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Eyupoglu G, Altug E, Sener K, Guven R, Cabalar M, Guven ME, Acir I. Effect of teleconsultation on the application of thrombolytic therapy in stroke patients in the emergency department. Ir J Med Sci 2024; 193:1019-1024. [PMID: 37597035 DOI: 10.1007/s11845-023-03497-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Recently, telemedicine has become a widely used method worldwide for the treatment of patients with acute ischemic stroke in hospitals where neurologists are unavailable. The purpose of this study was to determine the accuracy and reliability of treatment decisions made by remote neurologists via teleconference assisted by emergency physicians in acute stroke cases and to determine whether the use of teleconsultation would lead to any delays in assessment and treatment decisions. METHODS This single-center and prospective study was performed with 104 patients who met the inclusion criteria. Patients were concurrently assessed by a teleneurologist (TN) experienced in stroke and an on-site neurologist (OS-N). The TN performed their assessment via teleconference and assisted by an emergency physician for test results and physical examination. NIHSS (The National Institutes of Health Stroke Scale) scores, assessment times, treatment decisions by the two neurologists, and patient outcomes were recorded separately. The TN was asked to rate the quality of communication. RESULTS Of the 104 patients in the study, 59.6% (n = 62) were men and the median age was 66 (interquartile range = 56-78) years. The median duration of assessment by the OS-N was 30 (18-45) min and the median duration of assessment by the TN was 6 (5-8) min; the duration of assessment by the TN was significantly shorter (6.56 min vs. 33.35 min; Z = 8.669; p < 0.001). The median rating assigned by the TN to the quality of teleconsultation was 5.0 (4.25-5.0) (Table 1). The NIHSS scores assigned by both neurologists showed significant correlation (p < 0.001). Analysis of the agreement between the OS-N and TN in their treatment decisions yielded a Kappa value of 74.3% for interrater agreement. CONCLUSIONS Teleconsultation was a successful and reliable strategy in assessing patients with ischemic stroke and making decisions for IV-tPA. Moreover, patient assessment via teleconsultation was less time consuming. The results of the study are promising for the use of teleconsultation in the future.
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Affiliation(s)
- Gokhan Eyupoglu
- Istanbul Cam and Sakura City Hospital Department of Emergency Medicine, University of Health Sciences, Istanbul, Turkey.
| | - Ertugrul Altug
- Department of Emergence Medicine, Republic of Turkey, Ministry of Health Başaksehir Cam and Sakura State Hospital, Istanbul, Turkey
| | - Kemal Sener
- Department of Emergence Medicine, Republic of Turkey, Ministry of Health Mersin City Hospital, Mersin, Turkey
| | - Ramazan Guven
- Istanbul Cam and Sakura City Hospital Department of Emergency Medicine, University of Health Sciences, Istanbul, Turkey
| | - Murat Cabalar
- Department of Neurology, Republic of Turkey, Ministry of Health Başaksehir Cam and Sakura State Hospital, Istanbul, Turkey
| | - Munevver Ece Guven
- Department of Algology, Republic of Turkey, Ministry of Health Gulhane Training and Research Hospital, Ankara, Turkey
| | - Ibrahim Acir
- Department of Neurology, Republic of Turkey, Ministry of Health, Sadi Konuk Training and Research Hospital, Bakirkoy Dr, Istanbul, Turkey
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Kriegler C, Al Balushi M, Zhu YM, Hill J, Beruar A, Ghosh S, Fairchild A, Severin D. Do Radiation Oncology Residents Have a Preferred Radiation Treatment Planning Review Format? J Cancer Educ 2023; 38:1338-1343. [PMID: 36735173 PMCID: PMC9895963 DOI: 10.1007/s13187-023-02267-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
In an era of increasing virtual communication, we aimed to investigate current formats used by radiation oncology residents for reviewing radiation treatment plans with attendings, preferences for formats, and reasons contributing to preferences. Residents enrolled in Canadian radiation oncology programs received questionnaires examining training level, typical review formats, preferred format, and reasons for preference. Analysis excluded PGY-1s due to insufficient exposure. Fifty-two residents participated. National response rate was 55%. Overall, hybrid review was the most used format (77%). Virtual review was the most preferred format (44%). Preference for virtual review was most common among junior residents (57%), while in-person review was most preferred by senior residents (45.4%). Few residents typically use their preferred format (35%). Reasons for preference varied between groups in convenience (p < 0.01), interactivity (p < 0.01), and teaching quality (p = 0.04). The persistence of e-learning suggests that virtual treatment planning education will continue to some degree. Junior residents prefer virtual review, while a clearly preferred review format was less apparent among senior residents. Preferences are multifactorial, and the trends seen in reasons for preference between formats may reflect advantages inherent to each. Progress is still needed in optimizing treatment planning education, as suggested by few residents using their preferred format. Residents and staff should collectively decide which educational format for treatment planning best meets educational needs.
