affect the transition of an onsite assessment to one that is virtual, it was important to consider the technical, workflow, and usability aspects in developing this new method of performance assessment. Therefore, including usability testing and a human factors approach to exploring this emerging method was vital to ensuring its success. In this article, we discuss our experience, including benefits, technical and administrative considerations, barriers, challenges, and lessons learned.
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Affiliation(s)
- Danica Tuden
- Author Affiliations: Quality Assurance (Ms Wainwright), British Columbia College of Nurses and Midwives (Mss Tuden and Secong), British Columbia College of Nurses and Midwives, Vancouver, Canada
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Fuentes-Alabí S, Carpenter K, Shea M, Vásquez L, Benitez Majano S, Maza M, Luciani S, Albanti I. Storytelling workshop to encourage stakeholder engagement with the Global Initiative for Childhood Cancer. Rev Panam Salud Publica 2023; 47:e148. [PMID: 37818485 PMCID: PMC10561658 DOI: 10.26633/rpsp.2023.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/21/2023] [Indexed: 10/12/2023] Open
Abstract
Storytelling can enhance stakeholder engagement and support the implementation of the World Health Organization and Pan American Health Organization's (PAHO) Global Initiative for Childhood Cancer, which aims to improve care globally for children with cancer. The Initiative aligns with the United Nations Sustainable Development Goals, addressing health, education, inequalities and international collaboration. This report describes the design and implementation of a workshop that used storytelling through film to encourage stakeholders in national cancer control plans to engage with the Initiative in its focal countries in Central America, the Dominican Republic and Haiti. A six-step process was used to develop the virtual workshop hosted by PAHO: (i) define the audience; (ii) define the goals of storytelling; (iii) build an appropriate storyline, including choosing a platform and content, and addressing group dynamics and the length of the film; (iv) guide the workshop's design and implementation with current theoretical frameworks, including the Socioecological Model of Health and the Theory of Change; (v) design interactive group exercises; and (vi) disseminate workshop results. The skills-building component of the day-long workshop included 80 representatives from eight countries in the Region of the Americas, with participants representing pediatric oncology, hospital administration, ministries of health, nonprofit foundations, the scientific community and public health organizations. Outputs from the workshop included (i) a summary report, (ii) an empathy word cloud with live reactions from participants, (iii) qualitative responses (i.e. quotes from participants), (iv) stakeholders' analyses and (v) a prioritization matrix for country-level strategic activities that could be undertaken to strengthen health systems when caring for children with cancer. The workshop used storytelling through film to try to reduce health inequalities and have a regional impact. Combining art, public health and medicine, the workshop created positive change by sharing real-life experiences. Commitment was fostered among stakeholders through their engagement with the workshop, which aimed to increase their awareness of the need and advocacy to improve health systems and enhance access to health care for this vulnerable population.
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Affiliation(s)
- Soad Fuentes-Alabí
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Kendall Carpenter
- Boston Children’s HospitalHarvard Medical SchoolBostonUnited States of AmericaBoston Children’s Hospital, Harvard Medical School, Boston, United States of America
| | - Meghan Shea
- Persistent ProductionsRockportUnited States of AmericaPersistent Productions, Rockport, United States of America
| | - Liliana Vásquez
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Sara Benitez Majano
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Mauricio Maza
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Silvana Luciani
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Irini Albanti
- Harvard Humanitarian InitiativeHarvard School of Public HealthBostonUnited States of AmericaHarvard Humanitarian Initiative, Harvard School of Public Health, Boston, United States of America
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Aithal S, Karkou V, Makris S, Karaminis T, Powell J. Supporting the wellbeing of caregivers of children on the autism spectrum: A qualitative report on experiences of attending group dance movement psychotherapy. PLoS One 2023; 18:e0288626. [PMID: 37540687 PMCID: PMC10403118 DOI: 10.1371/journal.pone.0288626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/02/2023] [Indexed: 08/06/2023] Open
Abstract
Caregivers of children on the autism spectrum can carry a significant amount of practical, psychological, and social demands and responsibilities that are highly stressful. A group Dance Movement Psychotherapy (DMP) was offered to facilitate the wellbeing of caregivers. In this article, we explore the experiences of the therapeutic processes and outcomes of the intervention from the perspectives of caregivers, the therapist, and the researcher/co-facilitator. METHOD Four clusters of caregivers of children on the autism spectrum (N = 20 Mean age = 39.25 years) took part in five group DMP sessions lasting 90 minutes delivered across two special educational needs settings. Twenty reflective focus groups took place in total, with each taking place at the end of each DMP session. Participants were invited to capture their experiences through arts-based drawings, while therapist and participating researcher/co-facilitator kept session-based notes and arts-based reflections. These arts-based and verbal data were grouped to generate themes. RESULTS Six overarching themes emerged from the arts-based and verbal data with multiple subthemes that describe the contribution of DMP towards promoting caregivers' wellbeing and identified key challenges in implementing the intervention. These themes are: (1) Beholding within and around; (2) Reflecting and reinforcing strengths; (3) Exchanging views; (4) Looking back and carrying forward; (5) Core benefits; and (6) Challenges to engage in DMP. CONCLUSION Caregivers talked about their experience of participating in the DMP groups as positive and acknowledged the helpful and challenging aspects of taking part in DMP intervention. They appreciated the creative and expressive nature of the intervention to promote their emotional and social wellbeing. The challenges identified in the study indicate that further awareness is needed within school environments about the contribution arts therapies can make towards establishing appropriate and sustainable interventions for caregivers.
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Affiliation(s)
- Supritha Aithal
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Vicky Karkou
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Stergios Makris
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Themis Karaminis
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Joanne Powell
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
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Fritz J, Overmeer T. Do Physical Therapists Practice a Behavioral Medicine Approach? A Comparison of Perceived and Observed Practice Behaviors. Phys Ther 2023; 103:pzad025. [PMID: 37249532 PMCID: PMC10228382 DOI: 10.1093/ptj/pzad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/30/2022] [Accepted: 12/23/2022] [Indexed: 05/31/2023]
Abstract
OBJECTIVE A behavioral medicine approach, incorporating a biopsychosocial view and behavior change techniques, is recommended in physical therapy for the management of musculoskeletal pain. However, little is known about physical therapists' actual practice behavior regarding the behavioral medicine approach. The aim of this study was to examine how physical therapists in primary health care judge their own practice behavior of a behavioral medicine approach in the assessment and treatment of patients with persistent musculoskeletal pain versus how they practice a behavioral medicine approach as observed by independent experts in video recordings of patient consultations. METHODS A prospective cohort study was conducted. Video recordings of 23 physical therapists' clinical behavior in 139 patient consultations were observed by independent experts and compared with the physical therapists' self-reported practice behavior, using a protocol including 24 clinical behaviors. The difference between observed and self-reported clinical behaviors was analyzed with a Chi-square test and a Fisher exact test. RESULTS The behavioral medicine approach was, in general, practiced to a small extent and half of the self-reported clinical behaviors were overestimated when compared with the observed behaviors. According to the observations, the physical perspective dominated in assessment and treatment, the functional behavioral analysis was never performed, and the mean number of behavior change techniques used was 0.7. CONCLUSION There was a discrepancy between how physical therapists perceived the extent to which they practiced a behavioral medicine approach in their clinical behavior compared with what the independent researchers observed in the video recordings. IMPACT This study demonstrates the importance of using observations instead of using self-reports when evaluating professionals' clinical behavior. The results also suggest that-to ensure that physical therapy integrates the biopsychosocial model of health-physical therapists need to increase their focus on psychosocial factors in clinical practice.
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Affiliation(s)
- Johanna Fritz
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Thomas Overmeer
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Ting NI, Dang-Xuan S, Gilbert J, Nguyen NTT, Lam S, Nguyen-Viet H. A glance into traditional pig slaughtering practices in Vietnam and opportunities for zoonotic disease prevention. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2023. [DOI: 10.3389/fsufs.2023.1101282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
IntroductionAfrican swine fever in Vietnam is contributing to existing concerns over zoonotic disease transmission from sick pigs to humans. While slaughterhouses are key sites of occupational hazards to workers and contamination of meat, the specific slaughtering practices contributing to zoonotic occupational and foodborne disease risks remain under-researched. Our objective is to identify and characterize aspects of pig slaughtering processes that contribute to such risks.MethodsWe draw on qualitative observations, photos, and videos from three mobile slaughterhouses and seven abattoirs in Hung Yen, Vietnam.ResultsBased on our analysis, areas likely leading to zoonotic disease risks include slaughtering procedures, personal hygiene of workers, equipment sanitation, and facility sanitation. Within the small-scale swine industry, slaughtering practices are long-standing and difficult to change.ConclusionOur study underscores the importance of hygiene training of workers, improvements to equipment and facilities, and awareness-building activities targeting consumers to reduce the burden of zoonotic disease risks in small-scale pig slaughter settings.
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Mu J, Kang J. Dining comfort in elderly care facility dining rooms and influencing factors before and after the outbreak of the COVID-19 pandemic. Front Psychol 2023; 14:1106741. [PMID: 36935961 PMCID: PMC10022735 DOI: 10.3389/fpsyg.2023.1106741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction The COVID-19 pandemic has changed dining modes in elderly care facilities. This study explores the relationship between the dining environment of four elderly care facilities and the sensitivity of the elderly residents to it before and after the outbreak of the COVID-19 pandemic. Methods The study examined differences in subjective comfort levels by measuring the facilities' physical environment, analysing dining behavior, and surveying the elderly residents. And the study examined how the interaction between the physical environment factors, demographic factors, and dining mode affected the residents' evaluation of their dining comfort. Results (1) The physical environmental parameters of the four dining rooms differed between the pre- and post-epidemic periods, as shown by increased Sound Pressure Level (SPL), humidity, and temperature levels. (2) The residents' evaluations of physical environment comfort also changed after the outbreak of the COVID-19 pandemic. The subjective comfort levels of the 'dining with baffle' and 'dining across a seat' modes decreased, though the level of the former was slightly higher than that of the latter. The elderly had stronger SPL tolerance in the dining with baffle mode and dining across a seat mode, and their subjective comfort levels for thermal environment and air quality were higher in the dining across a seat mode. (3) When dining time, crowd density, and communication frequency were kept equal, the subjective comfort level of the elderly in the dining with baffle mode and dining across a seat mode was lower than that in the 'normal' dining mode, when the level in the dining with baffle mode was lower than that in the dining across a seat mode. (4) Differences were observed in subjective comfort levels according to age, education level, and residence duration across the dining modes. Discussion The need for changes in dining modes during the COVID-19 isolation period require dining rooms in elderly care facilities to design their physical environments in a way that improves dining comfort for the elderly.
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Affiliation(s)
- Jingyi Mu
- Key Laboratory of Cold Region Urban and Rural Human Settlement Environment Science and Technology, School of Architecture, Ministry of Industry and Information Technology, Harbin Institute of Technology, Harbin, China
| | - Jian Kang
- Institute for Environmental Design and Engineering, The Bartlett, University College London, London, United Kingdom
- *Correspondence: Jian Kang,
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The Effect of the Modified Constraint-Induced Movement Therapy on the Upper Extremity Functions of Obstetric Brachial Plexus Palsy Patients. SISLI ETFAL HASTANESI TIP BULTENI 2022; 56:525-535. [PMID: 36660395 PMCID: PMC9833333 DOI: 10.14744/semb.2022.32956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/20/2022] [Accepted: 06/21/2022] [Indexed: 01/22/2023]
Abstract
Objectives Functional limitation of the upper extremity (UE) in obstetrical brachial plexus paralysis (OBPP) restricts a child's participation in daily living and social activities. In treatment, the participation of UE in rehabilitation is important. Constraint-induced movement therapy (CIMT) is a promising rehabilitation approach that is used to improve the UE functions of patients with neurological dysfunctions. Methods This single-blinded randomized controlled clinical trial includes 30 pediatric patients diagnosed with chronic OBPP aged between 2 and 12 years. The patients were divided into two groups as a modified CIMT group and a control group. Patients in both groups underwent classical rehabilitation treatment 4 times a week for 8 weeks. Range of motion (ROM), stretching, strengthening, and proprioceptive exercises were given to both control and CIMT group. The patients in the CIMT group had to wear constraining arm slings 2 h per day and 4 days a week for 8 weeks. The patients were evaluated both before and after treatment using the Mallet classification system and the Melbourne unilateral upper limb assessment-2 (The MA2) scale. Results In both groups, the Mallet and MA2 scores significantly increased after the treatment process. However, the percentage of improvement was higher for the CIMT group. Conclusion Modified CIMT improves the joint ROM and the functional use of the extremity among OBPP-diagnosed children. This improvement is greater in the CIMT group compared to the improvement in the control group. Implementation of CIMT in a routine rehabilitation process may be helpful.
