Experiences of young adults affected by cancer within an 8-week yoga intervention delivered by videoconference: a qualitative interview study

BACKGROUND

Yoga may reduce negative cancer- and treatment-related effects and help improve a range of outcomes, including flexibility, mindfulness, and quality of life among adults affected by cancer. Yet there is little evidence for the role of yoga among young adults (18-39 years) affected by cancer.

PURPOSE

The purpose of this study was to explore the experiences of young adults affected by cancer in an 8-week yoga intervention delivered by videoconference.

METHODS

Young adults who were diagnosed with cancer between the ages of 18 and 39 years, at any stage of the cancer trajectory, who were living in Canada, and who completed an 8-week yoga intervention were approached to complete a semi-structured interview. A social constructivist paradigm was adopted. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis.

RESULTS

Twenty-eight young adults (Mean age = 34.67 ± 5.11 years; n = 25 female) with varied cancer diagnoses participated. Participants' perspectives were represented across 6 themes: (1) I was juggling a number of challenges and changes throughout the yoga intervention; (2) I noticed some improvements in my mental and physical health; (3) I made time to discover new strategies to take care of myself; (4) I was able to see what my body is capable of; (5) I was held accountable and I appreciated that, and; (6) I was able to be around similar others in a safe (virtual) space.

CONCLUSIONS

Findings suggest that an 8-week yoga intervention may offer some benefits for young adults affected by cancer. Self-care, self-compassion, mindfulness, feelings of physical competence, establishing a routine, and being around similar others were viewed as important components of the intervention and may have contributed to the benefits experienced. Findings underscore the potential utility of yoga as a supportive care intervention for young adults affected by cancer.

Women's experiences of online antenatal education: An integrative literature review

AIM

To identify what is currently known about how women experience online antenatal education.

DESIGN

Integrative literature review.

REVIEW METHODS

This integrative review applied the five-stage methodological framework outlined by Whittemore and Knafl (2005), supporting rigour in problem identification, selection and critical appraisal of quality literature, data analysis and synthesis of findings.

DATA SOURCES

A literature search was conducted in May/June 2022, utilizing databases including OVID Embase, CINAHL, Joanna Briggs Institute EBP database, Nursing and Allied Health database, Wiley Online Library, Google scholar search engine and related reference lists. The search was limited to English language and primary research articles published in the last 10-year period (2012-2022).

RESULTS

12 articles met inclusion criteria. Three primary themes were identified: Comprehensibility: Looking back - understanding women's needs and preferences; Manageability: In the moment - flexibility versus social connection; and Meaningfulness & sustainability: Looking forward - the future of digital maternity education.

CONCLUSION

Findings identified a marked digital divide for women accessing online antenatal education, placing vulnerable women at risk of continuing inequity. E-health literacy frameworks need to be implemented to create genuine accessibility, comprehensibility and cultural responsiveness to best meet the needs of users.

IMPLICATIONS FOR THE PROFESSION AND/OR HEALTH CARE CONSUMER

As digital health is an emerging field, there is strong evidence that online antenatal education requires further evaluation to better meet the needs of pregnant women and their support people. Enhancing digital health literacy for health professionals will also promote a greater understanding for how to uphold and support the socio-technical dimensions of online service delivery.

PATIENT OR PUBLIC CONTRIBUTION

There were no patient or public contributions as part of this integrative review of the literature.

Experiences of motivational interviewing in virtual healthcare visits for adults with type 2 diabetes mellitus: A qualitative analysis

AIMS

The purpose of this qualitative study is to identify barriers minimizing the effectiveness of motivational interviewing during virtual clinic encounters for individuals with type 2 diabetes based on the Capability, Opportunity, Motivation-Behaviour (COM-B) model.

METHODS

One-on-one semi-structured interviews were conducted from March to June 2023 with 17 adults with type 2 diabetes (64.7% female, median age 69 years with age range 47-83 years) followed at St. Michael's Hospital (Toronto, Canada). Themes from transcribed interviews were identified through descriptive analysis using a grounded theory approach.

RESULTS

The following main themes were identified: 1) Face-to-face appointments strengthen provider-patient rapport and collaboration, 2) virtual encounters reduce patient accountability and hinder health-seeking behaviour, 3) individuals with physical disabilities and/or low technological proficiency experience decreased provider accessibility. Protective factors that can mitigate these negative impacts include establishing rapport during in-person appointments prior to transitioning to virtual appointments and incorporating video component during virtual encounters.

CONCLUSIONS

Several barriers of virtual appointments currently limit the effectiveness of motivational interviewing for individuals with type 2 diabetes and make it difficult to provide person-centered care, especially over telephone. However, there are protective factors that help to maintain healthy lifestyle behaviours even after transitioning to virtual settings and are areas for optimization moving forward.

Traditional versus virtual interviews: A perspective of paediatric dentistry program directors and residents

BACKGROUND

COVID-19 pandemic restrictions necessitated changes in conduct of the interview process for the selection of candidates in paediatric dentistry residency programs.

AIMS

To examine the experiences and attitudes of paediatric dentistry program directors and residents regarding the virtual interview process during the 2020/2021 application cycle.

DESIGN

A survey was sent to 82 directors and 416 postdoctoral members of the American Academy of Pediatric Dentistry with data collected from individuals interviewed during the 2020/2021 cycle.

RESULTS

Response rates for directors and residents were 27% (N = 22/82) and 17% (N = 72/416), respectively. Seventy-three percent of directors (N = 16) believed that virtual interviews were not an adequate substitute for in-person interviews and made it difficult to present facilities, observe applicant interactions, and assess personality. Fifty-nine percent of the directors (N = 13) were not interested in using virtual interviews if restrictions were lifted. Residents reported that virtual interviews were accommodating but were unable to observe interpersonal interactions, assess the location and facilities, and understand the program culture. Sixty-one percent of residents (N = 44) prefer to interview in-person.

CONCLUSION

The majority of program directors (73%) felt that virtual interviews could not substitute for in-person interviews and 59% would not be interested in using virtual interviews in the future. Residents (94%) reported inability to evaluate the location and facilities, and 61% prefer to interview in-person for future interviews.

Prepandemic Feasibility of Tele-Exercise as an Alternative Delivery Mode for an Evidence-Based, Tai Ji Quan Fall-Prevention Intervention for Older Adults

There is a critical need for fall-prevention interventions to reach medically underserved, hard-to-reach, rural older adults. The evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program reduces falls in older adults. This pre-COVID-19 pandemic study assessed the feasibility and impact of a 16-week tele-TJQMBB intervention in older adults. Instructors led six tele-TJQMBB classes via Zoom for 52 older adults (mean age ± SD 68.5 ± 7.7 years) at one academic and four community sites. Nearly all (97%) planned sessions were delivered. Average attendance was 61%. There were no adverse events. Fidelity was fair to good (mean 67%). Forty-one percent of sessions experienced technical disruptions. Participants improved their gait speed, balance, lower-extremity strength, and body mass index. Tele-TJQMBB was feasible with a positive impact on outcomes. This study was the first step toward establishing an additional delivery mode that could potentially expand TJQMBB's reach and maintenance.

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

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

Efficacy of a Virtual 3D Simulation-Based Digital Training Module for Building Dental Technology Students' Long-Term Competency in Removable Partial Denture Design: Prospective Cohort Study

Background

Removable partial denture (RPD) design is crucial to long-term success in dental treatment, but shortcomings in RPD design training and competency acquisition among dental students have persisted for decades. Digital production is increasing in prevalence in stomatology, and a digital RPD (D-RPD) module, under the framework of the certified Objective Manipulative Skill Examination of Dental Technicians (OMEDT) system reported in our previous work, may improve on existing RPD training models for students.

Objective

We aimed to determine the efficacy of a virtual 3D simulation-based progressive digital training module for RPD design compared to traditional training.

