Smartphones as multimodal communication devices to facilitate clinical knowledge processes: randomized controlled trial

Collaboration Between Physicians from Different Medical Specialties in Hospital Settings: A Systematic Review

Health care today is characterized by an increasing number of patients with comorbidities for whom interphysician collaboration seems very important. We reviewed the literature to understand what factors affect interphysician collaboration, determine how interphysician collaboration is measured, and determine its effects. We systematically searched six major databases. Based on 63 articles, we identified five categories that influence interphysician collaboration: personal factors, professional factors, preconditions and tools, organizational elements, and contextual characteristics. We identified a diverse set of mostly unvalidated tools for measuring interphysician collaboration that focus on information being transferred and understood, frequency of interaction and tone of the relationship, and value judgements about quality or satisfaction. We found that interphysician collaboration increased clinical outcomes as well as patient and staff satisfaction, while error rates and length of stay were reduced. The results should, however, be interpreted with caution, as most of the studies provide a low level of evidence.

Knowledge, attitude and practice of people with HIV regarding a healthy lifestyle: clinical trial

ABSTRACT Objective: To evaluate the effectiveness of an educational booklet on the knowledge, attitude and practice of a healthy lifestyle in people with HIV. Methods: Randomized clinical trial with 75 intervention group patients using the booklet, and 75 control group patients undergoing usual service care. Data collection occurred in four moments, with a Survey pertaining Knowledge, Attitude and Practice. Nonparametric analysis of variance of repeated measures was used. Results: 70 participants in the intervention group and 74 in the control group completed the study. In terms of knowledge, there was no difference between groups, the booklet impact came late, increasing after reassessments. In attitudes, there was a difference between groups in the two- and four-month reassessments compared to the baseline. In practices, there was a difference in the intervention group compared to the control group at two, four, and six months compared to baseline. Conclusion: The booklet was effective in improving healthy lifestyle knowledge, attitudes, and practices in people with HIV.

Speech-Language Pathology and Audiology in South Africa: Clinical Training and Service in the Era of COVID-19

INTRODUCTION AND PURPOSE

The novel coronavirus (COVID-19) presented new and unanticipated challenges to the provision of clinical services, from student training to the care of patients with speech-language and hearing (SLH) disorders. Prompt changes in information and communication technologies (ICT), were required to ensure that clinical training continued to meet the Health Professions Council of South Africa's regulations and patients received effective clinical care. The purpose of this study was to investigate online clinical training and supervision to inform current and future training and clinical care provision in SLH professions.

METHODOLOGY

A scoping review was conducted using the Arksey and O'Malley (2005) framework. The electronic bibliographic databases Science Direct, PubMed, Scopus, MEDLINE, and ProQuest were searched to identify publications about online clinical training and supervision and their impact on clinical service during COVID-19. Selection and analysis were performed by three independent reviewers using pretested forms.

RESULTS AND CONCLUSIONS

The findings revealed important benefits of teletraining and telepractice with potential application to South African clinical training and service provision. Five themes emerged: (1) practice produces favorable outcomes, (2) appreciation for hybrid models of training and service delivery, (3) cost effectiveness is a "big win" (4) internationalization of remote clinical training and service provision, and (5) comparable modality outcomes. These findings may have significant implications for teletraining and telepractice in low-and-middle income countries (LMICs) in the COVID-19 era and beyond, wherein demand versus capacity challenges (e.g., in human resources) persist. Current findings highlight the need for SLH training programmes to foster a hybrid clinical training model. Few studies were conducted in LMICs, indicating a gap in such research.

Google Glass-Supported Cooperative Training for Health Professionals: A Case Study Based on Using Remote Desktop Virtual Support

Purpose

Observation of medical trainees’ care performance by experts can be extremely helpful for ensuring safety and providing quality care. The advanced technology of smart glasses enables health professionals to video stream their operations to remote supporters for collaboration and cooperation. This study monitored the clinical situation by using smart glasses for remote cooperative training via video streaming and clinical decision-making through simulation based on a scenario of emergency nursing care for patients with arrhythmia.

Participants and Methods

The clinical operations of bedside trainees, who is Google Glass Enterprise Edition 2(Glass EE2) wearers, were live streamed via their Google Glasses, which were viewed at a remote site by remote supporters via a desktop computer. Data were obtained from 31 nursing students using eight essay questions regarding their experience as desktop-side remote supporters.

Results

Most of the participants reported feeling uneasy about identifying clinical situations (84%), patients’ condition (72%), and trainees’ performance (69%). The current system demonstrated sufficient performance with a satisfactory level of image quality and auditory communication, while network and connectivity are areas that require further improvement. The reported barriers to identifying situations on the remote desktop were predominantly a narrow field of view and motion blur in videos captured by Glass EE2s, and using the customized mirror mode.

Conclusion

The current commercial Glass EE2 can facilitate enriched communication between remotely located supporters and trainees by sharing live videos and audio during clinical operations. Further improvement of hardware and software user interfaces will ensure better applicability of smart glasses and video streaming functions to clinical practice settings.