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Mwenge MM, Figge CJ, Metz K, Kane JC, Kohrt BA, Pedersen GA, Sikazwe I, Van Wyk SS, Mulemba SM, Murray LK. Improving inter-rater reliability of the enhancing assessment of common therapeutic factors (ENACT) measure through training of raters. J Public Health Afr 2022; 13:2201. [PMID: 36277943 PMCID: PMC9585605 DOI: 10.4081/jphia.2022.2201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background As evidence supports task-shifting approaches to reduce the global mental health treatment gap, counselor competency evaluation measures are critical to ensure evidence-based therapies are administered with quality and fidelity. Objective This article describes a training technique for evaluating lay counselors' competency for mental health lay practitioners without rating scale experience. Methods Mental health practitioners were trained to give the Enhancing Assessment of Common Therapeutic Factors (ENACT) test to assess counselor proficiency in delivering the Common Elements Treatment Approach (CETA) in-person and over the phone using standardized video and audio recordings. A two-day in-person training was followed by a one-day remote training session. Training includes a review of item scales through didactic instructions, active learning by witnessing and scoring role-plays, peer interactions, and trainer observation and feedback. The trainees rated video and audio recordings, and ICC values were calculated. Results The training technique presented in this research helped achieve high counselor competency scores among lay providers with no prior experience using rating scales. ICC rated both trainings satisfactory to exceptional (ICC: .71 - .89). Conclusions Raters with no past experience with rating scales can achieve high consistency when rating counselor competency through training. Effective rater training should include didactic learning, practical learning with trainer observation and feedback, and video and audio recordings to assess consistency.
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Affiliation(s)
- Mwamba M. Mwenge
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Caleb J. Figge
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Kristina Metz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Jeremy C. Kane
- Columbia University Mailman School of Public Health, New York, USA
| | - Brandon A. Kohrt
- George Washington University School of Medicine, Washington, DC, USA, Washington, USA
| | - Gloria A. Pedersen
- George Washington University School of Medicine, Washington, DC, USA, Washington, USA
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | | | - Laura K. Murray
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Moula Z, Powell J, Brocklehurst S, Karkou V. Feasibility, acceptability, and effectiveness of school-based dance movement psychotherapy for children with emotional and behavioral difficulties. Front Psychol 2022; 13:883334. [PMID: 36072049 PMCID: PMC9443698 DOI: 10.3389/fpsyg.2022.883334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSchools have been increasingly employing dance movement psychotherapists to support children cope with daily worries and stress, express and understand their emotions, develop self-awareness and self-esteem. However, evidence on the impact of dance movement psychotherapy as a tool for prevention of mental health difficulties in childhood remains limited.MethodsSixteen children (aged 7–9) with mild emotional and behavioral difficulties from two primary schools were randomly assigned to a Dance Movement Psychotherapy (DMP) intervention or to a waiting list, within a larger pilot cross-over randomized controlled study which aimed to (a) test whether all elements of study design can work together and run smoothly in a full-scale RCT; and (b) investigate the effectiveness of arts therapies in improving children’s health related quality of life (HRQOL; EQ-5D-Y), wellbeing and life functioning (Child Outcome Rating Scale; CORS), emotional and behavioral difficulties (Strengths and Difficulties Questionnaire; SDQ), and duration of sleep (Fitbits). The therapeutic process was also evaluated through interviews with children, participant observations, the Children’s Session Rating Scale (CSRS), and ratings of adherence to the therapeutic protocol.ResultsThe findings indicated that DMP led to improvements in children’s life functioning, wellbeing, duration of sleep, emotional and behavioral difficulties, but not in quality of life. The improvements were maintained at the follow-up stages, up to 6 months post-intervention. Interviews with children also suggested positive outcomes, such as self-expression; emotional regulation; mastery and acceptance of emotions; improved self-confidence and self-esteem; reduced stress; and development of positive relationships. However, children would have preferred smaller groups and longer sessions.ConclusionThis study indicated that all outcome measures would be suitable for inclusion in a larger randomized controlled trial, though the EQ-5D-Y is not recommended as a stand-alone measure due to its lack of sensitivity and specificity for young participants. The adherence to the therapeutic protocol ratings differed between children and adults, highlighting the need to include children’s voice in future research. Strategies are also proposed of how to conduct randomization of participants in ways that do not hinder the therapeutic process.
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Affiliation(s)
- Zoe Moula
- Imperial College London, London, United Kingdom
- *Correspondence: Zoe Moula,
| | - Joanne Powell
- Faculty of Health, Social Care & Medicine and Faculty of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Shirley Brocklehurst
- Faculty of Health, Social Care & Medicine and Faculty of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Vicky Karkou
- Faculty of Health, Social Care & Medicine and Faculty of Psychology, Edge Hill University, Ormskirk, United Kingdom
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Davies EH, Matthews C, Merlet A, Zimmermann M. Time to See the Difference: Video Capture for Patient-Centered Clinical Trials. THE PATIENT 2022; 15:389-397. [PMID: 34993934 PMCID: PMC8736327 DOI: 10.1007/s40271-021-00569-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 11/25/2022]
Abstract
Developing therapeutics for the treatment of rare diseases usually requires a strong understanding of the natural history of the disease. Often, it also requires the creation of novel assessment tools and clinical trial endpoints. In diseases where mobility is impacted, the use of video to capture the impact of the disease and the assessment of specific parameters, such as gait and stride length, can help design sensitive endpoints. Video as an assessment tool also allows the use of historical videos or videos filmed by non-experts outside of clinical settings. Given the increased use of telemedicine, the use of video may be a useful addition to clinical trial assessments. Two cases are presented: (1) the use of video in the development of asfotase alfa (Strensiq®) in hypophosphatasia is detailed as an example of the utility of this type of assessment in rare diseases; and (2) a home-setting video tool that was developed and validated (SARAhome) from a commonly used clinical scale (Scale for the Assessment and Rating of Ataxia [SARA]), allowing patients to record their own severity of ataxia. While there are certain limitations associated with video assessment, advancing technologies such as automated analysis and machine learning provide a tremendous opportunity for automated analysis of video recordings, reducing the bias associated with human assessment.
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Affiliation(s)
- Elin Haf Davies
- Aparito, Wrexham, Wales, UK. .,Chair at Metabolic Support UK, University College London, London, UK.
| | | | - Adeline Merlet
- Global Regulatory Affairs, AstraZeneca Rare Disease, Alexion, Zurich, Switzerland
| | - Martine Zimmermann
- Global Regulatory Affairs, AstraZeneca Rare Disease, Alexion Europe SAS, Paris, France
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14
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Understanding healthcare providers' experiences with video recording of patient consultations. Prim Health Care Res Dev 2022; 23:e35. [PMID: 35678200 PMCID: PMC9247682 DOI: 10.1017/s1463423622000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To understand healthcare providers’ experiences with video recording of patient consultations. Background: Video recordings have been recognised to be an effective method to evaluate in situ interactions in clinical practice. The video recordings are often conducted by researchers, but active involvement of healthcare providers into the process of recording is evolving. Still, little is known of how video recordings by healthcare providers may influence daily clinical practice and potentials for direct use to guide practice development. Methods: A qualitative design was used, conducting two focus group interviews including 12 healthcare providers representing eight different healthcare services who provide municipal cardiac rehabilitation. Interpretive description was used as the methodological framework, and symbolic interactionism served as the theoretical lens. Findings: Three themes were identified reflecting healthcare providers’ experiences with video recording of patient consultations: ‘Concerns of compromising primary work tasks’, ‘Exposing professional and personal skills’ and ‘A new learning dimension’. Overall, the three themes represent the process of video recording own practices attached to patient consultations and the personal investment attached to the video data. Also, how the recordings may provide new insights for practice development in terms of individual and team-based performance in patient consultations. Conclusion: Video recordings by healthcaref providers may be a useful source to provide information and learning about patient consultation practice to use in research and supervision, keeping in mind their challenges of implementation into daily clinical practice.
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Joseph A, Neyens D, Taaffe K, Bayramzadeh S, Catchpole K. Understanding "Work as Done": Using a Structured Video-Based Observational Method to Understand and Model the Role of the Physical Environment in Complex Clinical Work Systems. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:13-27. [PMID: 35403456 DOI: 10.1177/19375867221089271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the planning, development, and implementation of a structured video-based observational method that can be used to systematically examine and model the role of the physical environment within healthcare systems. BACKGROUND Direct observation methods are often used in healthcare to study complex healthcare systems. However, these observations often occur in real time, which predisposes the collected data to shortcomings such as time lags in recording of activities, overlooking events, or limiting the scope of information than can be collected. Video observation approaches eliminate many of these challenges and provide opportunities for researchers to understand and model the role of the physical environment. METHODS An approach to developing and implementing a structured video-based observational method to study and model complex health systems is presented. RESULTS A structured observational approach can be highly effective for collecting multiple layers of data necessary for understanding interactions between the physical environment and other systems components in healthcare settings. The proposed video-based observation method is effective in settings that have clearly defined environmental boundaries, limited number of people, are complex and fast-paced such as the OR, ED trauma rooms, and ICU rooms. CONCLUSIONS Video-based observation is an effective complement to the traditional observational method for in-depth study of the built environment in health systems, enabling researchers to employ quantitative approaches to data collection and analysis, in addition to qualitative interpretations.
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Affiliation(s)
- Anjali Joseph
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, Clemson, SC, USA
| | - David Neyens
- Department of Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Kevin Taaffe
- Department of Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Sara Bayramzadeh
- Health Care Design Program, Kent State University, Kent, OH, USA
| | - Ken Catchpole
- College of Medicine, Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
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- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, Clemson, SC, USA
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16
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Varpula J, Välimäki M, Lantta T, Berg J, Soininen P, Lahti M. Safety hazards in patient seclusion events in psychiatric care: A video observation study. J Psychiatr Ment Health Nurs 2022; 29:359-373. [PMID: 34536315 DOI: 10.1111/jpm.12799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Coercive measures such as seclusion are used to maintain the safety of patients and others in psychiatric care. The use of coercive measures can lead to harm among patients and staff. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is the first of its kind to rely on video observation to expose safety hazards in seclusion events that have not been reported previously in the literature. The actions that both patients and staff take during seclusion events can result in various safety hazards. IMPLICATIONS FOR PRACTICE?: Constant monitoring of patients during seclusion is important for identifying safety hazards and intervening to prevent harm. Nursing staff who use seclusion need to be aware of how their actions can contribute to safety hazards and how they can minimize their potential for harm ABSTRACT: Introduction Seclusion is used to maintain safety in psychiatric care. There is still a lack of knowledge on potential safety hazards related to seclusion practices. Aim To identify safety hazards that might jeopardize the safety of patients and staff in seclusion events in psychiatric hospital care. Method A descriptive design with non-participant video observation was used. The data consisted of 36 video recordings, analysed with inductive thematic analysis. Results Safety hazards were related to patient and staff actions. Patient actions included aggressive behaviour, precarious movements, escaping, falling, contamination and preventing visibility. Staff actions included leaving hazardous items in a seclusion room, unsafe administration of medication, unsecured use of restraints and precarious movements and postures. Discussion This is the first observational study to identify safety hazards in seclusion, which may jeopardize the safety of patients and staff. These hazards were related to the actions of patients and staff. Implications for Practice Being better aware of possible safety hazards could help prevent adverse events during patient seclusion events. It is therefore necessary that nursing staff are aware of how their actions might impact their safety and the safety of the patients. Video observation is a useful method for identifying safety hazards. However, its use requires effort to safeguard the privacy and confidentiality of those included in the videos.