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Affiliation(s)
- Conley Kriegler
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, 11560 University Ave, Edmonton, AB, T6G 1Z2, Canada.
| | - Mustafa Al Balushi
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, 11560 University Ave, Edmonton, AB, T6G 1Z2, Canada
| | - Yiming Michael Zhu
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, 11560 University Ave, Edmonton, AB, T6G 1Z2, Canada
| | - Jordan Hill
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, 11560 University Ave, Edmonton, AB, T6G 1Z2, Canada
| | - Ananya Beruar
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, 11560 University Ave, Edmonton, AB, T6G 1Z2, Canada
| | - Sunita Ghosh
- Division of Experimental Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Alysa Fairchild
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, 11560 University Ave, Edmonton, AB, T6G 1Z2, Canada
| | - Diane Severin
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, 11560 University Ave, Edmonton, AB, T6G 1Z2, Canada
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Michaels RE, Zugris NV, Cin MD, Monovoukas DA, Koka KK, Smith C, Bohm L, Kim J, Green G, Roby B, Jabbour N, Lind M, Goudy S, Zopf DA. A national pediatric otolaryngology fellowship virtual dissection course using 3D printed simulators. Int J Pediatr Otorhinolaryngol 2022; 162:111273. [PMID: 36030629 DOI: 10.1016/j.ijporl.2022.111273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/27/2022] [Accepted: 08/06/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Our objective was to create and evaluate a novel virtual platform dissection course to complement pediatric otolaryngology fellowship training in the setting of the COVID-19 pandemic. METHODS A four-station, four-simulator virtual course was delivered to pediatric otolaryngology fellows virtually using teleconferencing software. The four stations consisted of microtia ear carving, airway graft carving, cleft lip repair, and cleft palate repair. Fellows were asked to complete pre- and post-course surveys to evaluate their procedural confidence, expertise, and attitudes towards the course structure. RESULTS Statistical analysis of pre-course survey data showed fellows agreed that simulators should play an important part in surgical training (4.59 (0.62)); would like more options for training with simulators (4.31 (0.88)); and would like the option of saving their simulators for later reference (4.41 (0.85)). Fellows found the surgical simulators used in the course to be valuable as potential training tools (3.96 (0.96)), as competency or evaluation tools (3.91 (0.98)), and as rehearsal tools (4.06 (0.93)). Analysis showed a statistically significant improvement in overall surgical confidence in performing all four procedures. CONCLUSION This virtual surgical dissection course demonstrates 3D printed surgical simulators can be utilized to teach fellows advanced surgical techniques in a low-risk, virtual environment. Virtual platforms are a viable, highly-rated option for surgical training in the setting of restricted in-person meetings and as a mechanism to increase access for fellows by reducing costs and travel requirements during unrestricted periods.