Developing a health education comic book: the advantages of learning the behaviours of a target audience

The objective of this study was to determine the positive and negative coping mechanisms practiced by parents of paediatric inpatients and outpatients in order to prepare a health educational comic aimed at improving these response mechanisms. Data were collected from parents visiting general paediatric outpatient clinics or hospitalisation units, at a children's hospital in a metropolitan city. Data analysis was based on 258 completed surveys received from 308 (83.77%) respondents. Each parent completed a survey that included the Brief-COPE-Coping Orientation to Problems Experienced questionnaire that encompassed 14 subscales of positive and negative coping mechanisms. Parents used both positive and negative coping mechanisms in outpatient clinics and hospitalisation units. Scores involving negative coping mechanisms were increased and associated with the severity of a child's reason for visiting a children's hospital. The lowest scores were reported by parents whose children were seen at outpatient clinics, whereas the highest scores were reported by parents whose children were treated in critical care units. Learning about parents' coping mechanisms provided key information for preparing an electronic health education comic book (electronically distributed free of charge) and can be used to teach and promote the reinforcement of positive rather than negative coping mechanisms.

Strategies to improve communication in telementoring in acute care coordination: a scoping review

Background

Telementoring facilitates the coordination of advanced medical care in rural, remote or austere environments. Because the interpersonal element of telementoring has been relatively underexplored, we conducted a scoping review to identify strategies to improve communication in telementoring.

Methods

Two independent reviewers searched all English-language articles in MEDLINE and Scopus from 1964 to 2017, as well as reference lists of relevant articles to identify articles addressing telementored interactions between health care providers. Search results were gathered in June 2017 and updated in January 2018. Identified articles were categorized by theme.

Results

We identified 144 articles, of which 56 met our inclusion criteria. Forty-one articles focused on improving dispatcher-directed cardiopulmonary resuscitation (CPR). Major themes included the importance of language in identifying out-of-hospital cardiac arrest and how to provide instructions to enable administration of effective CPR. A standardized approach with scripted questions was associated with improved detection of out-of-hospital cardiac arrest, and a concise script was associated with improved CPR quality compared to no mentoring, unscripted mentoring or more complex instructions. Six articles focused on physician-physician consultation. Use of a handover tool that highlighted critical information outperformed an unstructured approach regarding transmission of vital information. Nine articles examined telementoring in trauma resuscitation. A common theme was the need to establish an understanding between mentor and provider regarding the limitations of the provider and his or her environment.

Conclusion

The available data suggest that standardization coupled with short, concise validated scripts could improve efficacy, safety and engagement. Improvements will require multidisciplinary input, practice and deliberate efforts to address barriers.

Social Cognitive Theories and Electronic Health Design: Scoping Review

Background

There are several social cognitive theories (SCTs) and models that support platform design in electronic health (eHealth) promotion trials. The rationale for this scoping review was to determine how social design features (informational aid, expressive support, gaming, and tailored content) are used to promote self-efficacy, engagement, knowledge, and behavior change.

Objective

This study aimed to review a broad spectrum of digital health interventions in the literature seeking trials that use SCTs for the design of eHealth applications.

Methods

The author conducted a systematic scoping review of 161 Web-based health interventions from published randomized clinical trials using 1 or more tools to address the social cognitive determinants in their website design from January 2006 to April 2016. An iterative approach was used in the selection of studies and data extraction. The studies were analyzed for quality and coded for type of social design features employed.

Results

Expressive interaction tools were found in 48.6% (54/111) of studies categorized as a strong recommendation by the Joanna Briggs Institute criteria. Overall, less than half of the studies addressed participant social support and motivational needs (43.8%). The vast majority of studies (100%) relied on the use of the Web for delivery of informational aid and tailored content for the individual participant (75.9%).

Conclusions

This review fills a research gap by linking social theory to Web strategy to improve the impact and sustainability of eHealth interventions. A Digital Health Intervention Model was developed to provide a framework to enhance future Web-based health intervention design and execution.

Use of Smartphone-Based Head-Mounted Display Devices to View a Three-Dimensional Dissection Model in a Virtual Reality Environment: Pilot Questionnaire Study

BACKGROUND

Virtual reality (VR) technology has started to gain attention as a form of surgical support in medical settings. Likewise, the widespread use of smartphones has resulted in the development of various medical applications; for example, Google Cardboard, which can be used to build simple head-mounted displays (HMDs). However, because of the absence of observed and reported outcomes of the use of three-dimensional (3D) organ models in relevant environments, we have yet to determine the effects of or issues with the use of such VR technology.

OBJECTIVE

The aim of this paper was to study the issues that arise while observing a 3D model of an organ that is created based on an actual surgical case through the use of a smartphone-based simple HMD. Upon completion, we evaluated and gathered feedback on the performance and usability of the simple observation environment we had created.

METHODS

We downloaded our data to a smartphone (Galaxy S6; Samsung, Seoul, Korea) and created a simple HMD system using Google Cardboard (Google). A total of 17 medical students performed 2 experiments: an observation conducted by a single observer and another one carried out by multiple observers using a simple HMD. Afterward, they assessed the results by responding to a questionnaire survey.