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Affiliation(s)
- Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Xiangya School of Nursing, Central South University, Hunan, China
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Johanna Berg
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
| | | | - Mari Lahti
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
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17
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Bosméan L, Chaffanjon P, Bellier A. Impact of physician-patient relationship training on medical students' interpersonal skills during simulated medical consultations: a cross-sectional study. BMC MEDICAL EDUCATION 2022; 22:117. [PMID: 35193554 PMCID: PMC8862366 DOI: 10.1186/s12909-022-03171-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In medicine, the patient-centered approach is based on interpersonal skills, including communication, structuring the medical interview, and empathy, which have an impact on health professionals' interpersonal relationships and the quality of care. Training courses on this issue are therefore being developed in universities. We hypothesized that specific training courses in the physician-patient relationship could improve interpersonal skills among medical students during simulated consultations and the immediate satisfaction of standardized patients. METHODS This cross-sectional study enrolled fourth-year medical students who participated in a simulated medical consultation session with standardized patients. The evaluation of interpersonal skills was carried out using the Four Habits Coding Scheme, producing a synthetic score out of 115 points used as the primary endpoint. Some students benefited from the training courses offered by the university or by other organizations, mainly based on communication, active listening, or patient-centered approach. A comparison was made with students from the same graduating class who had not received any training. RESULTS The analysis of the primary endpoint showed a difference of 5 points between the group of students who had attended at least one training course and those who did not (p = 0.001). This difference was even more marked when the students had completed several training courses, up to 14 points higher with three training courses (p = 0.001), each with positive results in different areas of the care relationship. CONCLUSIONS Physician-patient relationship training currently provided in initial education appears to be effective in improving interpersonal skills. A repetition of this training is necessary to increase its impact.
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Affiliation(s)
- Lucie Bosméan
- Department of Family Medicine, University of Grenoble Alpes, Grenoble, France
| | | | - Alexandre Bellier
- School of Medicine, University of Grenoble Alpes, Grenoble, France.
- Clinical Epidemiology Unit, Grenoble Alpes University Hospital, CS10217, Cedex 09, 38043, Grenoble, France.
- Computational and Mathematical Biology Team, TIMC UMR 5525, CNRS, University of Grenoble Alpes, Grenoble, France.
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18
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Gray R, Faraghat S, Gow AJ. Assessing Emotional Expressions During a Cycling-Based Initiative for Older Care Home Residents Using Video-Based Recordings. Gerontol Geriatr Med 2022; 8:23337214221099689. [PMID: 35966638 PMCID: PMC9373177 DOI: 10.1177/23337214221099689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/17/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022] Open
Abstract
Objective: Through Cycling Without Age, trained volunteers use specially
designed trishaws to provide rides for older adults living in care homes and other
supported living environments. Qualitative and quantitative research suggests benefits in
terms of improvements in mood and wellbeing. Those studies have predominantly been
interviews with participants reflecting on previous rides, or as pre-/post-assessments.
The current study assessed emotional experiences using video recordings acquired during
participants’ rides. Methods: Twelve older adults (50% female; 67-92 years
old (M = 81.8, SD = 7.4)) living in care homes or supported living environments were
recruited. During a Cycling Without Age ride, participants were filmed using an action
camera mounted on the trishaw. Recordings were rated using the Facial Expression Coding
System by two researchers to assess the frequency, duration and intensity of positive and
negative emotions. Results: On average, 23.7 positive emotional expressions
were observed per ride, significantly higher than negative emotions (0.4). As well as more
frequent, positive emotions were observed over a longer duration in total (139.5 seconds
vs. 1.3) and rated as more intense (1.9 out of 5 vs. 0.3). Conclusion: The
study supported the value of directly assessing emotional responses during this
cycling-based initiative, including minimising the input required from participants. The
predominantly positive emotional expressions observed were consistent with both
qualitative and quantitative assessments of Cycling Without Age, and suggests a potential
pathway by which those benefits manifest. Future studies might adopt a triangulated
approach, using in-activity monitoring, quantitative assessments and participant
reflections.
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Affiliation(s)
- Ryan Gray
- Centre for Applied Behavioural Sciences, Department of Psychology, School of Social Sciences, Heriot-Watt University, Edinburgh, UK
| | - Shana Faraghat
- Centre for Applied Behavioural Sciences, Department of Psychology, School of Social Sciences, Heriot-Watt University, Edinburgh, UK
| | - Alan J Gow
- Centre for Applied Behavioural Sciences, Department of Psychology, School of Social Sciences, Heriot-Watt University, Edinburgh, UK
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19
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Bradwell HL, Edwards K, Shenton D, Winnington R, Thill S, Jones RB. User-Centered Design of Companion Robot Pets Involving Care Home Resident-Robot Interactions and Focus Groups With Residents, Staff, and Family: Qualitative Study. JMIR Rehabil Assist Technol 2021; 8:e30337. [PMID: 34723825 PMCID: PMC8593804 DOI: 10.2196/30337] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/04/2021] [Accepted: 09/27/2021] [Indexed: 01/30/2023] Open
Abstract
Background Globally, pressure is increasing on health and social care resources due to the aging population and growing prevalence of dementia. Companion robots, such as Paro, demonstrate strong potential for helping reduce this pressure through reported benefits including reduced agitation, depression, loneliness, care provider burden, and medication use. However, we previously identified that user-centered design of robot pets is both essential and understudied. We observed that commonly used robot pets are poorly matched to end-user requirements, and that end users and developers of robot pets differ significantly in their perception of appropriate design. This may explain some of the contradictory outcome research and variance in results for robot pets, such as Paro. Objective In response to the literature gap, we aimed to provide user-centered insights into the design of robot pets from key stakeholders to inform future robot development and the choice of robots for real-world implementation and research. We focused on understanding user requirements. Methods We conducted a qualitative study with 65 participants from 5 care homes (26 care home residents, 29 staff members. and 10 family members). Care home residents formed groups of between 3 and 4 individuals and experienced free interactions with a range of 8 companion robots and toys, including Paro and more affordable alternatives. The robots provided had a range of esthetics, shell types, interactivity levels, and designs for comparison. Care staff and family members observed the interactions. All participants then engaged in focus groups within their stakeholder category to discuss preferences and user requirements in companion robot design. Both free interactions and focus groups were video and audio recorded, transcribed, and subjected to thematic analysis. Results Care home residents, family members, and staff were open and accepting of the use of companion robot pets, with the majority suggesting that they would keep a device for themselves or the residents. The most preferred device was the Joy for All cat, followed by the Joy for All dog. In discussions, the preferred design features included familiar animal embodiment (domestic pet), soft fur, interactivity, big appealing eyes, simulated breathing, and movements. Unfamiliar devices were more often seen as toy-like and suitable for children, producing some negative responses. Conclusions This work provides important and user-centered insights into future robot designs for care home residents by means of a comprehensive comparison with key stakeholders. This work strongly supports the use of familiar embodiment in future robot pet designs, with domestic cat and dog morphologies appearing most acceptable. The results have implications for future robot designs and the selection of robot pets for both research and real-world implementations.
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Affiliation(s)
- Hannah Louise Bradwell
- Centre for Health Technology, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Katie Edwards
- Centre for Health Technology, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Deborah Shenton
- Faculty of Arts and Humanities, University of Plymouth, Plymouth, United Kingdom
| | | | - Serge Thill
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Ray B Jones
- Centre for Health Technology, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
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20
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How doctors make themselves understood in primary care consultations: A mixed methods analysis of video data applying health literacy universal precautions. PLoS One 2021; 16:e0257312. [PMID: 34547015 PMCID: PMC8454934 DOI: 10.1371/journal.pone.0257312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/30/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To mitigate the health risks that result from low health literacy and difficulty identifying patients with insufficient health literacy, health organizations recommend physicians apply health literacy universal precaution communication skills when communicating with all patients. Our aim was to assess how health literacy universal precautions are delivered in routine GP consultations, and explore whether there were differences in how GPs used universal precaution approaches according to areas of deprivation in England. METHODS This was a mixed methods study using video and interview data. Ten physicians conducted 217 consultations in primary care settings with adults over 50 years old between July 2017 and March 2018 in England. Eighty consultations (N = 80) met the inclusion criteria of new or persisting problems. Descriptive quantitative analysis of video-recorded consultations using an observation tool and qualitative thematic analysis of transcribed scripts. Meta-themes explored differences in physicians' communication by areas of deprivation. RESULTS Descriptive statistics showed physicians used a caring tone of voice and attitude (n = 73, 91.3%) and displayed comfortable body language (n = 69, 86.3%) but infrequently demonstrated profession-specific health literacy universal precaution communication skills, such as the teach-back technique (n = 3, 3.8%). Inferences about physicians' communication from qualitative analysis converged with the quantitative findings. Differences in physicians' communication varied according to areas of deprivation. CONCLUSIONS Physicians need health literacy universal precautions communication skills to improve population health.