Methods

We developed a prospective cohort study including dental technology students at the Stomatology College of Chongqing Medical University. Cohort 1 received traditional RPD design training (7 wk). Cohort 2 received D-RPD module training based on text and 2D sketches (7 wk). Cohort 3 received D-RPD module pilot training based on text and 2D sketches (4 wk) and continued to receive training based on 3D virtual casts of real patients (3 wk). RPD design tests based on virtual casts were conducted at 1 month and 1 year after training. We collected RPD design scores and the time spent to perform each assessment.

Results

We collected the RPD design scores and the time spent to perform each assessment at 1 month and 1 year after training. The study recruited 109 students, including 58 (53.2%) female and 51 male (56.8%) students. Cohort 1 scored the lowest and cohort 3 scored the highest in both tests (cohorts 1-3 at 1 mo: mean score 65.8, SD 21.5; mean score 81.9, SD 6.88; and mean score 85.3, SD 8.55, respectively; P<.001; cohorts 1-3 at 1 y: mean score 60.3, SD 16.7; mean score 75.5, SD 3.90; and mean score 90.9, SD 4.3, respectively; P<.001). The difference between cohorts in the time spent was not statistically significant at 1 month (cohorts 1-3: mean 2407.8, SD 1370.3 s; mean 1835.0, SD 1329.2 s; and mean 1790.3, SD 1195.5 s, respectively; P=.06) but was statistically significant at 1 year (cohorts 1-3: mean 2049.16, SD 1099.0 s; mean 1857.33, SD 587.39 s; and mean 2524.3, SD 566.37 s, respectively; P<.001). Intracohort comparisons indicated that the differences in scores at 1 month and 1 year were not statistically significant for cohort 1 (95% CI -2.1 to 13.0; P=.16), while cohort 3 obtained significantly higher scores 1 year later (95% CI 2.5-8.7; P=.001), and cohort 2 obtained significantly lower scores 1 year later (95% CI -8.8 to -3.9; P<.001).

Conclusions

Cohort 3 obtained the highest score at both time points with retention of competency at 1 year, indicating that progressive D-RPD training including virtual 3D simulation facilitated improved competency in RPD design. The adoption of D-RPD training may benefit learning outcomes.

Conducting Virtual Interviews With Sexual Assault Survivors and Their Informal Supports During COVID-19 and Beyond

The current paper describes the author's experience conducting virtual interviews with sexual assault survivors and their informal supports (e.g., family, friend, partner) during the COVID-19 pandemic, drawing on past and present interviewing experiences with this population, and the recent literature on best practices for virtual interviewing and survivor/trauma-informed research methods. The experience of pivoting from past projects using face-to-face interview methods to doing virtual interviews with this population is presented and critically analyzed. Potential advantages and drawbacks of various methods and adaptations for doing virtual interviews in a dyadic sample of survivors and their informal supports are described to facilitate future research using virtual methods with sexual assault survivors and their informal supporters. Issues related to access (e.g., e.g., age, gender, race, ability, poverty) to interview participation are also noted as in need of more consideration. Finally, the impact on interviewers of doing this work in virtual versus face-to-face contexts is discussed.

A National Survey of Problem-Solving Court Staff Perceptions of In-Person versus Virtual Hearings

During the COVID-19 pandemic, problem-solving courts adopted virtual hearings. We conducted an online nationwide survey with a convenience sample of court staff to elicit their perceptions of court participants' attendance, engagement, willingness to talk, and ability to form connection with judges during in-person versus virtual hearings. Sign tests compared ordinal ratings for perceptions of court participant outcomes during in-person versus virtual hearing modalities, and for audiovisual technology versus audio-only technology. The final analysis included 146 staff. Staff felt that during in-person hearings judges could form closer relationships with participants, quality of information exchanged was higher, and participants were more willing to talk. Staff rated attendance as high regardless of the modality. Staff felt participant engagement was higher with audiovisual technology than audio-only technology. Our results suggest that staff have concerns about effects of virtual hearings on court participant engagement and ability to form relationships with judges. Courts should address these potential negative effects of virtual hearings. We are concerned that staff perceived participants more negatively when participants used audio-only versus audiovisual technology, because technology access could be associated with participant demographic characteristics. Further research is needed to examine court participant perceptions and outcomes.

Virtual focus groups among individuals with use disorders: assessing feasibility and acceptability in an underserved clinical population

Objective

There are substantial barriers to conducting research among individuals with stigmatized and complicated health conditions like substance use disorders. These barriers slow progress when developing, refining, and assessing interventions to better treat underserved populations. Virtual focus groups are an innovative method for collecting data from individuals via a discreet and accessible platform which can inform novel as well as existing treatment approaches. This article reports on the feasibility and acceptability of virtual focus groups as a mechanism to recruit and engage geographically and demographically diverse samples of participants with substance use disorders that are otherwise logistically difficult to assess.

Method

Participants were assessed for eligibility for a virtual focus group study based on demographic features, drug use history, and psychiatric history via a remote, interview-based screening. Focus groups were completed anonymously without video or name-sharing. Discussion contributions, quantified with number of times speaking and total number of words spoken, were compared across gender, and treatment status. Participants provided quantitative and qualitative feedback on the focus group experience in a follow-up survey.

Results

Focus groups (N=26) based in geographical areas throughout the United States were conducted with 88 individuals with opioid use disorder or stimulant use disorder. Discussion contributions were comparable between genders and among individuals in treatment versus those seeking treatment. A follow-up survey (n=50, 57% of focus group participants) reflected high levels of enjoyment, comfort, and honesty during focus group discussions.

Discussion

Findings suggest virtual focus groups can be an effective and efficient tool for substance use research.

Virtual food exposure with positive mood induction or social support to reduce food anxiety in anorexia nervosa: A feasibility study

OBJECTIVE

Aversive emotions toward food and the consequences of eating are at the core of anorexia nervosa. Exposure therapy is effective to reduce anxiety and avoidance toward feared stimuli. Based on the inhibitory learning framework, this study examined the feasibility to induce social support or positive mood to enhance the impact of a single session virtual food exposure on food-related anxiety in anorexia nervosa.

METHOD

One hundred and forty-five patients were randomized to: (1) virtual food exposure (i.e., baseline condition), (2) virtual food exposure plus positive mood induction (i.e., positive mood condition), or (3) virtual food exposure plus social support (i.e., social support condition). They completed self-report assessments of anxiety toward virtual foods, general anxiety, positive mood, social support, and hunger, before and after virtual food exposure. Number of eye gazes and touches toward foods were recorded during the virtual reality exposure.

RESULTS

Patients had lower levels of anxiety toward virtual foods in the positive mood condition, compared to the baseline condition [F(2,141)  = 4.36, p = .015; medium effect size]. They also touched food items more often in the baseline condition. No other significant changes were found.

DISCUSSION

Virtual food exposure enhanced by positive mood induction seems a feasible approach to strengthen the impact of food exposure in anorexia nervosa.

PUBLIC SIGNIFICANCE

This research contributes to the understanding of how patients with anorexia nervosa can be supported to overcome fear and anxiety around food. Virtual reality enables patients to expose themselves to difficult situations (e.g., kitchen with foods of various calorie contents) while experiencing positive stimuli, such as a loving and kind pet or a supportive avatar.

Acceptability, feasibility and preliminary effects of an online group psychotherapy intervention for adolescents and young adults with cancer

BACKGROUND

Adolescents and young adults (AYAs; ages 15-29 years) diagnosed with cancer are increasingly recognized as an oncology population with distinct psychosocial needs. However, few specialized psychosocial interventions for AYAs currently exist. This study reports on the development of a novel group-based psychotherapy intervention to address the psychosocial needs of AYAs. The objective was to evaluate the acceptability, feasibility, and preliminary effects of the intervention.

METHODS

The manualized group psychotherapy program is delivered virtually over an 8-week period by registered psychologists. Four groups (n = 5-11 AYAs per group) with a total of N = 33 participants (Mage = 20.97 years, SD = 3.68, range = 15-29 years, 76% women) were conducted. Recruitment and retention data assessed intervention feasibility. Patient-reported psychosocial outcomes were measured at baseline and immediately following the intervention to assess preliminary effects. Acceptability was assessed following the intervention using a self-report measure of participant satisfaction.