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Affiliation(s)
- Ross E Michaels
- Medical School, University of Michigan, Ann Arbor, MI, USA; University of Michigan, Department of Orthopedic Surgery, USA
| | | | - Mitchell D Cin
- Medical School, Central Michigan University, Mount Pleasant, MI, USA
| | | | - Krishna K Koka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Connor Smith
- Otolaryngology - Head and Neck Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Lauren Bohm
- Otolaryngology - Head and Neck Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Jennifer Kim
- Otolaryngology - Head and Neck Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Glenn Green
- Otolaryngology - Head and Neck Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Brianne Roby
- Pediatric ENT and Facial Plastic Surgery, Children's of Minnesota, University of Minnesota Department of Otolaryngology-Head and Neck Surgery, Minneapolis, MN, USA
| | - Noel Jabbour
- University of Pittsburgh Department of Otolaryngology Eye and Ear Institute, Pittsburgh, PA, USA
| | - Meredith Lind
- Department of Otolaryngology and Head & Neck Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Steven Goudy
- Department of Otolaryngology-Head and Neck Surgery, Emory Medicine, Atlanta, GA, USA
| | - David A Zopf
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Otolaryngology - Head and Neck Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA.
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Ohman JW, Annest SJ, Azizzadeh A, Burt BM, Caputo FJ, Chan C, Donahue DM, Freischlag JA, Gelabert HA, Humphries MD, Illig KA, Lee JT, Lum YW, Meyer RD, Pearl GJ, Ransom EF, Sanders RJ, Teijink JAW, Vaccaro PS, van Sambeek MRHM, Vemuri C, Thompson RW. Evaluation and treatment of thoracic outlet syndrome during the global pandemic due to SARS-CoV-2 and COVID-19. J Vasc Surg 2020; 72:790-798. [PMID: 32497747 PMCID: PMC7262516 DOI: 10.1016/j.jvs.2020.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/26/2020] [Indexed: 11/02/2022]
Abstract
The global SARS-CoV-2/COVID-19 pandemic has required a reduction in nonemergency treatment for a variety of disorders. This report summarizes conclusions of an international multidisciplinary consensus group assembled to address evaluation and treatment of patients with thoracic outlet syndrome (TOS), a group of conditions characterized by extrinsic compression of the neurovascular structures serving the upper extremity. The following recommendations were developed in relation to the three defined types of TOS (neurogenic, venous, and arterial) and three phases of pandemic response (preparatory, urgent with limited resources, and emergency with complete diversion of resources). • In-person evaluation and treatment for neurogenic TOS (interventional or surgical) are generally postponed during all pandemic phases, with telephone/telemedicine visits and at-home physical therapy exercises recommended when feasible. • Venous TOS presenting with acute upper extremity deep venous thrombosis (Paget-Schroetter syndrome) is managed primarily with anticoagulation, with percutaneous interventions for venous TOS (thrombolysis) considered in early phases (I and II) and surgical treatment delayed until pandemic conditions resolve. Catheter-based interventions may also be considered for selected patients with central subclavian vein obstruction and threatened hemodialysis access in all pandemic phases, with definitive surgical treatment postponed. • Evaluation and surgical treatment for arterial TOS should be reserved for limb-threatening situations, such as acute upper extremity ischemia or acute digital embolization, in all phases of pandemic response. In late pandemic phases, surgery should be restricted to thrombolysis or brachial artery thromboembolectomy, with more definitive treatment delayed until pandemic conditions resolve.
