Alternative Modes Of Delivery Research Articles

Feasibility of telemedicine in maintaining follow-up of orthopaedic patients and their satisfaction: A preliminary study

BackgroundThe current COVID-19 pandemic has implications on the morbidities of orthopedic patients due to lack of routine follow-ups, and inpatient and outpatient-based interventions. Telemedicine has recently emerged as an alternative for healthcare delivery to the patients and providing them with important information about orthopedic self-care and medications that can be followed without a hospital visit. However, due to lack of physical assessment, telemedicine is bound to have some limitations as well. The aim of this study is to analyze the effectiveness of proactive telemedicine in maintaining follow-up of orthopedic patients, and their satisfaction with telemedicine as an alternative mode of treatment delivery. MethodsThis one-month cross-sectional study enrolled the follow-up patients that visited the orthopedic outpatient-department in February 2020. The patients were sequentially called according to the order of their registration, on a daily basis. Consenting patients were provided with telemedicine-based consultations, and those requiring physical evaluation were called for outpatient visits after documenting the valid reasons. The response-rates and the volume of patients requiring physical visits were measured for different diagnosis-based groups. Patients were asked to complete a questionnaire that included overall patient satisfaction with telemedicine, its effectiveness, and ease in following the telemedicine-based treatment. ResultsThe response rate to telemedicine was 88.67%. Among the patients availing telemedicine, 71.43% were managed without needing physical visits to the outpatient-department. The need for physical examination and failed patient-doctor communication were the most common reasons for advising physical outpatient visits. The overall satisfaction-rate to telemedicine was 92%, and only 7.2% of patients had difficulty in understanding or following telemedicine-based advice. ConclusionsTelemedicine can effectively reduce the need for physical visits to outpatient-departments for follow up of orthopedic patients. The response-rate and overall patient-satisfaction rates to telemedicine are high. Further efforts in expanding the use of telemedicine and addressing its limitations, especially those related to the failed communications, are needed to develop it as an alternative to physical orthopedic consultations in the current situation.

A feasibility investigation of mindfulness-based cognitive therapy for people with Huntington\u2019s disease

BackgroundHuntington’s disease (HD) is an inherited neurodegenerative condition which affects movement, coordination and cognitive functioning. Psychological difficulties are commonly experienced; however, psychological interventions have been little researched with this population. We investigated the feasibility of conducting a randomised controlled trial (RCT) of mindfulness-based cognitive therapy (MBCT) with people with the HD genetic mutation, either pre-manifest (before onset of movement symptoms) or at an early disease stage. Specifically, we evaluated the willingness of participants to be recruited into and complete the intervention; the acceptability of the study measures in relation to completion; the feasibility of offering the standard MBCT course to people with HD; the acceptability of the intervention and the estimated effect sizes.MethodsParticipants were recruited from two UK HD centres and took part in an 8-week course of MBCT, with three reunions throughout the following year. Stress, depression, anxiety, and mindfulness were measured pre-, mid-, and post-course, at 3 months and at 1 year. Sleep, quality of life, positive affect and coping were measured pre- and post-course, at 3 months and at 1 year. Descriptive data and approximate effect sizes were calculated. Interviews were conducted post-course and at 1 year and data pertaining to the acceptability of the course were extracted.ResultsTwelve participants took part in two groups; all were pre-manifest. Levels of depression and anxiety were low pre-course leaving little room for improvement. Changes in stress and in some aspects of mindfulness were medium to large. The qualitative data suggested participants rated the course highly and found it helpful and no changes to the standard course were needed. Recruitment levels were below those anticipated. Most measures were found to be acceptable.ConclusionsAlthough the course was acceptable to those who took part, given the difficulties in recruiting and the rarity of HD, conducting an RCT of MBCT teaching groups in person does not seem feasible. However, alternative modes of course delivery (e.g. online) would allow the recruitment of people from a greater geographical area and may make an RCT feasible; this revised focus would be suitable for future feasibility studies.Trial registrationClinicalTrials.gov identifier NCT02464293, registered 8 June 2015.

Making Audiology Work During COVID-19 and Beyond

Making Audiology Work During COVID-19 and Beyond

Indoor use of attractive toxic sugar bait in combination with long-lasting insecticidal net against pyrethroid-resistant Anopheles gambiae: an experimental hut trial in Mb\xe9, central C\xf4te d\u2019Ivoire