RESULTS

Overall, the completion rate of the intervention was 85% (n = 28). All participants "strongly agreed" (88%) or "agreed" (13%) that they were satisfied with the group. Meeting, sharing experiences, and expressing feelings with other AYAs were identified as the most helpful aspects. Participants reported significant improvements in emotional (p < 0.05) and functional (p < 0.01) quality of life from baseline to immediately post-intervention with medium effect sizes (d = 0.58-0.70).

CONCLUSIONS

Findings suggest that the intervention is feasible, acceptable, and shows promise for improving psychosocial outcomes for AYAs. Further research will refine the intervention and establish efficacy in a randomized trial.

A Qualitative Analysis of Low-Income Pregnant and Parenting Caregivers' Experiences With Home Visiting in California During the First 2 Years of the COVID-19 Pandemic

CONTEXT

In-person home visiting programs that provide evidence-based parenting and child development support improve outcomes for low-income children and families. The COVID-19 pandemic led to a shift from primarily in-person to virtual home visiting services, and little is known about clients' experience of home visiting in this context.

OBJECTIVE

To describe the experience of clients in the California Work Opportunity and Responsibility to Kids (CalWORKs) Home Visiting Program (HVP) across California during the first 2 years of the pandemic.

DESIGN

Three repeated cross-sectional surveys over a 2-year period. Clients' free-text responses to open-ended questions were analyzed using a directed content analysis approach.

SETTING

Forty-one counties in California.

PARTICIPANTS

Current CalWORKs HVP clients and those who left the program in the 6 months prior to each survey.

MAIN OUTCOME MEASURES

Clients' experience of the CalWORKs HVP.

RESULTS

Five main themes emerged: (1) benefits received from the program; (2) life challenges; (3) COVID-19-related or other program changes; (4) client dissatisfaction and suggestions for improvement; and (5) appreciation for the program. Clients valued the practical, financial, parenting, and interpersonal support provided to themselves and their children. Almost three-quarters commented on life challenges experienced during the program. Significant programmatic changes related to COVID-19 pandemic public health safety and organizational constraints impacted clients both positively and negatively. Very few clients experienced overt dissatisfaction with the program. Many clients expressed appreciation for the program, particularly the individualized and relational support offered by a consistent home visitor.

CONCLUSIONS

The findings provide insights into the benefits and challenges experienced by clients receiving evidence-based home visiting services. The findings highlight the ongoing life challenges faced by clients who experience poverty, and how those challenges were exacerbated by a global pandemic. The CalWORKs HVP may buffer the substantial personal stresses clients experience related to parenting in the context of poverty and major public health challenges.

Virtual Motivational Interviewing (VIMINT) to support physical activity: Experiences of older adults and counsellors

The aim of this study was to explore the experiences of older adults and counsellors involved in virtual motivational interviewing (MI). This study was part of the Virtual Motivational INTerviewing (VIMINT) feasibility trial of virtual MI for physical activity in older adults. A descriptive qualitative design utilized content analysis. Seven older adults and three counsellors were interviewed. Four categories were developed: (i) Benefits and limitations of using technology (ii) Relationships between older adults and counsellors (iii) MI skills and spirit and (iv) Effects of virtual MI. Older adults and counsellors reported that receiving/delivering MI virtually was convenient and flexible. They described reduced non-verbal communication in virtual MI. Virtual MI facilitates interpersonal relationships, and counsellors reported that MI skills and spirit can be applied virtually. This study showed that virtual MI offers potential benefits with some limitations. The findings could inform future research involving virtual delivery of MI.

Factors Influencing Music Therapists' Retention of Clinical Hours with Autistic Clients over Telehealth During the COVID-19 Pandemic

The 2019 coronavirus disease pandemic influenced music therapists to migrate services to online platforms, though some lost clinical hours during the pandemic when telehealth was not a viable option. This survey study aimed to ascertain factors that helped music-based therapists to continue serving autistic clients over telehealth during the pandemic. We surveyed 193 accredited music therapists located mainly in Canada and the US. In addition to gathering data on general perceptions of telehealth music therapy and Neurologic Music Therapy (NMT), one-way ANOVAs were applied to determine differences in percent-change loss of clinical hours for music therapists: (1) working in different employment settings; (2) serving children, youth, adults, or a mixture of ages; and (3) practicing NMT or not. The general perception of telehealth music therapy was positive, and NMTs believed that the clear protocols and transformation design model were helpful to them in adapting services to telehealth. There were no significant differences in percent-change of clinical hours among music therapists in different employment settings or serving different client age groups. Music therapists who said they practiced within the NMT treatment model lost a significantly lower percentage of clinical hours with autistic clients than those who did not practice NMT. Possible reasons for this result and the need for further research are discussed.

Extended Reality-New Opportunity for People With Disability? Practical and Ethical Considerations

Since the introduction of virtual environments in the 70s, technologies have moved through virtual reality, mixed reality, and augmented reality into extended reality (XR). This development is promising for various groups. Previous research has shown people with disability benefiting from using technology in social and professional settings. Technology has offered people with disability the opportunity to communicate, interact, participate, and build new relationships. However, we do not know what impact XR has or will have and whether it will offer new opportunities for people with disability. This paper aims to indicate potential opportunities and challenges afforded by XR to people with disability. We offer reflections on the opportunities as well as the ethical considerations needed when introducing immersive technologies to a marginalized group.

Comparing Online and In-Person Delivery of a Fall Prevention Exercise Program for Older Adults

Exercise is the single most effective strategy to reduce the risk of falls. Online classes have grown in popularity, but the benefits of online classes remain unknown. Zoomers on the Go is a peer-led 12-week exercise program offered twice weekly to adults 50+ years old. The main outcome was lower body strength measured by the 30-s chair stand test. Other outcomes included dropout, attendance, balance, cardiorespiratory fitness, and perceived health. A total of 74 participants (age 66.3 ± 7.1 years) in the online group and 84 participants in the in-person group (age 67.3 ± 7.2 years) completed the program, with attendance for the online group. Both groups significantly improved their 30-s chair stand, cardiorespiratory fitness, and balance (p < .001) with no difference in functional benefits between groups. The in-person group improved their perceived health and significantly reduced levels of stress and depression, while no such changes were observed in the online group.

Virtual group psychotherapy for chronic pain: exploring the impact of the virtual medium on participants' experiences

BACKGROUND

Virtual psychotherapy for chronic pain (CP) has been shown to be feasible, efficacious, and acceptable; however, little is known about how virtual delivery of group psychotherapy affects participants' experiences. This study aimed to explore the impact of a virtual medium during the coronavirus disease 2019 (COVID-19) pandemic on social interactions and therapeutic processes in the context of group psychotherapy for CP management.

METHODS

This qualitative, interview-based study collected data on 18 individuals who participated in virtual group psychotherapy in a tertiary care pain management unit.

RESULTS

Results of the thematic analysis showed 4 themes. First, the ability to participate and connect was modified by not meeting in person. Connections also occurred differently as the usual patterns of interactions changed. Participants described important shifts in how emotions are communicated and subsequent experience of empathy. Finally, the commonality of chronic pain experience was identified as a central driver of connection between participants.

CONCLUSIONS

Mixed impacts of the virtual medium on group psychotherapy dynamics and processes were found. Future research could explore ways to mitigate the negative impacts.