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Affiliation(s)
- J Westley Ohman
- Center for Thoracic Outlet Syndrome and Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Stephen J Annest
- Vascular Surgery, Presbyterian/St. Luke's Hospital and St. Joseph Hospital, Denver, Colo
| | - Ali Azizzadeh
- Division of Vascular Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Bryan M Burt
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Francis J Caputo
- Department of Vascular Surgery, Sydell and Arnold Miller Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Colin Chan
- Department of Vascular Surgery, Wirral University Teaching Hospital and Countess of Chester Hospital NHS Foundation Trust, Chester, United Kingdom
| | - Dean M Donahue
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Julie A Freischlag
- Wake Forest Baptist Medical Center, Wake Forest School of Medicine, Winston-Salem, NC
| | - Hugh A Gelabert
- Division of Vascular Surgery, Gonda (Goldschmied) Vascular Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif
| | - Misty D Humphries
- Division of Vascular Surgery, University of California, Davis Medical Center, Sacramento, Calif
| | - Karl A Illig
- Dialysis Access Institute, Regional Medical Center, Orangeburg, SC
| | - Jason T Lee
- Division of Vascular Surgery, Department of Surgery, Stanford Hospital and Clinics, Stanford, Calif
| | - Ying Wei Lum
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Richard D Meyer
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | - Gregory J Pearl
- Division of Vascular Surgery, Baylor University Medical Center, and Baylor Scott & White Heart and Vascular Hospital, Dallas, Tex
| | - Erin F Ransom
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | - Richard J Sanders
- Department of Surgery, University of Colorado Health Science Center, Aurora, Colo
| | - Joep A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Patrick S Vaccaro
- Division of Vascular Diseases and Surgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Marc R H M van Sambeek
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Biomedical Technology, University of Technology Eindhoven, Eindhoven
| | - Chandu Vemuri
- Section of Vascular Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Mich
| | - Robert W Thompson
- Center for Thoracic Outlet Syndrome and Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo.
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Tan KA, Thadani VN, Chan D, Oh JYL, Liu GKP. Addressing Coronavirus Disease 2019 in Spine Surgery: A Rapid National Consensus Using the Delphi Method via Teleconference. Asian Spine J 2020; 14:373-381. [PMID: 32403894 PMCID: PMC7280919 DOI: 10.31616/asj.2020.0224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 12/15/2022] Open
Abstract
The magnitude and potential duration of the current coronavirus disease 2019 (COVID-19) pandemic is something that most doctors currently in practice have yet to experience. While considerable information regarding COVID-19 is being published every day, it is challenging to filter out the most relevant or appropriate information for our individual practice. The Spine Society of Singapore convened via a teleconference on April 24, 2020 to collaborate on a national level and share collective wisdom in order to tackle the ongoing crisis. In the teleconference, 13 spine surgeons from across various hospitals in Singapore constituted the panel of experts. The following topics were discussed: repurposing of surgeons, continuity of spine services, introduction of telemedicine, triaging of spinal surgeries, preoperative testing, new challenges in performing spine surgery, and preparing for the post-pandemic era. While some issues required only the sharing of best practices, the Delphi panel method was adopted to form a consensus on others. Existing spine specific triage guidelines were debated and a locally accepted set of guidelines was established. Although preoperative testing is currently not performed routinely, the panel voted in favor of its implementation because they concluded that it is vital to protect themselves, their colleagues, and their patients. Solutions to operating room specific concerns were also discussed. This article reflects the opinions and insights shared during this meeting and reviews the evidence relevant to the issues that were raised. The rapid consensus reached during the teleconference has enabled us to be concerted, and thus stronger, in our national efforts to provide the best standard of care via our spine services in these challenging times. We believe that this article will provide some guidance for addressing COVID-19 in spine surgery and encourage other national/regional societies to conduct similar discussions that would help their navigation of this pandemic.
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Affiliation(s)
- Kimberly-Anne Tan
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, Singapore
| | - Vishaal Nanik Thadani
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, Singapore
| | - Daniel Chan
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
| | | | - Gabriel Ka-Po Liu
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, Singapore
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Abstract
Tele-education is the use of communications technologies to distribute knowledge from one health care provider to another when distance separates providers. At the University of Arkansas for Medical Sciences, tele-education has been used for more than two decades to educate and support rural obstetrician/gynecologists throughout the state. Tele-education at University of Arkansas for Medical Sciences incorporates numerous interactive videoconferences and other digital portals and platforms. Continued provider education through tele-education increases access to quality care and evidenced-based practices for rural populations and is an effective strategy in the battle against health care disparities.