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21
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Gidlow CJ, Ellis NJ, Cowap L, Riley V, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. Cardiovascular disease risk communication in NHS Health Checks using QRISK®2 and JBS3 risk calculators: the RICO qualitative and quantitative study. Health Technol Assess 2021; 25:1-124. [PMID: 34427556 DOI: 10.3310/hta25500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The NHS Health Check is a national cardiovascular disease prevention programme. There is a lack of evidence on how health checks are conducted, how cardiovascular disease risk is communicated to foster risk-reducing intentions or behaviour, and the impact on communication of using different cardiovascular disease risk calculators. OBJECTIVES RIsk COmmunication in Health Check (RICO) study aimed to explore practitioner and patient understanding of cardiovascular disease risk, the associated advice or treatment offered by the practitioner, and the response of the patients in health checks supported by either the QRISK®2 or the JBS3 lifetime risk calculator. DESIGN This was a qualitative study with quantitative process evaluation. SETTING Twelve general practices in the West Midlands of England, stratified on deprivation of the local area (bottom 50% vs. top 50%), and with matched pairs randomly allocated to use QRISK2 or JBS3 during health checks. PARTICIPANTS A total of 173 patients eligible for NHS Health Check and 15 practitioners. INTERVENTIONS The health check was delivered using either the QRISK2 10-year risk calculator (usual practice) or the JBS3 lifetime risk calculator, with heart age, event-free survival age and risk score manipulation (intervention). RESULTS Video-recorded health checks were analysed quantitatively (n = 173; JBS3, n = 100; QRISK2, n = 73) and qualitatively (n = 128; n = 64 per group), and video-stimulated recall interviews were undertaken with 40 patients and 15 practitioners, with 10 in-depth case studies. The duration of the health check varied (6.8-38 minutes), but most health checks were short (60% lasting < 20 minutes), with little cardiovascular disease risk discussion (average < 2 minutes). The use of JBS3 was associated with more cardiovascular disease risk discussion and fewer practitioner-dominated consultations than the use of QRISK2. Heart age and visual representations of risk, as used in JBS3, appeared to be better understood by patients than 10-year risk (QRISK2) and, as a result, the use of JBS3 was more likely to lead to discussion of risk factors and their management. Event-free survival age was not well understood by practitioners or patients. However, a lack of effective cardiovascular disease risk discussion in both groups increased the likelihood of a maladaptive coping response (i.e. no risk-reducing behaviour change). In both groups, practitioners often missed opportunities to check patient understanding and to tailor information on cardiovascular disease risk and its management during health checks, confirming apparent practitioner verbal dominance. LIMITATIONS The main limitations were under-recruitment in some general practices and the resulting imbalance between groups. CONCLUSIONS Communication of cardiovascular disease risk during health checks was brief, particularly when using QRISK2. Patient understanding of and responses to cardiovascular disease risk information were limited. Practitioners need to better engage patients in discussion of and action-planning for their cardiovascular disease risk to reduce misunderstandings. The use of heart age, visual representation of risk and risk score manipulation was generally seen to be a useful way of doing this. Future work could focus on more fundamental issues of practitioner training and time allocation within health check consultations. TRIAL REGISTRATION Current Controlled Trials ISRCTN10443908. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 50. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Christopher J Gidlow
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Naomi J Ellis
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Lisa Cowap
- Centre for Psychological Research, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Victoria Riley
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Diane Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Elizabeth Cottrell
- School of Primary, Community and Social Care, Keele University, Keele, Newcastle-under-Lyme, UK
| | - Sarah Grogan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Stoke-on-Trent, UK
| | - David Clark-Carter
- Centre for Psychological Research, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
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22
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Daniel Lai LL, Crutch SJ, West J, Harding E, Brotherhood EV, Takhar R, Firth N, Camic PM. Development of the Video Analysis Scale of Engagement (VASE) for people with advanced dementia. Wellcome Open Res 2021; 5:230. [PMID: 34368465 PMCID: PMC8311801 DOI: 10.12688/wellcomeopenres.16189.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The current study sought to develop a valid, reliable and unobtrusive tablet computer-based observational measure to assess engagement of people with advanced dementia. The Video Analysis Scale of Engagement (VASE) was designed to enable the rating of moment-by-moment changes in engagement during an activity, which would be useful for both future research and current residential care. Methods: An initial version of the VASE was tested. Face validity and content validity were assessed to validate an operational definition of engagement and develop an acceptable protocol for the scale. Thirty-seven non-professional and professional volunteers were recruited to view and rate level of engagement in music activities using the VASE. Results: An inter-class coefficient (ICC) test gave a high level of rating agreement across professionals and non-professionals. However, the ICC results of within-professionals were mixed. Linear mixed modelling suggested that the types of interventions (active or passive music listening), the particular intervention session being rated, time period of video and the age of raters could affect the ratings. Conclusions: Results suggested that raters used the VASE in a dynamic fashion and that the measure was able to distinguish between interventions. Further investigation and adjustments are warranted for this to be considered a valid and reliable scale in the measurement of engagement of people with advanced dementia in a residential care setting.
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Affiliation(s)
- L L Daniel Lai
- Clinical Psychology, Kwong Wah Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Sebastian J Crutch
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Julian West
- Open Academy, Royal Academy of Music, London, UK
| | - Emma Harding
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Emilie V Brotherhood
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Rohan Takhar
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Nicholas Firth
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Paul M Camic
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
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Daniel Lai L, Crutch SJ, West J, Harding E, Brotherhood EV, Takhar R, Firth N, Camic PM. Development of the Video Analysis Scale of Engagement (VASE) for people with advanced dementia. Wellcome Open Res 2021; 5:230. [PMID: 34368465 PMCID: PMC8311801 DOI: 10.12688/wellcomeopenres.16189.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 08/08/2023] Open
Abstract
Background: The current study sought to develop a valid, reliable and unobtrusive tablet computer-based observational measure to assess engagement of people with advanced dementia. The Video Analysis Scale of Engagement (VASE) was designed to enable the rating of moment-by-moment changes in engagement during an activity, which would be useful for both future research and current residential care. Methods: An initial version of the VASE was tested. Face validity and content validity were assessed to validate an operational definition of engagement and develop an acceptable protocol for the scale. Thirty-seven non-professional and professional volunteers were recruited to view and rate level of engagement in music activities using the VASE. Results: An inter-class coefficient (ICC) test gave a high level of rating agreement across professionals and non-professionals. However, the ICC results of within-professionals were mixed. Linear mixed modelling suggested that the types of interventions (active or passive music listening), the particular intervention session being rated, time period of video and the age of raters could affect the ratings. Conclusions: Results suggested that raters used the VASE in a dynamic fashion and that the measure was able to distinguish between interventions. Further investigation and adjustments are warranted for this to be considered a valid and reliable scale in the measurement of engagement of people with advanced dementia in a residential care setting.
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Affiliation(s)
- L.L. Daniel Lai
- Clinical Psychology, Kwong Wah Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Sebastian J. Crutch
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Julian West
- Open Academy, Royal Academy of Music, London, UK
| | - Emma Harding
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Emilie V. Brotherhood
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Rohan Takhar
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Nicholas Firth
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Paul M. Camic
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
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Herbuela VRDM, Karita T, Furukawa Y, Wada Y, Yagi Y, Senba S, Onishi E, Saeki T. Integrating Behavior of Children with Profound Intellectual, Multiple, or Severe Motor Disabilities With Location and Environment Data Sensors for Independent Communication and Mobility: App Development and Pilot Testing. JMIR Rehabil Assist Technol 2021; 8:e28020. [PMID: 34096878 PMCID: PMC8218217 DOI: 10.2196/28020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/25/2021] [Accepted: 04/13/2021] [Indexed: 01/10/2023] Open
Abstract
Background Children with profound intellectual and multiple disabilities (PIMD) or severe motor and intellectual disabilities (SMID) only communicate through movements, vocalizations, body postures, muscle tensions, or facial expressions on a pre- or protosymbolic level. Yet, to the best of our knowledge, there are few systems developed to specifically aid in categorizing and interpreting behaviors of children with PIMD or SMID to facilitate independent communication and mobility. Further, environmental data such as weather variables were found to have associations with human affects and behaviors among typically developing children; however, studies involving children with neurological functioning impairments that affect communication or those who have physical and/or motor disabilities are unexpectedly scarce. Objective This paper describes the design and development of the ChildSIDE app, which collects and transmits data associated with children’s behaviors, and linked location and environment information collected from data sources (GPS, iBeacon device, ALPS Sensor, and OpenWeatherMap application programming interface [API]) to the database. The aims of this study were to measure and compare the server/API performance of the app in detecting and transmitting environment data from the data sources to the database, and to categorize the movements associated with each behavior data as the basis for future development and analyses. Methods This study utilized a cross-sectional observational design by performing multiple single-subject face-to-face and video-recorded sessions among purposively sampled child-caregiver dyads (children diagnosed with PIMD/SMID, or severe or profound intellectual disability and their primary caregivers) from September 2019 to February 2020. To measure the server/API performance of the app in detecting and transmitting data from data sources to the database, frequency distribution and percentages of 31 location and environment data parameters were computed and compared. To categorize which body parts or movements were involved in each behavior, the interrater agreement κ statistic was used. Results The study comprised 150 sessions involving 20 child-caregiver dyads. The app collected 371 individual behavior data, 327 of which had associated location and environment data from data collection sources. The analyses revealed that ChildSIDE had a server/API performance >93% in detecting and transmitting outdoor location (GPS) and environment data (ALPS sensors, OpenWeatherMap API), whereas the performance with iBeacon data was lower (82.3%). Behaviors were manifested mainly through hand (22.8%) and body movements (27.7%), and vocalizations (21.6%). Conclusions The ChildSIDE app is an effective tool in collecting the behavior data of children with PIMD/SMID. The app showed high server/API performance in detecting outdoor location and environment data from sensors and an online API to the database with a performance rate above 93%. The results of the analysis and categorization of behaviors suggest a need for a system that uses motion capture and trajectory analyses for developing machine- or deep-learning algorithms to predict the needs of children with PIMD/SMID in the future.
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Affiliation(s)
| | - Tomonori Karita
- Department of Special Needs Education, Graduate School of Education, Ehime University, Matsuyama, Ehime, Japan
| | - Yoshiya Furukawa
- Department of Special Needs Education, Graduate School of Education, Ehime University, Matsuyama, Ehime, Japan.,Graduate School of Humanities and Social Sciences, Hiroshima University, Higashihiroshima, Hiroshima, Japan
| | - Yoshinori Wada
- Department of Special Needs Education, Graduate School of Education, Ehime University, Matsuyama, Ehime, Japan
| | - Yoshihiro Yagi
- Department of Special Needs Education, Graduate School of Education, Ehime University, Matsuyama, Ehime, Japan.,Department of Contemporary Liberal Arts, Faculty of Humanities and Social Sciences, Showa Women's University, Setagaya-ku, Tokyo, Japan
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Daniel Lai L, Crutch SJ, West J, Harding E, Brotherhood EV, Takhar R, Firth N, Camic PM. Development of the Video Analysis Scale of Engagement (VASE) for people with advanced dementia. Wellcome Open Res 2021; 5:230. [DOI: 10.12688/wellcomeopenres.16189.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The current study sought to develop a valid, reliable and unobtrusive tablet computer-based observational measure to assess engagement of people with advanced dementia. The Video Analysis Scale of Engagement (VASE) was designed to enable the rating of moment-by-moment changes in engagement during an activity, which would be useful for both future research and current residential care. Methods: An initial version of the VASE was tested. Face validity and content validity were assessed to validate an operational definition of engagement and develop an acceptable protocol for the scale. Thirty-seven non-professional and professional volunteers were recruited to view and rate level of engagement in music activities using the VASE. Results: An inter-class coefficient (ICC) test gave a high level of rating agreement across professionals and non-professionals. However, the ICC results of within-professionals were mixed. Linear mixed modelling suggested that the types of interventions (active or passive music listening), the particular intervention session being rated, time period of video and the age of raters could affect the ratings. Conclusions: Results suggested that raters used the VASE in a dynamic fashion and that the measure was able to distinguish between interventions. Further investigation and adjustments are warranted for this to be considered a valid and reliable scale in the measurement of engagement of people with advanced dementia in a residential care setting.
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Boet S, Etherington N, Lam S, Lê M, Proulx L, Britton M, Kenna J, Przybylak-Brouillard A, Grimshaw J, Grantcharov T, Singh S. Implementation of the Operating Room Black Box Research Program at the Ottawa Hospital Through Patient, Clinical, and Organizational Engagement: Case Study. J Med Internet Res 2021; 23:e15443. [PMID: 33724199 PMCID: PMC8074833 DOI: 10.2196/15443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 12/11/2019] [Accepted: 02/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background A large proportion of surgical patient harm is preventable; yet, our ability to systematically learn from these incidents and improve clinical practice remains limited. The Operating Room Black Box was developed to address the need for comprehensive assessments of clinical performance in the operating room. It captures synchronized audio, video, patient, and environmental clinical data in real time, which are subsequently analyzed by a combination of expert raters and software-based algorithms. Despite its significant potential to facilitate research and practice improvement, there are many potential implementation challenges at the institutional, clinician, and patient level. This paper summarizes our approach to implementation of the Operating Room Black Box at a large academic Canadian center. Objective We aimed to contribute to the development of evidence-based best practices for implementing innovative technology in the operating room for direct observation of the clinical performance by using the case of the Operating Room Black Box. Specifically, we outline the systematic approach to the Operating Room Black Box implementation undertaken at our center. Methods Our implementation approach included seeking support from hospital leadership; building frontline support and a team of champions among patients, nurses, anesthesiologists, and surgeons; accounting for stakeholder perceptions using theory-informed qualitative interviews; engaging patients; and documenting the implementation process, including barriers and facilitators, using the consolidated framework for implementation research. Results During the 12-month implementation period, we conducted 23 stakeholder engagement activities with over 200 participants. We recruited 10 clinician champions representing nursing, anesthesia, and surgery. We formally interviewed 15 patients and 17 perioperative clinicians and identified key themes to include in an information campaign run as part of the implementation process. Two patient partners were engaged and advised on communications as well as grant and protocol development. Many anticipated and unanticipated challenges were encountered at all levels. Implementation was ultimately successful, with the Operating Room Black Box installed in August 2018, and data collection beginning shortly thereafter. Conclusions This paper represents the first step toward evidence-guided implementation of technologies for direct observation of performance for research and quality improvement in surgery. With technology increasingly being used in health care settings, the health care community should aim to optimize implementation processes in the best interest of health care professionals and patients.