Improving Interprofessional Collaboration Between Social Work and Pharmacy Through Hybrid and Virtual Learning Experiences

The professions of pharmacy and social work are not generally assumed to directly collaborate in patient care; however, these professions are complementary. Health and wellbeing outcomes are significantly improved when care is managed by an interprofessional team that communicates and collaborates to ensure all aspects of care are effectively managed. The creation of educational opportunities for students to practice working together provides enhanced educational experiences and leads to their success as professionals. Pharmacy and social work faculty developed an interprofessional education activity specifically aimed at integrative student learning. Faculty and students based on various islands throughout the state of Hawai'i and the US territory of Guam participated in the experience. The case study encouraged interprofessional teamwork and collaboration. The case study also challenged students to share profession-specific knowledge with each other. Mean evaluation scores were compared between hybrid and fully online platforms. Evaluation scores were high and at least as good or higher in the fully online exercise compared to the hybrid exercises. Using the 20-item pre-post format, Interprofessional Collaborative Competencies Attainment Survey, results indicated statistically significant improvements in scores for all questions and domains (all P<.001). When hybrid training and fully online training were compared, there were no significant differences in pre scores, but post domain scores were significantly higher in students who experienced fully online training. This interprofessional case-based activity successfully promoted interprofessional learning and collaboration. Introducing learners to this type of collaborative practice while in school is critical for future collaboration in the workforce.

Self-perceived learning outcomes of virtual and in-person academic detailing among general practitioners in Norway

Self-perceived learning outcomes of virtual academic detailing (AD) are poorly studied. We compared self-perceived learning outcomes of virtual and in-person AD among general practitioners (GPs). GPs from the Western region of Norway received a questionnaire before and after AD concerning rational pharmacotherapy of migraine in the autumn 2022. Five statements addressing specific knowledge and two statements addressing general knowledge and skills in pharmacotherapy of migraine were rated in both questionnaires. A 7-point Likert scale ranging from 1: Strongly disagree to 7: Strongly agree was applied to all the statements. Histograms that showed the difference in the mean composite scores before and after AD were used to compare learning outcomes of virtual and in-person AD. Positive self-perceived learning outcomes were observed among 80%-88% of the GPs. No significant differences between virtual and in-person AD were observed.

Harnessing the power of telemedicine to accomplish international pediatric outcome research during the COVID-19 pandemic

The COVID-19 pandemic occurred during planned neurodevelopmental follow-up of Colombian children with antenatal Zika-virus exposure. The objective of the study was to leverage the institution's telemedicine infrastructure to support international clinical child outcome research. In a prospective cohort study of child neurodevelopment (NCT04398901), we used synchronous telemedicine to remotely train a research team and perform live observational assessments of children in Sabanalarga, Colombia. An observational motor and conceptional standardized tool kit was mailed to Colombia; other materials were translated and emailed; team training was done virtually. Children were recruited by team on the ground. Synchronous activities were video-recorded directly to two laptops, each with a telehealth Zoom link to allow simultaneous evaluation of "table" and "standing" activities, and backup recordings were captured directly on the device in Colombia. The U.S. team attended live over Zoom from four states and five distinct locations, made observational notes, and provided real-time feedback. Fifty-seven, 3-4-year-old children with Zika-virus exposure and 70 non-exposed controls were studied during 10 daytrips. Direct laptop recording ensured complete record of child activities due to internet outages. Telemedicine can be used to successfully perform international neurodevelopmental outcome research in children during the COVID-19 pandemic. Telemedicine can benefit global health studies.

Ankle Telemedicine Planning Considerations

A virtual medical visit, also known as telemedicine or telehealth, is a valuable alternative method of providing health care to patients who do not have easy access to a hospital, or during times when limited social interaction is crucial such as our current COVID-19 pandemic. A virtual approach to evaluating musculoskeletal system ailments is particularly challenging, for diagnosis of these conditions generally rely greatly on physical examination, which may be challenging. However, a properly planned and executed telemedicine visit will yield successful results in most cases. Our aim is to produce a document with instructions and suggestions, including physical examination maneuvers, to help physicians carry out a proper virtual medical visit with patients complaining of ankle musculoskeletal problems. Virtual visits should not be thought of as a replacement for traditional face-to-face medical consultations, but rather a complementary method to provide health care when deemed appropriate. By following this guide, and tailoring it to the specific case at hand, medical providers should be able to effectively carry out a successful telemedicine consultation for musculoskeletal ailments relating to the ankle.Levels of Evidence: Level V.

Instructors' Perceptions and Experiences of Teaching Online Exercise Classes to Older Adults: A Qualitative Study

Online exercise programming has become increasingly popular in recent years, including for older adults. Instructors hold unique perspectives on such programming that could yield important insights for effective program design and delivery. The purpose of this study was to qualitatively examine instructors' perceptions and experiences teaching exercise classes online to older adults. Using qualitative description, 19 instructors from a community exercise program for seniors completed a one-on-one semistructured interview. We analyzed data using reflexive thematic analysis and generated three main themes: (a) characteristics of effective online instructors, (b) challenges to delivering online exercise programming to older adults, and (c) future of online exercise programming. Most participants enjoyed delivering online exercise classes and developing the unique skills (particularly related to fostering social experiences and engaging with participants) required to be effective online exercise instructors. Our findings speak to the importance of ensuring instructors are adequately trained to deliver online exercise to seniors.

Development of a Culinary Medicine Toolkit to Improve Implementation of Virtual Cooking Classes for Low-Income Adults with Type 2 Diabetes

Culinary medicine (CM) addresses diseases through nutrition and culinary education. To promote access to educational material for people with diabetes and engagement in virtual classes, we created a virtual culinary medicine toolkit (VCMT) sensitive to literacy levels and language preferences. The VCMT was developed to accompany existing virtual CM programs and help improve participant interaction and retention, offering educational materials for providers and participants. The provider VCMT offers level-setting education to reduce mixed nutrition messaging, including educational resources discussing inclusive nutrition and mindful eating topics. Each handout has a QR code and link to engaging, animated videos that provide further explanation. The participant VCMT offers a range of fundamental cooking skill videos and infographics, including knife skills and preparing whole grains and healthy beverages. Participant handouts and animated videos, which are played during the virtual CM class, allow participants to learn more about diabetes management and food literacy topics, including interpreting nutrition labels, and are employed during a CM to facilitate discussion and reflection. The animated videos replace a traditional slide-based lecture, allowing space for patient-centered facilitated discussions during virtual cooking sessions. The VCMT could guide the development of virtual CM interventions to shift learning from lecture-based to patient-centered discussions via a visual and inclusive medium.

Facilitating virtual social connections for youth with disabilities: lessons for post-COVID-19 programming

PURPOSE

Social connections are essential for the development of life skills for youth. Youth with disabilities have long faced barriers to meaningful social connections. The onset of COVID-19 increased barriers to social connections for all youth, and also led to enhanced use of virtual platforms in paediatric rehabilitation programming. Harnessing this opportunity, service providers created a suite of online programs to foster social connections and friendships. The current study explores participant and service provider experiences of such programs.

METHODS

This qualitative descriptive study used interviews and focus groups to explore how youth with disabilities (n = 8), their parents (n = 7), and service providers (n = 13) involved in program development and delivery experienced the programs, the accessibility of the virtual platforms, and their social connections in relation to program participation.

RESULTS

Participants were satisfied with the programs' content, accessibility and ability to meet their social needs. Qualitative themes included facilitating social connections, accessibility of virtual spaces, and recommendations for future virtual programming.

DISCUSSION

For youth with disabilities who have been historically marginalized in social spheres, the newly ubiquitous infrastructure regarding virtual programming must be supported and enhanced. A hybrid approach involving virtual/in-person options in future programming is recommended.

Mentoring across difference and distance: building effective virtual research opportunities for underrepresented minority undergraduate students in biological sciences

IMPORTANCE

Summer Research Experiences for Undergraduates (REUs) are established to provide platforms for interest in scientific research and as tools for eventual matriculation to scientific graduate programs. Unfortunately, the COVID-19 pandemic forced the cancellation of in-person programs for 2020 and 2021, creating the need for alternative programming. The National Summer Undergraduate Research Project (NSURP) was created to provide a virtual option to REUs in microbiology to compensate for the pandemic-initiated loss of research opportunities. Although in-person REUs have since been restored, NSURP currently remains an option for those unable to travel to in-person programs in the first place due to familial, community, and/or monetary obligations. This study examines the effects of the program's first 3 years, documenting the students' experiences, and suggests future directions and areas of study related to the impact of virtual research experiences on expanding and diversifying science, technology, engineering, and mathematics.