RESULTS

We received a largely favorable response in the evaluation of the dissection model, but also a low score because of visually induced motion sickness and eye fatigue. In an introspective report on simultaneous observations made by multiple observers, positive opinions indicated clear image quality and shared understanding, but displeasure caused by visually induced motion sickness, eye fatigue, and hardware problems was also expressed.

CONCLUSIONS

We established a simple system that enables multiple persons to observe a 3D model. Although the observation conducted by multiple observers was successful, problems likely arose because of poor smartphone performance. Therefore, smartphone performance improvement may be a key factor in establishing a low-cost and user-friendly 3D observation environment.

The educational effects of mobile learning on students of medical sciences: A systematic review in experimental studies

INTRODUCTION

The demand for mobile learning in the medical science educational program is increasing. The present review study gathers evidence highlighted by the experimental studies on the educational effects of mobile learning for medical science students.

METHODS

The study was carried out as a systematic literature search published from 2007 to July 2017 in the databases PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Knowledge (Thomson Reuters) , Educational Resources and Information Center (ERIC), EMBASE (Elsevier), Cochrane library, PsycINFO and Google Scholar. To examine quality of the articles, a tool validated by the BEME Review was employed.

RESULTS

Totally, 21 papers entered the study. Three main themes emerged from the content of papers: (1) improvement in student clinical competency and confidence, (2) acquisition and enhancing of students' theoretical knowledge, and (3) students' positive attitudes to and perception of mobile learning. Level 2B of Kirkpatrick hierarchy had been examined by all the papers and seven of them had reported two or more outcome levels, but level 4 was not reported in the papers.

CONCLUSION

Our review showed that the students of medical sciences had positive response and attitudes to mobile learning. Moreover, implementation of mobile learning in medical sciences program might lead to valuable educational benefits and improve clinical competence and confidence along with theoretical knowledge, attitudes, and perception of mobile learning. The results indicated that mobile learning strategy in medical education can positively affect learning in all three domains of Bloom's Taxonomy.

Mobile Endoscopy vs Video Tower

Objective

To determine if any significant difference exists between endoscopic videos captured with a mobile adaptor and videos captured with a traditional tower.

Study Design

Prospective controlled blinded comparison of mobile endoscopic videos captured through 2 methods.

Methods

Thirty randomly selected patients underwent video endoscopy with both mobile and video tower recording methods. Sixty videos were edited into a series of 10-second clips. Thirteen otolaryngology staff and residents rated the video quality and provided a diagnosis for each video.

Results

We found no significant difference in the video quality ratings between mobile and tower videos (mean difference, −0.07; P < .37). Similarly, we found no significant difference in the observers’ diagnostic accuracy (mean difference, 1.54%; P < .686).

Conclusion

With adequate power, our study was unable to demonstrate a difference between mobile adapter videos and tower videos. Our findings suggest that mobile adapter videos may reasonably be used in lieu of tower videos in clinical practice.

A balancing act: a phenomenological exploration of medical students' experiences of using mobile devices in the clinical setting

OBJECTIVE

The aims of this study were to describe the experiences of senior students using mobile devices in a clinical setting while learning and interacting with clinical teachers, patients and each other, and to identify challenges that facilitated or impeded the use of such devices in the hospital.

DESIGN

Interpretative phenomenology was chosen to guide our enquiry. Semi-structured interviews were conducted to examine the experiences of five senior medical students using mobile devices in the clinical setting.

SETTING AND PARTICIPANTS

Senior medical students at an international medical school in the Middle East.

RESULTS

Three main themes emerged from the data analysis: learning; professional identity and transitioning from student to doctor. The findings showed that using mobile devices in the clinical area as a learning tool was not a formalised process. Rather, it was opportunistic learning at the bedside and on occasion a source of distraction from clinical teaching. Students needed to negotiate relationships between themselves, the clinical teacher and patients in order to ensure that they maintained an acceptable professional image. Participants experienced and negotiated the change from student to doctor making them mindful of using their devices at the bedside.

CONCLUSIONS

Mobile devices are part of daily life for a medical student and there is a need to adapt medical education in the clinical setting, to allow the students to use their devices in a sensitive manner.

Providing specialty consultant expertise to primary care: an expanding spectrum of modalities

In most models of health care delivery, the bulk of services are provided in primary care and there is frequent request for the input of specialty consultants. A critical issue for current and future health care systems is the effective and efficient delivery of specialist expertise for clinicians and patients. Input on a patient's care from specialty consultants usually requires a face-to-face visit between the patient and the consultant. New and complementary models of knowledge sharing have emerged. We describe a framework assessment of a spectrum of knowledge-sharing methods in the context of a patient-centered medical home. This framework is based on our experience in the Veterans Health Administration and a purposive review of the literature. These newer modes of specialty consultation include electronic consultation, secure text messaging, telemedicine of various types, and population preemptive consults. In addition to describing these modes of consultation, our framework points to several important areas in which further research is needed to optimize effectiveness.