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Affiliation(s)
- Sylvain Boet
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada.,Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nicole Etherington
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sandy Lam
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Maxime Lê
- Patient and Family Advisory Council, The Ottawa Hospital, Ottawa, ON, Canada
| | - Laurie Proulx
- Patient and Family Advisory Council, The Ottawa Hospital, Ottawa, ON, Canada
| | - Meghan Britton
- Main Operating Room, The Ottawa Hospital, Ottawa, ON, Canada
| | - Julie Kenna
- Main Operating Room, The Ottawa Hospital, Ottawa, ON, Canada
| | - Antoine Przybylak-Brouillard
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Teodor Grantcharov
- Department of General Surgery, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Sukhbir Singh
- Department of Obstetrics, Gynecology, and Newborn Care, University of Ottawa, Ottawa, ON, Canada
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Danielsen KG, Fougner M, Haugstad GK. Treating gynecological pain: key factors in promoting body awareness and movement in somatocognitive therapy (SCT). A case study of a physiotherapy student´s treatment approaches. Physiother Theory Pract 2021; 38:1705-1717. [PMID: 33427550 DOI: 10.1080/09593985.2021.1872125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Longstanding gynecological pain affects large numbers of women in the Western world. Somatocognitive therapy (SCT), a hybrid of cognitive psychotherapy and physiotherapy, is an evidence-based approach that has been successfully applied in the treatment of women suffering from such disorders, for example chronic pelvic pain (CPP) and provoked vestibulodynia (PVD), both demanding pain conditions. The curriculum of Oslo Metropolitan University's Mensendieck physiotherapy bachelor's program includes SCT training for the management of PVD.Purpose: The purpose of this study is to describe and explore the content of a SCT session based on a body and mind approach as performed by a physiotherapy student at a student outpatient clinic.Methods: A video-based case study of the student-patient encounter was undertaken midway through an SCT treatment course and subjected to content analysis.Findings: Three categories illustrating the learning process of body awareness, associated with the three-phase SCT were identified: 1) demystifying genital and chronic pain; 2) concentration, and body and mind experiences; and 3) patience, persistence, and willingness to change.Conclusion: The observation of the somatocognitive therapy session illustrates the value of an empathic relationship with the patient, in order to encourage her to explore body sensations and become familiar with the vulvar area. The therapy engages the patient in understanding pain mechanisms, thus educating her to overcome the fear of pain.
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Affiliation(s)
| | - Marit Fougner
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Mårtensson S, Hodges EA, Knutsson S, Hjelm C, Broström A, Swanson KM, Björk M. Caring Behavior Coding Scheme based on Swanson's Theory of Caring - development and testing among undergraduate nursing students. Scand J Caring Sci 2020; 35:1123-1133. [PMID: 33124708 PMCID: PMC9291006 DOI: 10.1111/scs.12927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/11/2020] [Indexed: 12/05/2022]
Abstract
Rationale To maintain patients’ dignity and well‐being and alleviate suffering, it is essential that healthcare providers engage in caring behaviours. Yet, every year patient boards receive an increasing number of complaints from patients and significant others regarding healthcare providers’ non‐caring behaviours. Defining and measuring both verbal and nonverbal caring and non‐caring behaviour in healthcare delivery is vital to address such complaints. However, no studies were found that incorporated a comprehensive theory of caring to code encounters between healthcare providers and patients. Aim The aim was to develop and test a Caring Behavior Coding Scheme based on Swanson’s Theory of Caring. Method An instrument development process was used for behavioural coding including observational data from thirty‐eight video recordings collected in an undergraduate nursing course at a Swedish University. The observational data involved interactions between undergraduate nursing students and a standardised patient. Result The Caring Behavior Coding Scheme (the CBCS), contains seventeen verbal and eight nonverbal behavioural codes, categorised as caring and non‐caring in accordance with Swanson’s Theory of Caring. Content and face validity were assessed. Timed‐event sequential continuous coding was performed in INTERACT software. The coder achieved excellent agreement with the developed gold standard (k = 0.87) and excellent mean inter‐rater reliability (k = 0.82). All domains in Swanson’s Theory of Caring were observed and coded in the interaction. Discussion/Conclusion The CBCS is a theory‐based instrument that contributes to research on healthcare providers’ behavioural encounters. It uses verbal and nonverbal caring and non‐caring behavioural codes to assess the alignment of both the theory and practice of caring. The CBCS can contribute to both development and measurement of interventions focused on improving healthcare providers’ caring behaviour with the intended outcome of patient well‐being.
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Affiliation(s)
- Sophie Mårtensson
- Department of Nursing Science, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,CHILD Research Group, Jönköping University, Jönköping, Sweden
| | - Eric A Hodges
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Susanne Knutsson
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Carina Hjelm
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Broström
- Department of Nursing Science, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
| | | | - Maria Björk
- Department of Nursing Science, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,CHILD Research Group, Jönköping University, Jönköping, Sweden
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Henry SG, White AEC, Magnan EM, Hood-Medland EA, Gosdin M, Kravitz RL, Torres PJ, Gerwing J. Making the most of video recorded clinical encounters: Optimizing impact and productivity through interdisciplinary teamwork. PATIENT EDUCATION AND COUNSELING 2020; 103:2178-2184. [PMID: 32576422 PMCID: PMC7508819 DOI: 10.1016/j.pec.2020.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/28/2020] [Accepted: 06/02/2020] [Indexed: 05/20/2023]
Abstract
Patient-clinician interactions are central to technical and interpersonal processes of medical care. Video recordings of these interactions provide a rich source of data and a stable record that allows for repeated viewing and analysis. Collecting video recordings requires navigating ethical and feasibility constraints; further, realizing the potential of video requires specialized research skills. Interdisciplinary collaborations involving practitioners, medical educators, and social scientists are needed to provide the clinical perspectives, methodological expertise, and capacity needed to make collecting video worthwhile. Such collaboration ensures that research questions will be based on scholarship from the social sciences, resonate with practice, and produce results that fit educational needs. However, the literature lacks suggested practices for building and sustaining interdisciplinary research collaborations involving video data. In this paper, we provide concrete advice based on our experience collecting and analyzing a single set of video-recorded clinical encounters and non-video data, which have so far yielded nine distinct studies. We present the research process, timeline, and advice based on our experience with interdisciplinary collaboration. We found that integrating disciplines and traditions required patience, compromise, and mutual respect; learning from each other enhanced our enjoyment of the process, our productivity, and the clinical relevance of our research.
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Affiliation(s)
- Stephen G Henry
- Department of Internal Medicine, University of California, Davis, Sacramento, USA; University of California Davis Center for Healthcare Policy and Research, Sacramento, USA.
| | - Anne Elizabeth Clark White
- Department of Internal Medicine, University of California, Davis, Sacramento, USA; University of California Davis Center for Healthcare Policy and Research, Sacramento, USA
| | - Elizabeth M Magnan
- University of California Davis Center for Healthcare Policy and Research, Sacramento, USA; Department of Family and Community Medicine, University of California Davis, Sacramento, USA
| | - Eve Angeline Hood-Medland
- Department of Internal Medicine, University of California, Davis, Sacramento, USA; University of California Davis Center for Healthcare Policy and Research, Sacramento, USA
| | - Melissa Gosdin
- University of California Davis Center for Healthcare Policy and Research, Sacramento, USA
| | - Richard L Kravitz
- Department of Internal Medicine, University of California, Davis, Sacramento, USA; University of California Davis Center for Healthcare Policy and Research, Sacramento, USA
| | | | - Jennifer Gerwing
- Health Services Research Unit, Akershus University Hospital, Oslo, Norway
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Gidlow CJ, Ellis NJ, Cowap L, Riley VA, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. Quantitative examination of video-recorded NHS Health Checks: comparison of the use of QRISK2 versus JBS3 cardiovascular risk calculators. BMJ Open 2020; 10:e037790. [PMID: 32978197 PMCID: PMC7520846 DOI: 10.1136/bmjopen-2020-037790] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Quantitatively examine the content of National Health Service Health Check (NHSHC), patient-practitioner communication balance and differences when using QRISK2 versus JBS3 cardiovascular disease (CVD) risk calculators. DESIGN RIsk COmmunication in NHSHC was a qualitative study with quantitative process evaluation, comparing NHSHC using QRISK2 or JBS3. We present data from the quantitative process evaluation. SETTING AND PARTICIPANTS Twelve general practices in the West Midlands (England) conducted NHSHC using JBS3 or QRISK2 (6/group). Patients were eligible for NHSHC based on national criteria (aged 40-74, no existing cardiovascular-related diagnoses, not taking statins). Recruitment was stratified by patients' age, gender and ethnicity. METHODS Video recordings of NHSHC were coded, second-by-second, to quantify who was speaking and what was being discussed. Outcomes included consultation duration, practitioner verbal dominance (ratio of practitioner:patient speaking time (pr:pt ratio)) and proportion of time discussing CVD risk, risk factors and risk management. RESULTS 173 video-recorded NHSHC were analysed (73 QRISK, 100 JBS3). The sample was 51% women, 83% white British, with approximately equal proportions across age groups. NHSHC duration varied greatly (6.8-38.0 min). Most (60%) lasted less than 20 min. On average, CVD risk was discussed for less than 2 min (9.06%±4.30% of consultation time). There were indications that, compared with NHSHC using JBS3, those with QRISK2 involved less CVD risk discussion (JBS3 M=10.24%, CI: 8.01-12.48 vs QRISK2 M=7.44%, CI: 5.29-9.58) and were more verbally dominated by practitioners (pr:pt ratio JBS3 M=3.21%, CI: 2.44-3.97 vs QRISK2=2.35%, CI: 1.89-2.81). The largest proportion of NHSHC time was spent discussing causal risk factors (M=37.54%, CI: 32.92-42.17). CONCLUSIONS There was wide variation in NHSHC duration. Many were short and practitioner-dominated, with little time discussing CVD risk. JBS3 appears to extend CVD risk discussion and patient contribution. Qualitative examination of how it is used is necessary to fully understand the potential benefits of these differences. TRIAL REGISTRATION NUMBER ISRCTN10443908.
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Affiliation(s)
| | - Naomi J Ellis
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Lisa Cowap
- Department of Psychology, Staffordshire University, Stoke on Trent, UK
| | - Victoria A Riley
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Diane Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Elizabeth Cottrell
- School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - Sarah Grogan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Stoke on Trent, UK
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Myrberg K, Hydén LC, Samuelsson C. The mini-mental state examination (MMSE) from a language perspective: an analysis of test interaction. CLINICAL LINGUISTICS & PHONETICS 2020; 34:652-670. [PMID: 31739693 DOI: 10.1080/02699206.2019.1687757] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
Assessment of language and cognitive abilities are associated with clinical challenges. The aim of the present study was to learn more about the MMSE test process from a language perspective by looking in detail at the interaction between patient and tester. In addition, we aimed to further explore the relationship between linguistic and cognitive difficulties. The study was based on an analysis of 20 MMSE test dyads, 10 persons with aphasia and 10 persons with dementia, in interaction with speech and language pathologists. All conversations were audio and video recorded and transcribed verbatim according to Conversation Analytical principles. The thorough analysis of the interactions highlighted some main findings that affected the communicative project of the test interactions. Finally, the test results were summarized and analyzed. Through the analysis, some particularly challenging aspects emerged; the understanding of the verbal instructions, the handling of the instructions and the evaluation of the answers. The test results demonstrated that there were no significant differences between the two groups of participants' MMSE results. The results in the 'language' category did not seem to capture the language disorders among many of the participants more than the remaining test items. By qualitative analyses of the interactional aspects of test situations, information about both cognitive and linguistic abilities that otherwise would have been overlooked may be revealed.