Establishing a School Nurse Mentoring Network

Often, nurses new to the school setting find they have more questions than answers about school nursing practice but no mentor to ask. Questions often arise regarding medication administration, health records, health requirements to attend school, student illness, school health legislation, and state reporting requirements in the school setting, plus many more. This article outlines how one Regional Office of Education (ROE) in central Illinois partnered with a Certified School Nurse to establish a mentoring and networking program to foster relationships and information sharing among school nurses.

"I loved interacting with this younger generation": Exploring the impact of a virtual service-learning program on social connectedness among older adults during the COVID-19 pandemic

Pervasive feelings of social isolation and loneliness have been longstanding among up to half of older adults, and have received increased attention amid the COVID-19 pandemic. Programs to address loneliness and facilitate meaningful connections are vital for physical and mental wellbeing. The purpose of this study was to explore older adults' experiences participating as volunteers in the Aging is Very Personal (AIVP) service-learning program in relation to feelings of social connectedness. As part of an interprofessional gerontology course, 112 undergraduate students interviewed 55 older adult volunteers via Zoom on the lived experience of aging. Older adult volunteers were surveyed on their experiences with the COVID-19 pandemic and the virtual AIVP program. Data were analyzed using descriptive statistics and reflexive thematic analysis of open-ended questions. Participants reported participation in AIVP had a positive effect on their mood (86%) and made them feel more socially connected (71%). Six themes summarized their experiences: reduced feelings of social isolation; brought me joy; created meaningful intergenerational relationships; gave me a sense of purpose; facilitated genuine engagement; and created important learning opportunities for future health professionals. Virtual AIVP was identified as a valuable program to improve mood and feelings of social connectedness.

The High Impact of Low Intensity: Effectiveness of the BounceBack Program for Depression and Anxiety in Ontario

High costs, long wait times, and lack of access to mental health supports in Ontario are leaving millions with unmet treatment needs. To address this need, Ontario launched BounceBack, a large-scale coach-supported intervention grounded in cognitive behavioral therapy (CBT) to target symptoms of anxiety, depression, and functional impairment. The objective of this program evaluation was to examine the effectiveness of the BounceBack program in Ontario by exploring (a) changes in participants' depression and anxiety symptoms and functional impairment (as measured by the PHQ-9, GAD-7, and WSAS, respectively); and (b) rates for recovery and reliable improvement. Multilevel modelling (MLM) results indicated that participants reported significant improvements in their depression, anxiety, and functioning symptoms over time, which are not better accounted for by other demographic factors. Higher baseline severity of symptoms were associated with greater decreases in these symptoms. The strong recovery and reliable improvement rates identified further support the effectiveness of BounceBack as a potent intervention that leads to improvements in symptoms of anxiety and/or depression for the majority of its participants.

Virtual Group Music Therapy for Apathy in Parkinson's Disease: A Pilot Study

OBJECTIVE

To evaluate the effect of virtual group music therapy on apathy in people with Parkinson's disease (PD).

INTRODUCTION

Apathy affects 40% of people with PD, lacks effective therapies, and independently predicts poorer quality of life and greater caregiver burden. Music therapy is the clinical application of music to address a person's physical or emotional needs and is effective in treating apathy in dementia.

METHODS

People with idiopathic PD and apathy (Movement Disorders Society-Unified Parkinson's Disease Rating Scale, apathy item ≥ 2) and their caregivers participated in twelve, weekly virtual group music therapy sessions, with session attendance signifying adherence. Participants completed pre- and post-intervention assessments of apathy (Apathy Scale (AS)), quality of life (Parkinson's Disease Questionnaire-short form), functional ability (Schwab & England Activities of Daily Living Scale), depression (Beck Depression Inventory (BDI-II)), and cognition (Montreal Cognitive Assessment-Blind). Among secondary outcomes, we assessed caregiver burden (Zarit Burden Interview-short form) and strain (Multidimensional Caregiver Strain Index).

RESULTS

Sixteen PD participants (93.8% men, mean age 68.3 ± 8.4 years, median 6 years PD duration) and their caregivers (93.8% women, mean age 62.6 ± 11 years) completed the study. All PD participants and 88% of caregivers were >70% adherent to the intervention. Apathy (AS, effect size = 0.767, P = 0.002) and depression (BDI-II, effect size = 0.542, P = 0.03) improved, with no change in caregiver measures.

CONCLUSION

Group music therapy is an effective treatment for apathy in PD and may improve mood. The virtual format is a feasible alternative to in-person sessions with high adherence and satisfaction.

Evaluation of Vascular Neurology Fellowship Websites in the U.S

Objectives

Due to the limitations of the Coronavirus disease pandemic, medical applicants have relied on remote means of information, such as a program's website, to decide where to apply. However, studies have shown that many residency and fellowship websites lack information. Vascular neurology fellowship websites have not yet been studied. This study evaluates the availability and accessibility of information on vascular neurology fellowship websites.

Methods

From 2021 to 2022, a total of 109 U.S. vascular neurology fellowship programs from the Fellowship and Residency Electronic Interactive Database were investigated to determine whether they had websites. Each website was evaluated on the immediate availability of 34 different criteria, which were deemed important by past studies. These criteria were reviewed under four categories: program overview, application information, fellow life, and curriculum. The comprehensiveness of the information among these different categories were analyzed. Programs were grouped by geographic region and electronic residency application service (ERAS)-participation status and comparisons were made within these groups.

Results

There were 107 programs with websites (98%). ERAS-participating programs fulfilled more criteria on average than non-participating programs (P = 0.004). All websites provided information on general descriptions of their programs, but information on board exam pass rates, fellow testimonials, history of the fellowship program, responsibility progression, family and social events, parking availability, and application deadline were provided by less than 25% of websites.

Conclusion

This study found that there was a large lack of information on vascular neurology fellowship websites, which could be improved to attract more applicants.

Dementia "e"-consults for Behavioral and Psychological Symptoms of Dementia: Improving access to specialty dementia care for rural Veterans

OBJECTIVES

This paper characterizes a telephone-based e-consult program designed to assess and treat behavioral and psychological symptoms of dementia (BPSD) for older rural Veterans.

METHODS

E-consults required geriatricians to conduct chart review and telephone calls to caregivers to determine behavior triggers, prior management attempts, and medications. Pharmacologic and non-pharmacological recommendations were provided with follow-up calls as needed.

RESULTS

Evaluation of 364 Veterans (M age = 80.8, 32% in rural/distal clinics) showed 97% (n = 355) of E-consult interventions included caregiver dementia education to prepare them for managing disease progression and provide non-pharmacological strategies for BPSD. Ninety-four percent (n = 244) of Veterans received medication guidance. A total of 37,504 travel miles was saved, with an average of 108 miles for each Veteran.

CONCLUSIONS

Findings support continued implementation of telephone and other virtual modalities of assessing and treating BPSD for older Veterans, thereby increasing access to dementia specialists, especially for rural older adults and their caregivers. A limitation to e-consults is the time needed to provide services compared to the maximum workload credit allowed.

CLINICAL IMPLICATIONS

Virtual care improves access to Geriatric specialists and semi-urgent care that otherwise is not available. E-consults are effective in providing primary care providers guidance for diagnosis and management of dementia.

Impact of virtual learning on interprofessional simulation outcomes: A mixed-methods study

Health professions education is tasked with preparing the behavioral health workforce to provide accessible, high-quality, interprofessional care to meet the needs of geographically-isolated populations. Interprofessional experiences, like simulation, are an effective pedagogical tool, yet traditionally occur in-person. It is essential to adapt simulation experiences for the virtual environment to increase training accessibility among the emerging rural workforce. This study aimed to understand the impact of the virtual learning environment on interprofessional simulation (IPS) outcomes among social work (MSW) and nursing (MSN) students. The study sample (N=127) was composed of MSW (n=48) and MSN (n=79) students at a private university in the United States. The mixed-methods study utilized 1. independent samples t-tests to examine differences in students' interprofessional teaming behaviors, measured by the Performance Assessment Communication and Teamwork (PACT), after participation in a virtual interprofessional simulation (IPS) versus a traditional, in-person IPS; and 2. independent samples t-tests and qualitative thematic analysis to explore the feasibility and acceptability of the IPS among the virtual and in-person groups via the PACT and a satisfaction survey. Both IPS featured a case contextualized to take place in an underserved, rural area. Findings indicate virtual and in-person IPS provide comparable preparation in interprofessional team functioning and performance essential to interprofessional care. Students found the IPS feasible, acceptable, and were satisfied with the experience independent of platform. Virtual IPS experiences mitigate barriers to rural workforce development. Providing training in interprofessional practice using virtual platforms stands to benefit individuals in geographically-isolated communities.