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Nyamtema A, Mwakatundu N, Dominico S, Kasanga M, Jamadini F, Maokola K, Mawala D, Abel Z, Rumanyika R, Nzabuhakwa C, van Roosmalen J. Introducing eHealth strategies to enhance maternal and perinatal health care in rural Tanzania. Matern Health Neonatol Perinatol 2017; 3:3. [PMID: 28116114 PMCID: PMC5244514 DOI: 10.1186/s40748-017-0042-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, eHealth has attracted considerable attention as a means of supporting maternal and perinatal health care. This article describes best practices, gains and challenges of implementing eHealth for maternal and perinatal health care in extremely remote and rural Tanzania. METHODS Teleconsultation for obstetric emergency care, audio teleconferences and online eLearning systems were installed in ten upgraded rural health centres, four rural district hospitals and one regional hospital in Tanzania. Uptake of teleconsultation and teleconference platforms were evaluated retrospectively. A cross sectional descriptive study design was applied to assess performance and adoption of eLearning. RESULTS In 2015 a total of 38 teleconsultations were attended by consultant obstetricians and 33 teleconferences were conducted and attended by 40 health care providers from 14 facilities. A total of 240 clinical cases mainly caesarean sections (CS), maternal and perinatal morbidities and mortalities were discussed and recommendations for improvement were provided. Four modules were hosted and 43 care providers were registered on the eLearning system. For a period of 18-21 months total views on the site, weekly conference forum, chatroom and learning resources ranged between 106 and 1,438. Completion of learning modules, acknowledgment of having acquired and utilized new knowledge and skills in clinical practice were reported in 43-89% of 20 interviewed health care providers. Competencies in using the eLearning system were demonstrated in 62% of the targeted users. CONCLUSIONS E-Health presents an opportunity for improving maternal health care in underserved remote areas in low-resource settings by broadening knowledge and skills, and by connecting frontline care providers with consultants for emergency teleconsultations.
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Affiliation(s)
- Angelo Nyamtema
- Thamini Uhai Program, Dar es Salaam, Tanzania.,Tanzanian Training Centre for International Health, Ifakara, Tanzania.,Saint Francis University College for Health and Allied Sciences, Ifakara, Tanzania
| | | | | | | | | | | | | | - Zabron Abel
- Tanzanian Training Centre for International Health, Ifakara, Tanzania
| | - Richard Rumanyika
- Thamini Uhai Program, Dar es Salaam, Tanzania.,Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Calist Nzabuhakwa
- Thamini Uhai Program, Dar es Salaam, Tanzania.,Maweni Regional Hospital, Kigoma, Tanzania
| | - Jos van Roosmalen
- Thamini Uhai Program, Dar es Salaam, Tanzania.,Leiden University Medical Centre, Leiden, The Netherlands.,Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
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Abstract
While the past decades have seen a dramatic increase in the number of women who gamble and develop consequent problems, treatment services are being underutilized in Ontario. This pilot study explores the feasibility of using web- and phone-based group interventions to expand services available for women who might not otherwise seek or be able to access treatment. Distinct treatment considerations for working with women, such as the value of a women’s group, advantages of phone counselling, and the implementation of modern web-based services, were reviewed. The study involved a clinician-facilitated group that used teleconferencing and webinar technology (Adobe Connect) for support and discussion, and a Tutorial Workbook (TW) developed specifically to address the issues and treatment needs of women who gamble at a problematic level. A mixed method analysis used to evaluate the results suggested that the group-based teleconference/webinar approach provided a much-needed means of treatment support for women. Participants reported that the program helped them to understand their gambling triggers, to improve their awareness, to feel better about themselves, to modify their mood and anxiety levels, to feel less isolated, to address their relationships, and to feel more hopeful for the future. The Tutorial Workbook, which was used to supplement the educational component of the group interaction, was highly rated.
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