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Affiliation(s)
- Karin Myrberg
- Division of Speech Language Pathology, Audiology and Oto Rhino Laryngology, Linköping University , Linköping, Sweden
- Centre for Research and Development (CFUG), Uppsala University, County Council of Gävleborg , Gävle, Sweden
| | | | - Christina Samuelsson
- Division of Speech Language Pathology, Audiology and Oto Rhino Laryngology, Linköping University , Linköping, Sweden
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Investigating whether shared video-based consultations with patients, oncologists, and GPs can benefit patient-centred cancer care: a qualitative study. BJGP Open 2020; 4:bjgpopen20X101023. [PMID: 32238390 PMCID: PMC7330209 DOI: 10.3399/bjgpopen20x101023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background Guidelines have proposed that GPs should have a central role as coordinators of care and support patients with cancer during all stages of treatment, follow-up, and rehabilitation. Multidisciplinary video consultation involving the patient with cancer, the oncologist, and the GP may help to define roles and tasks, and this resulting clarity may enable greater support for patients with cancer. Aim To explore the consultation structure, content, and task clarification when a GP and an oncologist are attending a video consultation with a patient with cancer. Design & setting A qualitative study took place in the Region of Southern Denmark to investigate multidisciplinary video consultations, based on thematic analysis. Method Recordings of 12 video consultations were analysed using the framework method. A combined deductive and inductive approach was undertaken. The deductive themes were selected based on a consultation guide given to the doctors before the consultations. Results The study identified 15 themes, which were grouped into the following three categories: the implications of sharing a consultation; consultation structure; and health concerns. Conclusion Multidisciplinary video-based consultations with a patient and two health professionals succeeded in having a patient-centred communication style. In clarifying tasks between the GP and oncologist to support the patient, work-related issues and professional support for psychosocial challenges were always a task for the GP. Dissemination of this first-line evidence may improve acceptability among medical specialists and help assist GPs in supporting patients with cancer. However, focus on the involvement of relatives should be emphasised.
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Labeau SO. Recommendation and protocol compliance: "Yes, I do" may not be true; the complexity of measuring provider adherence. Intensive Crit Care Nurs 2020; 60:102890. [PMID: 32536513 PMCID: PMC7529399 DOI: 10.1016/j.iccn.2020.102890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 11/24/2022]
Affiliation(s)
- S O Labeau
- HOGENT University of Applied Sciences and Arts, Faculty of Education, Health and Social Work, Nursing Dept., Keramiekstraat 80, 9000 Ghent, Belgium.
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Warisse Turner J, Robinson J, Morris E, Oberkircher K, Roett M. Creating Middle Stage: Finding a New Space for Reflection within a Residency Program. HEALTH COMMUNICATION 2020; 35:548-559. [PMID: 30873866 DOI: 10.1080/10410236.2019.1573294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
While communication is essential to effective clinical outcomes, training programs that employ synchronous feedback systems are expensive and time consuming. Using a secure web blog as an asynchronous alternative for enhancing communication skills, we created a unique middle stage learning opportunity within a residency training program. Each resident was recorded interacting with a patient and that digital record was posted to a secure blog. By the end of year three, the residents (N = 6) interacted with 20 patients and wrote a blog post discussing each interaction. The other residents watched these interactions and responded to their peers' digitized interactions in the form of a blog post (N = 95). Transcripts were created and analyzed using the constant comparative method and yielded five categories of resident message types. They were: Narrative of the visit, visit issues, communication strategies, social support, and reflections on the experience and provided a unique opportunity to examine interaction among the residents.
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Affiliation(s)
- Jeanine Warisse Turner
- Communication, Culture and Technology Program, Georgetown University, Washington, DC, USA
| | - James Robinson
- Department of Communication, University of Dayton, Dayton, Ohio, USA
| | - Elise Morris
- Department of Family Medicine, Georgetown University, Washington, DC, USA
| | - Katherine Oberkircher
- Communication, Culture and Technology Program, Georgetown University, Washington, DC, USA
| | - Michelle Roett
- Department of Family Medicine, Georgetown University, Washington, DC, USA
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Quantifying Mobility in the ICU: Comparison of Electronic Health Record Documentation and Accelerometer-Based Sensors to Clinician-Annotated Video. Crit Care Explor 2020; 2:e0091. [PMID: 32426733 PMCID: PMC7188433 DOI: 10.1097/cce.0000000000000091] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. To compare the accuracy of electronic health record clinician documentation and accelerometer-based sensors with a gold standard dataset derived from clinician-annotated video to quantify early mobility activities in adult ICU patients.
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Bellier A, Chaffanjon P, Krupat E, Francois P, Labarère J. Cross-cultural adaptation of the 4-Habits Coding Scheme into French to assess physician communication skills. PLoS One 2020; 15:e0230672. [PMID: 32298278 PMCID: PMC7161987 DOI: 10.1371/journal.pone.0230672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/05/2020] [Indexed: 11/19/2022] Open
Abstract
Background The Four Habits Coding Scheme (4-HCS) is a standardized instrument designed to assess physicians’ communication skills from an external rater’s perspective, based on video-recorded consultations. Objective To perform the cross-cultural adaptation of the 4-HCS into French and to assess its psychometric properties. Methods The 4-HCS was cross-culturally adapted by conducting forward and backward translations with independent translators, following international guidelines. Four raters rated 200 video-recorded medical student consultations with standardized patients, using the French version of the 4-HCS. We examined the internal consistency, factor structure, construct validity, and reliability of the 4-HCS. Results The mean overall 4-HCS score was 76.44 (standard deviation, 12.34), with no floor or ceiling effects across subscales. The median rating duration of rating was 8 min (range, 4–19). Cronbach’s alpha was 0.94 for the overall 4-HCS, ranging from 0.72 to 0.88 across subscales. In confirmatory factor analysis, goodness-of-fit statistics did not corroborate the hypothesized 4-habit structure. Exploratory factor analysis resulted in two dimensions, with the merging of three conceptually related habits into a single dimension and substantial cross-loading for 15 out of 23 items. Median average absolute-agreement intra-class correlation coefficient estimates were 0.74 (range, 0.68–0.84) and 0.85 (range, 0.76–0.91) for inter- and intra-rater reliability of habit subscales, respectively. Conclusion The French version of the 4-HCS demonstrates satisfactory internal consistency but requires the use of two independent raters to achieve acceptable reliability. The underlying factor structure of the original US version and cross-cultural adaptations of the 4-HCS deserve further investigation.
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Affiliation(s)
- Alexandre Bellier
- Quality of Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- School of Medicine, Grenoble Alpes University, Grenoble, France
- Computational and Mathematical Biology Team, TIMC-IMAG, UMR 5525, CNRS, Grenoble Alpes University, Grenoble, France
- CIC 1406, INSERM, Grenoble Alpes University, Grenoble, France
- * E-mail:
| | | | - Edward Krupat
- Center for Evaluation, Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
| | - Patrice Francois
- Quality of Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - José Labarère
- Quality of Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- School of Medicine, Grenoble Alpes University, Grenoble, France
- Computational and Mathematical Biology Team, TIMC-IMAG, UMR 5525, CNRS, Grenoble Alpes University, Grenoble, France
- CIC 1406, INSERM, Grenoble Alpes University, Grenoble, France
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Choudhury A, Crotty B, Asan O. Comparing the Impact of Double and Single Screen Electronic Health Records on Doctor-Patient Non-Verbal Communication. IISE Trans Occup Ergon Hum Factors 2020. [DOI: 10.1080/24725838.2020.1742251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Avishek Choudhury
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Bradley Crotty
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, USA
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Understanding General Practitioners' Antibiotic Prescribing Decisions in Out-of-Hours Primary Care: A Video-Elicitation Interview Study. Antibiotics (Basel) 2020; 9:antibiotics9030115. [PMID: 32156082 PMCID: PMC7148451 DOI: 10.3390/antibiotics9030115] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 11/16/2022] Open
Abstract
Infections are the most common reason why patients consult out-of-hours (OOH) primary care. Too often there is an overprescribing of antibiotics for self-limiting infections and general practitioners (GPs) do not always choose the guideline recommended antibiotics. To improve antibiotic prescribing quality, a better understanding is needed of the (non) antibiotic prescribing decisions of GPs. This study sets out to unravel GPs’ (non) antibiotic prescribing decisions in OOH primary care. We video-recorded 160 consultations on infections during OOH primary care by 21 GPs and performed video-elicitation interviews with each GP. GPs reflected on their decision-making process and communication while watching their consultation. A qualitative thematic analysis was used. GPs found that their (non) antibiotic prescribing decision-making was not only based on objective arguments, but also subconsciously influenced by their own interpretation of information. Often GPs made assumptions (about for example the patients’ reason for encounter or expectations for antibiotics) without objectifying or verifying this with the patient. From the beginning of the consultation GPs follow a dichotomous thinking process: urgent versus not urgent, viral versus bacterial, antibiotics versus no antibiotics. Safety-netting is an important but difficult tool in the OOH care context, with no long-term follow-up or relationship with the patient. GPs talk about strategies they use to talk about diagnostic uncertainty, what patients can expect or should do when things do not improve and the difficulties they encounter while doing this. This video- elicitation interview study provides actionable insights in GPs’ (non) antibiotic prescribing decisions during OOH consultations on infections.
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Dohms MC, Collares CF, Tibério IC. Video-based feedback using real consultations for a formative assessment in communication skills. BMC MEDICAL EDUCATION 2020; 20:57. [PMID: 32093719 PMCID: PMC7041283 DOI: 10.1186/s12909-020-1955-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 01/30/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Pre-recorded videotapes have become the standard approach when teaching clinical communication skills (CCS). Furthermore, video-based feedback (VF) has proven to be beneficial in formative assessments. However, VF in CCS with the use of pre-recorded videos from real-life settings is less commonly studied than the use of simulated patients. To explore: 1) perceptions about the potential benefits and challenges in this kind of VF; 2) differences in the CCC scores in first-year medical residents in primary care, before and after a communication program using VF in a curricular formative assessment. METHOD We conducted a pre/post study with a control group. The intervention consisted of VF sessions regarding CCS, performed in a small group with peers and a facilitator. They reviewed clinical consultations pre-recorded in a primary care setting with real patients. Before and after the intervention, 54 medical residents performed two clinical examinations with simulated patients (SP), answered quantitative scales (Perception of Patient-Centeredness and Jefferson Empathy Scale), and semi-structured qualitative questionnaires. The performances were scored by SP (Perception of Patient-Centeredness and CARE scale) and by two blind raters (SPIKES protocol-based and CCOG-based scale). The quantitative data analysis employed repeated-measures ANOVA. The qualitative analysis used the Braun and Clarke framework for thematic analysis. RESULTS The quantitative analyses did not reveal any significant differences in the sum scores of the questionnaires, except for the Jefferson Empathy Scale. In the qualitative questionnaires, the main potential benefits that emerged from the thematic analysis of the VF method were self-perception, peer-feedback, patient-centered approach, and incorporation of reflective practices. A challenging aspect that emerged from facilitators was the struggle to relate the VF with theoretical references and the resident's initial stress to record and watch oneself on video. CONCLUSION VF taken from real-life settings seems to be associated with a significant increase in self-perceived empathy. The study of other quantitative outcomes related to this VF intervention needs larger sample sizes. VF with clinical patients from real healthcare settings appears to be an opportunity for a deeper level of self-assessment, peer-feedback, and reflective practices.