Medical Students' Perception of Telesimulation Training: A Qualitative Analysis

OBJECTIVES

Over the past 2 decades, simulation-based learning has become an essential part of medical training. Simulated clinics have proven to be effective for training medical students. Even so, this learning method presents organizational and financial challenges that limit its dissemination to all medical students, especially since the COVID-19 pandemic. Simulated teleconsultation retains the advantages of interactive simulated clinics while offering concrete solutions to the challenges faced. The project aims to explore students' perspectives on simulated teleconsultation training compared to simulated clinics in person.

METHODS

Ten pre-clerkship students in the Faculty of Medicine at the University of Ottawa participated in interviews following in-person and teleconsultation simulated clinic sessions. The interview guide was developed based on previous work. The questions asked concerned experience with teleconsultation, interaction with the tutor and patient, practical or logistical obstacles, educational value and feasibility. The authors evaluated the results using a thematic analysis.

RESULTS

The interview analysis showed that the tutor feedback received during the simulated teleconsultation was comparable to that received after the in-person simulated clinic. Although most of the students enjoy teleconsultation, they raised the challenge of carrying out physical examinations and creating a personal connection with the tutor/patient.

CONCLUSION

Given the circumstances of the pandemic and students' comfort with technology, the new generation of medical students seems prepared to embrace teleconsultation. The themes identified in the analysis will enable the necessary adjustments to be made in order to optimize their teleconsultation training, an inextricable step in promoting the active offer of healthcare services.

'I turn to my closest friends for support': queer youth navigating mental health during COVID-19

The objectives of this in-depth qualitative study were to identify how COVID-19 impacted the mental health experiences of queer youth in Vancouver, Canada. Between November 2020 and June 2021, fifteen queer youth aged 15 to 25 were enrolled in the study. They participated in semi-weekly, solicited digital diary entries and semi-structured intake and follow-up interviews about COVID-19, social distancing protocols, and mental health. Using thematic analysis, two major themes were identified. First, participants described how COVID-19 impacted social support by highlighting the limitations of their existing social networks and feelings of disconnect from others in the local queer community. Second, participants described how public health guidance and the offloading of responsibility for COVID-19 risk-management onto the individual was a significant source of anxiety and stress, and how they moralised the struggle to balance compliance with the desire to connect with others. These findings highlight the need to understand the negative mental health outcomes arising from moralising approaches to public health that offload risk-management onto the individual, isolate queer youth, and hamper their identity-development processes.

Testing the reliability of the rearticulation of osteological primate pelves in comparative morphological studies

The evolution of human pelvic form is primarily studied using disarticulated osteological material of living and fossil primates that need rearticulation to approximate anatomical position. To test whether this technique introduces errors that impact biological signals, virtual rearticulations of the pelvis in anatomical position from computed tomography scans were compared with rearticulated models from the same individuals for one female and one male of Homo sapiens, Pan troglodytes, Macaca mulatta, Lepilemur mustelinus, Galago senegalensis, and Nycticebus pygmaeus. "Cadaveric" pelvic bones were first analyzed in anatomical position, then the three bones were segmented individually, intentionally scattered, and "rearticulated" to test for rearticulation error. Three-dimensional landmarks and linear measurements were used to characterize the overall pelvis shape. Cadaveric and rearticulated pelves were not identical, but inter-specific and intra-specific shape differences were higher than the landmarking error in the cadaveric individuals and the landmarking/rearticulation error in the rearticulated pelves, demonstrating that the biological signal is stronger than the noise introduced by landmarking and rearticulation. The rearticulation process, however, underestimates the medio-lateral pelvic measurements in species with a substantial pubic gap (e.g., G. senegalensis, N. pygmaeus) possibly because the greater contribution of soft tissue to the pelvic girdle introduces higher uncertainty during rearticulation. Nevertheless, this discrepancy affects only the caudal-most part of the pelvis. This study demonstrates that the rearticulation of pelvic bones does not substantially affect the biological signal in comparative 3D morphological studies but suggests that anatomically connected pelves of species with wide pubic gaps should be preferentially included in these studies.

Virtual collaborative creative engagement in a pandemic world: creative connection for older adults with lived experience of dementia

Introduction

Older adults were disproportionately affected by COVID-19, and isolation and loneliness became key risk factors for mental illness and decreased quality of life. Older adults with lived experience of dementia and their care partners experienced isolation, loneliness, anxiety and depression, already heightened due to social stigma. Reduced access to resources was a notable problem.

Objective

This Canadian qualitative study investigates the Raising the Curtain on the Lived Experience of Dementia (RTC) Project's virtual turn in program delivery during the pandemic, asking "How did virtual collaborative creative engagement (CCE) impact well-being for people living with dementia and their care partners?"; and "What are key elements of RTC's unique virtual CCE approach?"

Methods

The study employs reflexive thematic analysis to analyse interviews and focus groups with the project's artist facilitators, researchers, peer collaborators living with dementia, and their care partners. Findings: Themes describe key elements of RTC's unique approach to virtual CCE and include: "Adjusting Expectations and Adapting to Technology"; "Re-imagining Creative Engagement in Virtual Space"; "Sustaining Reciprocal Caring, Learning, and Support"; "Disrupting Stigma and Welcoming a Wider Audience"; and "Supporting Well-being through Empowerment, Community, and Creativity."

Discussion

Findings offer new perspectives on how virtual CCE not only has the potential to decrease loneliness and isolation and associated mental health risks for older adults living with dementia and their care partners, but also can work to disrupt stigmatizing representations of dementia, promote inclusion, and enhance citizenship.

Development and Formative Evaluation of a Virtual Exercise Platform for a Community Fitness Center Serving Individuals With Physical Disabilities: Mixed Methods Study

BACKGROUND

People with disabilities experience numerous barriers to being physically active, such as transportation issues, a lack of trained exercise professionals who understand disabilities, and facility access. The use of a virtual exercise platform (VEP) may provide an alternative and limit certain barriers.

OBJECTIVE

The aim of this mixed method study was to evaluate user interaction (effectiveness, efficiency, and satisfaction), the strengths and weaknesses of the user interface, and the user experience with a VEP.

METHODS

Participants were recruited from a community fitness facility that offers programs for people with disabilities. Inclusion criteria were being older than 18 years, fluent in English, and availability of internet access. Features of the VEP included articles, prerecorded videos, live Zoom classes, web-based class registration, weekly progress tracking, incentives, and surveys. A one-on-one Zoom session was scheduled with each participant, during which they completed certain tasks: (1) create an account or login, (2) register for class, (3) join class, (4) add to calendar, and (5) complete surveys. As participants completed tasks, quantitative observations (time on task, task success, rate of task completion, and number of errors by users, which determined task difficulty), qualitative observations were made and interviews were conducted at the end of the session. The "concurrent think-aloud" method was encouraged by the moderator to gauge participants' thoughts as they worked through testing. Participants also completed the System Usability Scale (SUS) and Questionnaire for User Interface Satisfaction (QUIS).

RESULTS

A total of 5 people with disabilities (3 male, 2 female), aged 36-78 (mean 54) years, with education levels from high school to PhD, were recruited. Devices used for testing included a laptop (n=3), a Chromebook (n=1), and a desktop (n=1). All participants completed tasks #1 and #2 without errors but could not complete task #4. One participant completed task #5 with difficulty and another completed task #3 with difficulty. The average time to complete each task was: (1) 82 seconds (55-110), (2) 11 seconds (4-21), (3) 9 seconds (5-27), and (4) 921.5 seconds (840-958). The mean SUS score was 86.5/100, and the mean user QUIS score was 8.08 out of 10. Qualitative observations indicated that the system was simple, user-friendly, and accessible.

CONCLUSIONS

People with disabilities reported high usability and user satisfaction with the web-based exercise platform, and the system appears to be an efficient and effective physical activity option.

virtual team-based learning (TBL) in the didactic curriculum: A mixed-methods study

INTRODUCTION

Virtual TBL is an online adaptation of the team-based learning (TBL) instructional strategy, emphasizing collaborative learning and problem-solving. The emergency shift to virtual TBL during the COVID-19 pandemic presented unique challenges. This study aims to 1) compare overall pharmacy students' perceptions and attitudes toward face-to-face (FTF) TBL vs. virtual TBL in the didactic curriculum and stratify their perceptions and attitudes by various students' characteristics; 2) evaluate students' perceptions of the strengths and weaknesses of virtual TBL.

METHODS

This mixed-methods, pre-post, cross-sectional study utilized an anonymous survey to collect the data. Pharmacy students completed a survey to compare their perceptions and attitudes toward learning, class experience, learning outcomes achieved, and satisfaction with FTF TBL vs. virtual TBL using a 5-point Likert-type scale. Additionally, the survey included two open-ended questions to gather students' perceptions of the strengths and weaknesses of virtual TBL. Quantitative survey data were analyzed using the Wilcoxon matched-pairs signed rank exact test, while qualitative survey data were analyzed using thematic analysis.

RESULTS

A total of 117 students (response rate of 59.4%) completed the study survey. Pharmacy students perceived FTF TBL to be superior to virtual TBL in their attitudes toward learning, class experience, learning outcomes achieved, and overall satisfaction across various students' characteristics. While the students identified some unique strengths of using virtual TBL, they also highlighted several weaknesses of using this learning modality compared to FTF TBL.

CONCLUSIONS

Pharmacy students perceived FTF TBL to be superior to virtual TBL across various students' characteristics. These findings can be helpful to pharmacy programs considering the implementation of virtual TBL in their didactic curricula. Future research should explore whether a purposefully designed virtual TBL environment, as opposed to the pandemic-driven emergency TBL planning, can influence students' perceptions and attitudes toward virtual TBL.

An online alternative: a qualitative study of virtual abortion values clarification workshops

BACKGROUND

Following the U.S. Supreme Court Dobbs decision, access to abortion education is increasingly regionally dependent. Participation in values clarification workshops on abortion can improve abortion knowledge and reduce stigma. Traditionally, values clarification workshops occur in person, yet medical education increasingly utilizes online learning. We sought to understand how a virtual platform impacted medical students and Obstetrics and Gynecology (ObGyn) residents' experience with a values clarification workshop on abortion.

METHODS

We conducted values clarification workshops over Zoom with medical students and ObGyn residents at four midwestern teaching hospitals from January 2021-December 2021 during the COVID-19 pandemic. We held semi-structured interviews with participants and facilitators to learn about how the virtual format impacted their experience with the workshop. Four researchers analyzed transcripts using an inductive approach to generate codes then themes.

RESULTS

We interviewed 24 medical students, 13 ObGyn residents, and five workshop facilitators. Participants and facilitators found the virtual platform to have both unique advantages and disadvantages. Four central themes were identified: 1) Screen as a barrier: participants noted obstacles to conversation and intimacy. 2) Emotional safety: participants felt comfortable discussing sensitive topics. 3) Ease of access: participants could access virtual workshops regardless of location. 4) Technology-specific features: Zoom features streamlined aspects of the workshop and allowed for anonymous contributions to discussion.

CONCLUSIONS

Our findings suggest that a virtual platform can be a convenient and effective way to deliver values clarification workshops on abortion, and this technology could be leveraged to expand access to this training in areas without trained facilitators.

Presumptive Diagnosis in Tele-Health Laryngology: A Multi-Center Observational Study

OBJECTIVES

Early in the COVID-19 pandemic, outpatient visits were adapted for the virtual setting, forcing laryngologists to presume certain diagnoses without the aid of laryngoscopy, solely based on history and the limited physical exam available via video visit. This study aims to examine the accuracy of presumptive diagnoses made via telemedicine, compared to subsequent in-person follow up, where endoscopic examination could confirm or refute suspected diagnoses.

METHODS

A retrospective chart review was conducted of 38 patients evaluated for voice-related issues at NYU Langone Health and the University of California-San Francisco. Presumptive diagnoses at the initial telemedicine encounter were noted, along with diagnostic cues used for clinical reasoning and recommended treatment plans. These presumptive diagnoses were compared to diagnoses and plans established following laryngoscopy at follow-up in-person visits.

RESULTS

After laryngoscopy at the first in-person visit, 38% of presumptive diagnoses changed, as did 37% of treatment plans. The accuracy varied among conditions. Muscle tension dysphonia and Reinke's edema were accurately diagnosed without laryngoscopy, but other conditions, including vocal fold paralysis and subglottic stenosis, were not initially suspected, relying on laryngoscopy for diagnosis.

CONCLUSIONS

While some laryngologic conditions may be reasonably identified without in-person examination, laryngoscopy remains central to definitive diagnosis and treatment. Telemedicine can increase access to care, but it may provide more utility as a screening tool, triaging which patients should present more urgently for in-person laryngoscopy.

LEVEL OF EVIDENCE

4.

Perceived Quality of Online Music Therapy Sessions by Older Adults Aging at Home

Online delivery is new to the field of music therapy (MT). This research investigated older adults' perceived quality of MT online by certified music therapists. In this feasibility study, applying both process and outcome assessments, nine older adults volunteered to participate. Zoom was used, and a virtual music therapy (VMT) kit was developed as a resource. Surveys and observed technical difficulties revealed that perceived quality varied slightly by level of technical difficulty experienced; however, overall mean perceived quality was 7.2 out of 9. Post-study interviews revealed three main themes: (a) individual experiences with VMT, (b) individuals' suggestions for further development of VMT sessions, and (c) individuals' personal outcomes from VMT sessions. Participants reported overall positive experiences with VMT. Despite a slight decline in perceived quality when more technical difficulties were present, each participant reported a desire for more sessions, and they would recommend it to others.

Epistemology of synthetic biology: a new theoretical framework based on its potential objects and objectives

Synthetic biology is a new research field which attempts to understand, modify, and create new biological entities by adopting a modular and systemic conception of the living organisms. The development of synthetic biology has generated a pluralism of different approaches, bringing together a set of heterogeneous practices and conceptualizations from various disciplines, which can lead to confusion within the synthetic biology community as well as with other biological disciplines. I present in this manuscript an epistemological analysis of synthetic biology in order to better define this new discipline in terms of objects of study and specific objectives. First, I present and analyze the principal research projects developed at the foundation of synthetic biology, in order to establish an overview of the practices in this new emerging discipline. Then, I analyze an important scientometric study on synthetic biology to complete this overview. Afterwards, considering this analysis, I suggest a three-level classification of the object of study for synthetic biology (which are different kinds of living entities that can be built in the laboratory), based on three successive criteria: structural hierarchy, structural origin, functional origin. Finally, I propose three successively linked objectives in which synthetic biology can contribute (where the achievement of one objective led to the development of the other): interdisciplinarity collaboration (between natural, artificial, and theoretical sciences), knowledge of natural living entities (past, present, future, and alternative), pragmatic definition of the concept of "living" (that can be used by biologists in different contexts). Considering this new theoretical framework, based on its potential objects and objectives, I take the position that synthetic biology has not only the potential to develop its own new approach (which includes methods, objects, and objectives), distinct from other subdisciplines in biology, but also the ability to develop new knowledge on living entities.