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Affiliation(s)
- M. C. Dohms
- Center for Development in Medical Education, University of Sao Paulo, Av Dr. Arnaldo, São Paulo, 01246-903 Brazil
| | - C. F. Collares
- Department of Educational Development and Research, School of Health Professions, Education, Maastricht University, PO Box 616, 6200MD Maastricht, The Netherlands
| | - I. C. Tibério
- Center for Development in Medical Education, University of Sao Paulo, Av Dr. Arnaldo, São Paulo, 01246-903 Brazil
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Spence N, Rodrigues NC, Nomikos PA, Yaseen KM, Alshehri MA. Inter-rater reliability of physiotherapists using the Action Research Arm Test in chronic stroke. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2020; 20:480-487. [PMID: 33265075 PMCID: PMC7716686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVES The purpose of this study is to establish whether physiotherapists' ratings are consistent, when using the Action Research Arm Test (ARAT) to score a chronic stroke patient. METHODS This was part of a large project establishing the reliability in chronic stroke. This study used a correlational design comparing the association between physiotherapist scores of the same patient, to establish the ARAT's inter-rater reliability. The COSMIN checklist was followed to enhance the methodology of the study. RESULTS Twenty physiotherapists (8 female and 12 male) aged between 25 and 53 years were selected. There were no participant dropouts or withdrawals. The sample size was normally distributed. The physiotherapists appeared representative of the UK physiotherapy population, with the exception of gender. The distribution of scores showed a normal distribution with standard deviation of score of 1.9. The Kendall's W test showed 0.711 of agreement between the raters. The scores achieved statistical significance showing consistency between physiotherapists' scores with chronic stroke. Limitations of the study were the use of a small single center convenience sample that may reduce the generalizability of the findings. CONCLUSIONS The ARAT is consistent when scored by physiotherapists in a chronic stroke population. The inter-rater reliability range was (0.70 to 0.90) which is categorized as good.
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Affiliation(s)
- Nicky Spence
- Sport, Exercise and Physiotherapy Department, School of Health Sciences, University of Salford, United Kingdom
| | - Nancy C.L. Rodrigues
- Sport, Exercise and Physiotherapy Department, School of Health Sciences, University of Salford, United Kingdom
| | - Polykarpos Angelos Nomikos
- Academic Rheumatology, School of Medicine, University of Nottingham: Nottingham, Nottinghamshire, United Kingdom
| | - Khalid Mohammed Yaseen
- Academic Rheumatology, School of Medicine, University of Nottingham: Nottingham, Nottinghamshire, United Kingdom,Physiotherapy Department, School of Rehabilitation, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mansour Abdullah Alshehri
- Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia,Corresponding author: Mansour Abdullah Alshehri, Abdiya District, Umm Al-Qura University, PO Box 715, Postal Code 21421, Mecca city, Saudi Arabia E-mail:
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Ho K, Yao C, Novak Lauscher H, Koehler BE, Shojania K, Jamal S, Collins D, Kherani R, Meneilly G, Eva K. Remote assessment via video evaluation (RAVVE): a pilot study to trial video-enabled peer feedback on clinical performance. BMC MEDICAL EDUCATION 2019; 19:466. [PMID: 31852496 PMCID: PMC6921528 DOI: 10.1186/s12909-019-1905-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/09/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Video review processes for evaluation and coaching are often incorporated into medical education as a means to accurately capture physician-patient interactions. Compared to direct observation they offer the advantage of overcoming many logistical challenges. However, the suitability and viability of using video-based peer consultations for professional development requires further investigation. This study aims to explore the acceptability and feasibility of video-based peer feedback to support professional development and quality improvement in patient care. METHODS Five rheumatologists each provided four videos of patient consultations. Peers evaluated the videos using five-point scales, providing annotations in the video recordings, and offering recommendations. The rheumatologists reviewed the videos of their own four patient interactions along with the feedback. They were asked to document if they would make practice changes based on the feedback. Focus groups were conducted and analysed to explore the effectiveness of video-based peer feedback in assisting physicians to improve clinical practice. RESULTS Participants felt the video-based feedback provided accurate and detailed information in a more convenient, less intrusive manner than direct observation. Observations made through video review enabled participants to evaluate more detailed information than a chart review alone. Participants believed that reviewing recorded consultations allowed them to reflect on their practice and gain insight into alternative communication methods. CONCLUSIONS Video-based peer feedback and self-review of clinical performance is an acceptable and pragmatic approach to support professional development and improve clinical care among peer clinicians. Further investigation into the effectiveness of this approach is needed.
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Affiliation(s)
- Kendall Ho
- Digital Emergency Medicine, Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, 818 West 10th Avenue (3rd Floor), Vancouver, BC V5Z 1M9 Canada
| | - Christopher Yao
- Digital Emergency Medicine, Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, 818 West 10th Avenue (3rd Floor), Vancouver, BC V5Z 1M9 Canada
| | - Helen Novak Lauscher
- Digital Emergency Medicine, Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, 818 West 10th Avenue (3rd Floor), Vancouver, BC V5Z 1M9 Canada
| | - Barry E. Koehler
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, 10th Floor – 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Kamran Shojania
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, 10th Floor – 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Shahin Jamal
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, 10th Floor – 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - David Collins
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, 10th Floor – 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Raheem Kherani
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, 10th Floor – 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Graydon Meneilly
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, 10th Floor – 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Kevin Eva
- Centre for Health Education Scholarship, Department of Medicine, Faculty of Medicine, University of British Columbia, P.A. Woodward Instructional Resources Centre, 429 – 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
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Edwards PJ, Ridd MJ, Sanderson E, Barnes RK. Development of a tool for coding safety-netting behaviours in primary care: a mixed-methods study using existing UK consultation recordings. Br J Gen Pract 2019; 69:e869-e877. [PMID: 31740456 PMCID: PMC6863675 DOI: 10.3399/bjgp19x706589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/02/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Safety netting is recommended in a variety of clinical settings, yet there are no tools to record clinician safety-netting communication behaviours. AIM To develop and assess the inter-rater reliability (IRR) of a coding tool designed to assess safety-netting communication behaviours in primary care consultations. DESIGN AND SETTING A mixed-methods study using an existing dataset of video-and audio-recorded UK primary care consultations. METHOD Key components that should be assessed in a coding tool were identified using the published literature and relevant guidelines. An iterative approach was utilised to continuously refine and generate new codes based on the application to real-life consultations. After the codebook had been generated, it was applied to 35 problems in 24 consultations independently by two coders. IRR scores were then calculated. RESULTS The tool allows for the identification and quantification of the key elements of safety-netting advice including: who initiates the advice and at which stage of the consultation; the number of symptoms or conditions the patient is advised to look out for; what action patients should take and how urgently; as well as capturing how patients respond to such advice plus important contextual codes such as the communication of diagnostic uncertainty, the expected time course of an illness, and any follow-up plans. The final tool had substantial levels of IRR with the mean average agreement for the final tool being 88% (κ = 0.66). CONCLUSION The authors have developed a novel tool that can reliably code the extent of clinician safety-netting communication behaviours.
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Affiliation(s)
- Peter J Edwards
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol
| | - Matthew J Ridd
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol
| | - Emily Sanderson
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol
| | - Rebecca K Barnes
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol
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Karlsson J, Eriksson T, Lindahl B, Fridh I. The Patient's Situation During Interhospital Intensive Care Unit-to-Unit Transfers: A Hermeneutical Observational Study. QUALITATIVE HEALTH RESEARCH 2019; 29:1687-1698. [PMID: 30810097 DOI: 10.1177/1049732319831664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Interhospital intensive care unit-to-unit transfers are an increasing phenomenon, earlier mainly studied from a patient safety perspective. Using data from video recordings and participant observations, the aim was to explore and interpret the observed nature of the patient's situation during interhospital intensive care unit-to-unit transfers. Data collection from eight transfers resulted in over 7 hours of video material and field notes. Using a hermeneutical approach, three themes emerged: being visible and invisible; being in a constantly changing space; and being a fettered body in constant motion. The patient's situation can be viewed as an involuntary journey, one where the patient exists in a constantly changing space drifting in and out of the health personnel's attention and where movements from the journey become part of the patient's body. Interhospital transfers of vulnerable patients emerge as a complex task, challenging the health personnel's ability to maintain a caring atmosphere around these patients.
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Fazio S, Stocking J, Kuhn B, Doroy A, Blackmon E, Young HM, Adams JY. How much do hospitalized adults move? A systematic review and meta-analysis. Appl Nurs Res 2019; 51:151189. [PMID: 31672262 DOI: 10.1016/j.apnr.2019.151189] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/22/2019] [Accepted: 09/02/2019] [Indexed: 01/04/2023]
Abstract
AIM To quantify the type and duration of physical activity performed by hospitalized adults. BACKGROUND Inactivity is pervasive among hospitalized patients and is associated with increased mortality, functional decline, and cognitive impairment. Objective measurement of activity is necessary to examine associations with clinical outcomes and quantify optimal inpatient mobility interventions. METHODS We used PRISMA guidelines to search three databases in December 2017 to retrieve original research evaluating activity type and duration among adult acute-care inpatients. We abstracted data on inpatient population, measurement method, monitoring time, activity duration, and study quality. RESULTS Thirty-eight articles were included in the review and 7 articles were included in the meta-analysis. Study populations included geriatric (n = 5), surgical (n = 5), medical (n = 12), post-stroke (n = 10), psychiatric (n = 2), and critical care inpatients (n = 4). To measure activity, 29% of studies used human observation and 71% used activity monitors. Among inpatient populations, 87-100% of time was spent sitting or lying in-bed. Among medical inpatients monitored over a continuous 24-hour period (n = 7), 70 min per day was spent standing/walking (95% CI 57-83 min). CONCLUSIONS This review provides a baseline assessment and benchmark of inpatient activity, which can be used to compare inpatient mobility practices. While there is substantial heterogeneity in how researchers measure and define how much inpatients move, there is consistent evidence that patients are mostly inactive and in-bed during hospitalization. Future research is needed to establish standardized methods to accurately and consistently measure inpatient mobility over time.
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Affiliation(s)
- Sarina Fazio
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, 2570 48th Street, CA 95817, United States of America; UC Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, United States of America; Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of California, Davis, Sacramento, 4150 V Street, Suite 3400, CA 95817, United States of America.
| | - Jacqueline Stocking
- Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of California, Davis, Sacramento, 4150 V Street, Suite 3400, CA 95817, United States of America
| | - Brooks Kuhn
- Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of California, Davis, Sacramento, 4150 V Street, Suite 3400, CA 95817, United States of America
| | - Amy Doroy
- UC Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, United States of America
| | - Emma Blackmon
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, 2570 48th Street, CA 95817, United States of America; UC Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, United States of America
| | - Heather M Young
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, 2570 48th Street, CA 95817, United States of America
| | - Jason Y Adams
- Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of California, Davis, Sacramento, 4150 V Street, Suite 3400, CA 95817, United States of America
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van Dalen ASHM, Legemaate J, Schlack WS, Legemate DA, Schijven MP. Legal perspectives on black box recording devices in the operating environment. Br J Surg 2019; 106:1433-1441. [PMID: 31112294 PMCID: PMC6790687 DOI: 10.1002/bjs.11198] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 11/17/2022]
Abstract
Background A video and medical data recorder in the operating theatre is possible, but concerns over privacy, data use and litigation have limited widespread implementation. The literature on legal considerations and challenges to overcome, and guidelines related to use of data recording in the surgical environment, are presented in this narrative review. Methods A review of PubMed and Embase databases and Cochrane Library was undertaken. International jurisprudence on the topic was searched. Practice recommendations and legal perspectives were acquired based on experience with implementation and use of a video and medical data recorder in the operating theatre. Results After removing duplicates, 116 citations were retrieved and abstracts screened; 31 articles were assessed for eligibility and 20 papers were finally included. According to the European General Data Protection Regulation and US Health Insurance Portability and Accountability Act, researchers are required to make sure that personal data collected from patients and healthcare professionals are used fairly and lawfully, for limited and specifically stated purposes, in an adequate and relevant manner, kept safe and secure, and stored for no longer than is absolutely necessary. Data collected for the sole purpose of healthcare quality improvement are not required to be added to the patient's medical record. Conclusion Transparency on the use and purpose of recorded data should be ensured to both staff and patients. The recorded video data do not need to be used as evidence in court if patient medical records are well maintained. Clear legislation on data responsibility is needed to use the medical recorder optimally for quality improvement initiatives.