Framing asynchronous interprofessional education: a qualitative study on medical, physiotherapy and nursing students

Objectives

To explore how virtual, asynchronous modules can be used in interprofessional health education curricula and to identify any advantages and shortcomings of asynchronous interprofessional education.

Methods

A sample of 27 health professional students who attended in-person interprofessional education workshops at the McMaster Centre for Simulation-Based Learning from 2019-2020 were recruited through email discourse. Participants were asked to complete an asynchronous interprofessional education module and take part in a semi-structured interview that was recorded and transcribed verbatim. Techniques of direct content analysis were used to analyze the qualitative data from recorded transcripts.

Results

The following emergent themes from participants' responses were identified: 1) the modules, as well as the features interspersed throughout, taught strategies for conflict resolution and interprofessional communication, 2) the modules have utility in preparing students for future interprofessional learning, 3) the convenience of virtual asynchronous modules introduces a sense of learner safety, and 4) a sense of isolation and fatigue was identified as a consequence of the lack of face-to-face interaction in these modules.

Conclusion

Asynchronous interprofessional education modules may be best suited to prepare students for future interprofessional learning in a synchronous setting. Asynchronous modules effectively provide an introduction to interprofessional objectives such as conflict resolution and role clarification, yet the competency of team functioning is more difficult to achieve in an asynchronous environment. Future studies may focus on establishing a sequence of completing asynchronous modules for ideal development of interprofessional competencies in health professions learners.

Does virtual reality technology reduce pain and anxiety during outpatient hysteroscopy? A randomised controlled trial

OBJECTIVE

To evaluate the effectiveness of virtual reality technology in reducing pain and anxiety during outpatient hysteroscopy.

DESIGN

A prospective randomised controlled trial.

SETTING

A London University Teaching Hospital.

POPULATION

Women aged 18-70 years undergoing outpatient hysteroscopy procedures.

METHODS

An unblinded randomised controlled trial was performed between March and October 2022 comparing standard outpatient hysteroscopy care with standard care with the addition of a virtual reality headset playing a virtual reality immersive scenario as a distraction technique.

MAIN OUTCOME MEASURES

Pain and anxiety numeric rating scores (NRS) from 0 to 11.

RESULTS

Eighty-three participants were randomly allocated to the control (n = 42) and virtual reality groups (n = 41). The virtual reality group experienced significantly less anxiety during the procedure than the control group (mean NRS 3.29 versus 4.73, mean difference 1.50; 95% confidence interval [CI] 0.12-2.88; P = 0.03). There was no difference in reported average pain (mean NRS 3.73. versus 4.24, mean difference 0.51; 95% CI -1.76 to 0.64; p = 0.41) or maximum pain scores (mean NRS 5.32 versus 5.07, mean difference 0.25; 95% CI -1.05 to 1.55; P = 0.71).

CONCLUSIONS

The use of virtual reality technology as an adjunct to standard care can reduce patient-reported anxiety but not pain during outpatient hysteroscopy procedures. Continued improvements in the technology and the development of increasingly immersive environments may continue to increase the potential to improve the patient experience in this setting.

Medical Physics Leadership Academy Journal Club (Leadership Club) program: Two-year review in building a community of leaders

The American Association of Physicists in Medicine began the Medical Physics Leadership Academy Journal Club in the fall of 2020. The initiative was launched to provide a forum for medical physicists to learn about leadership topics using published material, discuss and reflect on the material, and consider incorporating the discussed skills into their professional practice. This report presents the framework for the MPLA Journal Club program, describes the lessons learned over the last 2 years, summarizes the data collected from attendees, and highlights the roadmap for the program moving forward.

Virtual parent-led peer support groups for parents of children with eating disorders: A mixed methods feasibility study

OBJECTIVE

To examine the feasibility of a virtual parent-led peer support group (vPLPSG) intervention for parents of children with eating disorders (EDs).

METHODS

Forty-four parents were invited to attend 2-h-long vPLPSG sessions every other week for 6 months. A convergent mixed methods design was used to integrate quantitative survey data (collected at three timepoints and analyzed using repeated measures ANOVA) and qualitative interview data (collected at 6 months and analyzed using content analysis) to assess intervention feasibility. Feasibility was comprised of acceptability (e.g., recruitment and retention rates, desire to continue attending the groups) and preliminary effectiveness (e.g., change in parents' self-reported burden).

RESULTS

The recruitment rate (67%), retention rate (77%), and attendance rate (60%) demonstrated adequate acceptability. All parents expressed their recommendation of this group to other parents, and most wanted to continue attending vPLPSG sessions. Participants qualitatively reported less isolation and burden as well as improvements in skills and confidence to manage their child's symptoms. These preliminary effectiveness findings were corroborated by quantitative data, with participants reporting a significant decrease in burden [mean difference (MD) = 6.61; p < .004], increase in confidence (MD = 11.17; p < .001), and decrease in unmet needs (MD = 5.03; p < .001) from baseline to 6-months.

DISCUSSION

The vPLPSG intervention demonstrated feasibility with respect to acceptability and improvements in preliminary parental outcomes. Future research should evaluate the effectiveness of this intervention using a larger, more diverse sample.

PUBLIC SIGNIFICANCE

Dedicated efforts to support caregivers, such as through virtual parent-led peer support groups, have the potential to increase confidence and decrease burden for parents managing their child's eating disorder.

Improving capacity to identify, assess, and manage adolescents engaging in non-suicidal self-injury using patient avatars

PURPOSE

We developed and evaluated a training comprising a didactic and virtual practice session with human-guided patient avatars to increase pediatric residents' competence to identify and assess non-suicidal self-injury (NSSI) and suicide risk.

METHODS

Thirty pediatric residents at three children's hospitals in Florida participated in the training and completed pre-, one-month post-, and three-months post-training surveys. One-way repeated measures ANOVA with post-hoc comparisons determined changes in confidence, comfort, behavioral intentions, attitudes, knowledge, and behavior over time. Qualitative responses provided feedback on the training, especially the novel practice session with adolescent patient avatars.

RESULTS

Three-months post-training residents expressed significantly greater confidence in talking to adolescents who self-injure, applying the SOARS method to assess self-injury, and assessing functions/reasons for self-injury; reported feeling significantly more comfortable asking about self-injury, well-equipped to handle the emotional aspects of self-injury, and comfortable treating adolescents who self-injure; reported greater behavioral intentions to talk to adolescents about self-injury, assess an adolescent's stage of change for stopping self-injury, and provide brief interventions for adolescents who self-injure; and used SOARS to evaluate current NSSI with a greater proportion of adolescent patients. Qualitative feedback expressed positive perceptions, especially related to the virtual-reality role-play session.

CONCLUSIONS

Incorporating an interactive, human-guided virtual experience using role-playing and feedback with patient avatars represents a viable option comparable to using typical standardized patients to expand the scalability of NSSI trainings for pediatric residents, especially when they occur virtually.

Striving to be of Value: Building a Virtual Radiology Consult Service for Patients

PURPOSE

Direct interactions between patients and diagnostic radiologists are uncommon, but recent medicolegal developments in the United States may increase patient interest in communicating directly with radiologists. Patient participation rates in prior attempts at direct radiology consultation vary widely in the literature. Our objective was to design and build a virtual radiology consult service for a subset of patients undergoing lung cancer screening CTs to enable communication between patients and radiologists regarding imaging results and radiology recommendations.

METHODS

Patients scheduled for lung cancer screening CTs were identified using a custom scheduling system and offered via text message a free 15-minute consultation with a radiologist to discuss the results.

RESULTS

Of 38 patients texted, 10 (26.3%) responded. Nine (90%) scheduled a consultation, but 5 (55.5%) subsequently cancelled. Of the remaining four, 3 (75%) attended their appointments, with an overall 3/38 (7.9%) text-to-consult conversation rate. The 3 consults averaged 18 (±8.2) minutes.

CONCLUSION

The recruitment rate for our virtual service was between the low rate of a prior phone consult line study and the high rate in consults integrated into another physician visit. Further research is needed to identify patients most interested in a radiology consultation and optimize consultation modality by patient population.