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Affiliation(s)
- A S H M van Dalen
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J Legemaate
- Department of Public Health and Health Law, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - W S Schlack
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - D A Legemate
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Gidlow CJ, Ellis NJ, Cowap L, Riley V, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. A qualitative study of cardiovascular disease risk communication in NHS Health Check using different risk calculators: protocol for the RIsk COmmunication in NHS Health Check (RICO) study. BMC FAMILY PRACTICE 2019; 20:11. [PMID: 30642267 PMCID: PMC6332912 DOI: 10.1186/s12875-018-0897-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 12/26/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND NHS Health Check is a national cardiovascular disease (CVD) risk assessment programme for 40-74 year olds in England, in which practitioners should assess and communicate CVD risk, supported by appropriate risk-management advice and goal-setting. This requires effective communication, to equip patients with knowledge and intention to act. Currently, the QRISK®2 10-year CVD risk score is most common way in which CVD risk is estimated. Newer tools, such as JBS3, allow manipulation of risk factors and can demonstrate the impact of positive actions. However, the use, and relative value, of these tools within CVD risk communication is unknown. We will explore practitioner and patient CVD risk perceptions when using QRISK®2 or JBS3, the associated advice or treatment offered by the practitioner, and patients' responses. METHODS RIsk COmmunication in NHS Health Check (RICO) is a qualitative study with quantitative process evaluation. Twelve general practices in the West Midlands of England will be randomised to one of two groups: usual practice, in which practitioners use QRISK®2 to assess and communicate CVD risk; intervention, in which practitioners use JBS3. Twenty Health Checks per practice will be video-recorded (n = 240, 120 per group), with patients stratified by age, gender and ethnicity. Post-Health Check, video-stimulated recall (VSR) interviews will be conducted with 48 patients (n = 24 per group) and all practitioners (n = 12-18), using video excerpts to enhance participant recall/reflection. Patient medical record reviews will detect health-protective actions in the first 12-weeks following a Health Check (e.g., lifestyle referrals, statin prescription). Risk communication, patient response and intentions for health-protective behaviours in each group will be explored through thematic analysis of video-recorded Health Checks (using Protection Motivation Theory as a framework) and VSR interviews. Process evaluation will include between-group comparisons of quantitatively coded Health Check content and post-Health Check patient outcomes. Finally, 10 patients with the most positive intentions or behaviours will be selected for case study analysis (using all data sources). DISCUSSION This study will produce novel insights about the utility of QRISK®2 and JBS3 to promote patient and practitioner understanding and perception of CVD risk and associated implications for patient intentions with respect to health-protective behaviours (and underlying mechanisms). Recommendations for practice will be developed. TRIAL REGISTRATION ISRCTN ISRCTN10443908 . Registered 7th February 2017.
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Affiliation(s)
| | - Naomi J. Ellis
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Lisa Cowap
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Victoria Riley
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Diane Crone
- Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD UK
| | | | - Sarah Grogan
- Manchester Metropolitan University, Manchester Campus, Bonsall Street, Manchester, M15 6GX UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Smithfield One Building, Stoke-on-Trent, ST1 4FA UK
| | - David Clark-Carter
- Staffordshire University, The Science Centre, Leek Road, Stoke-on-Trent, ST4 2DF UK
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Glew S, Ford EM, Smith HE. Filmed Monologue Vignettes: a novel method for investigating how clinicians document consultations in electronic health records. Int J Popul Data Sci 2018; 3:430. [PMID: 34095518 PMCID: PMC8142957 DOI: 10.23889/ijpds.v3i1.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Introduction and Objectives The accuracy of conclusions from research based on Electronic Healthcare Records (EHRs) is highly dependent on the correct selection of descriptors (codes) by users, but few methods exist for examining quality and drivers of documentation. We aimed to evaluate the feasibility and acceptability of filmed vignette monologues as a resource-light method of assessing and comparing how different EHR users record the same clinical scenario. Methods Six short monologues portraying simulated patients presenting allergic conditions to their General Practitioners were filmed head-on then electronically distributed for the study; no researcher was present during data collection. The method was assessed by participant uptake, reported ease of completion by participants, compliance with instructions, the receipt of interpretable data by researchers, and participant perceptions of vignette quality, realism and information content. Results Twenty-two participants completed the study, reporting only minor difficulties. 132 screenshots were returned electronically, enabling analysis of codes, free text and EHR features. Participants assigned a quality rating of 7.7/10 (range 2-10) to the vignettes and rated the extent to which vignettes reflected real-life at 93% (range 86-100%). Between 1 and 2 hours were required to complete the task. Full compliance with instructions varied between participants, but was largely successful. Conclusions Filmed monologues are a reproducible, standardized method, which require relatively few resources, yet allow clear assessment of clinicians' and EHRs systems' impact on documentation. The novel nature of this method necessitates clear instructions, so participants can fully complete the study without face-to-face researcher supervision.
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Affiliation(s)
- Simon Glew
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Elizabeth M Ford
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Helen Elizabeth Smith
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.,Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technical University Singapore, Singapore
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48
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Manojlovich M, Frankel RM, Harrod M, Heshmati A, Hofer T, Umberfield E, Krein S. Formative evaluation of the video reflexive ethnography method, as applied to the physician-nurse dyad. BMJ Qual Saf 2018; 28:160-166. [PMID: 30007915 DOI: 10.1136/bmjqs-2017-007728] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/30/2018] [Accepted: 06/24/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Despite decades of research and interventions, poor communication between physicians and nurses continues to be a primary contributor to adverse events in the hospital setting and a major challenge to improving patient safety. The lack of progress suggests that it is time to consider alternative approaches with greater potential to identify and improve communication than those used to date. We conducted a formative evaluation to assess the feasibility, acceptability and utility of using video reflexive ethnography (VRE) to examine, and potentially improve, communication between nurses and physicians. METHODS We begin with a brief description of the institutional review boardapproval process and recruitment activities, then explain how we conducted the formative evaluation by describing (1) the VRE process itself; (2) our assessment of the exposure to the VRE process; and (3) challenges encountered and lessons learnt as a result of the process, along with suggestions for change. RESULTS Our formative evaluation demonstrates that it is feasible and acceptable to video-record communication between physicians and nurses during patient care rounds across many units at a large, academic medical centre. The lessons that we learnt helped to identify procedural changes for future projects. We also discuss the broader application of this methodology as a possible strategy for improving other important quality and safety practices in healthcare settings. CONCLUSIONS The VRE process did generate increased reflection in both nurse and physician participants. Moreover, VRE has utility in assessing communication and, based on the comments of our participants, can serve as an intervention to possibly improve communication, with implications for patient safety.
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Affiliation(s)
| | - Richard M Frankel
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Molly Harrod
- Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | | | - Timothy Hofer
- Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Sarah Krein
- Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Hendricks M, Nair G, Staunton C, Pather M, Garrett N, Baadjies D, Kidd M, Moodley K. Impact of an educational video as a consent tool on knowledge about cure research among patients and caregivers at HIV clinics in South Africa. J Virus Erad 2018; 4:103-107. [PMID: 29682302 PMCID: PMC5892680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite increasing access to antiretroviral therapy in low- and middle-income countries, only 54% of eligible individuals were receiving treatment in Africa by 2015. Recent developments in HIV cure research have been encouraging. However, the complex science and procedures of cure research render the informed consent process challenging. OBJECTIVE This study evaluates the impact of a video tool on educating participants about HIV cure. METHODS A questionnaire assessing the content of the video was administered to adults recruited from two clinics in South Africa. Patients and their care partners, who provided voluntary informed consent, were included in the study. The questionnaire was administered in each participant's home language before, immediately after and at 3 months after viewing the video, in an uncontrolled quasi-experimental 'one group pre-test-post-test' design. Scoring was carried out according to a predetermined scoring grid, with a maximum score of 22. RESULTS A total of 88 participants, median age 32.0 years and 86% female, were enrolled and completed the pre- and post-video questionnaires. Twenty-nine (33%) completed the follow-up questionnaire 3 months later to assess retention of knowledge. Sixty-three (72%) participants had a known HIV-positive status. A significant increase (10.1 vs 15.1, P=0.001) in knowledge about HIV and HIV cure immediately after viewing the video was noted. No statistically significant difference in knowledge between HIV-positive and -negative patients was noted at baseline. After 3 months, a decrease in performance participation (14 vs 13.5, P=0.19) was noted. However, knowledge scores achieved after 3 months remained significantly higher than scores at baseline (13.5 vs 9.5, P<0.01). CONCLUSIONS This research showed that a video intervention improved participants' knowledge related to HIV, HIV cure research and ethics, and the improvement was sustained over 3 months. Video intervention may be a useful tool to add to the consent process when dealing with complex medical research questions.
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Affiliation(s)
- Melany Hendricks
- Centre for Medical Ethics and Law, Stellenbosch University,
South Africa,Corresponding author: Melany L Hendricks,
Centre for Medical Ethics and Law (CMEL) Department of Medicine, Faculty of Medicine and Health Sciences,
Stellenbosch University,
South Africa
| | | | - Ciara Staunton
- Centre for Medical Ethics and Law, Stellenbosch University,
South Africa
| | - Michael Pather
- Division of Family Medicine and Primary Care and Department of Statistics, Stellenbosch University,
South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal,
Durban, South Africa
| | - Dianno Baadjies
- Centre for Medical Ethics and Law, Stellenbosch University,
South Africa
| | - Martin Kidd
- Department of Statistics, Stellenbosch University,
South Africa
| | - Keymanthri Moodley
- Centre for Medical Ethics and Law, Stellenbosch University,
South Africa
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50
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Dowell A, Stubbe M, Macdonald L, Tester R, Gray L, Vernall S, Kenealy T, Sheridan N, Docherty B, Hall DA, Raphael D, Dew K. A Longitudinal Study of Interactions Between Health Professionals and People With Newly Diagnosed Diabetes. Ann Fam Med 2018; 16:37-44. [PMID: 29311173 PMCID: PMC5758318 DOI: 10.1370/afm.2144] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 05/24/2017] [Accepted: 06/23/2017] [Indexed: 01/31/2023] Open
Abstract
PURPOSE We undertook a study to observe in detail the primary care interactions and communications of patients with newly diagnosed diabetes over time. In addition, we sought to identify key points in the process where miscommunication might occur. METHODS All health interactions of 32 patients with newly diagnosed type 2 diabetes were recorded and tracked as they moved through the New Zealand health care system for a period of approximately 6 months. Data included video recordings of patient interactions with the health professionals involved in their care (eg, general practitioners, nurses, dietitians). We analyzed data with ethnography and interaction analysis. RESULTS Challenges to effective communication in diabetes care were identified. Although clinicians showed high levels of technical knowledge and general communication skill, initial consultations were often driven by biomedical explanations out of context from patient experience. There was a perception of time pressure, but considerable time was spent with patients by health professionals repeating information that may not be relevant to patient need. Health professionals had little knowledge of what disciplines other than their own do and how their contributions to patient care may differ. CONCLUSIONS Despite current high skill levels of primary care professionals, opportunities exist to increase the effectiveness of communication and consultation in diabetes care. The various health professionals involved in patient care should agree on the length and focus of each consultation.
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Affiliation(s)
- Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Maria Stubbe
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Lindsay Macdonald
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Rachel Tester
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Lesley Gray
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Sue Vernall
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Tim Kenealy
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Nicolette Sheridan
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Barbara Docherty
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Devi-Ann Hall
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Deborah Raphael
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Kevin Dew
- School of Social and Cultural Studies, Victoria University of Wellington, Wellington, New Zealand
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