BackgroundIndoor attractive toxic sugar bait (ATSB) has potential as a supplementary vector-control and resistance-management tool, offering an alternative mode of insecticide delivery to current core vector-control interventions, with potential to deliver novel insecticides. Given the high long-lasting insecticidal bed net (LLIN) coverage across Africa, it is crucial that the efficacy of indoor ATSB in combination with LLINs is established before it is considered for wider use in public health.MethodsAn experimental hut trial to evaluate the efficacy of indoor ATSB traps treated with 4% boric acid (BA ATSB) or 1% chlorfenapyr (CFP ATSB) in combination with untreated nets or LLINs (holed or intact), took place at the M’bé field station in central Côte d’Ivoire against pyrethroid resistant Anopheles gambiae sensu lato.ResultsThe addition of ATSB to LLINs increased the mortality rates of wild pyrethroid-resistant An. gambiae from 19% with LLIN alone to 28% with added BA ATSB and to 39% with added CFP ATSB (p < 0.001). Anopheles gambiae mortality with combined ATSB and untreated net was similar to that of combined ATSB and LLIN regardless of which insecticide was used in the ATSB. The presence of holes in the LLIN did not significantly affect ATSB-induced An. gambiae mortality. Comparative tests against pyrethroid resistant and susceptible strains using oral application of ATSB treated with pyrethroid demonstrated 66% higher survival rate among pyrethroid-resistant mosquitoes.ConclusionIndoor ATSB traps in combination with LLINs enhanced the control of pyrethroid-resistant An. gambiae. However, many host-seeking An. gambiae entering experimental huts with indoor ATSB exited into the verandah trap without sugar feeding when restricted from a host by a LLIN. Although ATSB has potential for making effective use of classes of insecticide otherwise unsuited to vector control, it does not exempt potential selection of resistance via this route.

THE CALLA-BASED ELENA MODEL FOR LINGUISTICS: DOES IT WORK?

This paper is aimed to describe the implementation of the CALLA-based ELENA model for introduction to linguistics course in the English Department of Universitas Negeri Semarang (UNNES). The research was conducted through descriptive analysis. The analysis of data is the impact of the implementation of the model for the Introduction to linguistics course. Data of the study were collected through observation, questionnaires, and tests. The result of the study shows that using the model can provide the learners' comprehension in learning linguistics concepts. Further, that model has emerged as one of the alternative modes of instruction delivery in the concept of linguistics. This research finding can be used to review current online learning model trends and to explore potential research directions.

Modeling the Factor Constructs Affecting the Integration of Technology in Classroom Instruction

Researchers in educational technology integration for teaching demonstrate that teachers often use technology to motivate students and as an alternative mode of lesson delivery. The present study aimed to find the underlying factor constructs on the reasons of teachers on why they would integrate technology into their teaching practices. Results of the study using exploratory factor analysis generated nine factors representing 69.45% of the total variability of the data with a mean communality value of 0.7025, KMO of 0.910 and Bartlett’s test of sphericity of p&lt;0.001, indicative of a good model fit and high discriminant validity of the subscales. Internal consistency measures also indicated good to excellent alpha levels demonstrating high reliability and convergent validity of the subscales. Results of the study found that the teachers’ reasons for adopting technology are more complex and differentiated than what previous researchers have thought contradicting earlier theorists of the phenomenon. Results also showed that the derived factor constructs imply the teachers’ pragmatic preferences for using technology. Keywords : Modeling, teaching with technology, exploratory factor analysis, Cronbach’s alpha, factor constructs

Assessment of the aerosol distribution pattern of a single-port device for intraperitoneal administration of therapeutic substances.

In the last 20years, intraperitoneal chemotherapy (IPC) has been explored as a modality for the management of peritoneal metastases of gynecologic, gastrointestinal, and primary peritoneal tumors. Direct delivery of chemotherapeutic agents to the peritoneal cavity space has proved superior to systemic chemotherapy when evaluating characteristics such as drug concentration reached in the peritoneal space, penetration into peritoneal metastases, and chemotherapy-related toxicity. Traditionally, IPC is delivered by peritoneal lavage with a liquid solution. This form of delivery has limitations, including inhomogeneous intraperitoneal distribution and limited ability to penetrate tissues and metastatic nodules. An alternative mode of delivery is so-called pressurized intraperitoneal aerosol chemotherapy (PIPAC). Within this context, the present study sought to identify the pattern of spatial distribution of therapeutic solutions aerosolized into the peritoneal space using a single-port PIPAC device and ascertain whether the aerosolized method is superior to the traditional (liquid) mode of IPC delivery. Analysis of the rate of intra-abdominal staining with aerosolized 2% silver nitrate in five porcine models. Assessment of differences in stain impregnation between the upper, middle, and lower abdomen did not reveal significant differences (p = 0.42). The median sum scores were 1 for the upper abdomen and 3 for the middle and lower abdomen. Aerosolization does not reach all regions of the abdomen homogeneously. However, adequate exposure of the upper abdomen, mid-abdomen, and lower abdomen to chemotherapeutic agents can be achieved with PIPAC.

Competency‐based education: Multiple approaches‐a single institution

AbstractThe purpose of this paper was to describe the development of two competency‐based curricula for existing programs at the largest community college with single accreditation serving nearly 160,000 students each year. Utilizing a competency framework and industry partners, program level and students level outcomes were defined to adequately prepare students to meet industry needs. Although the programs were developed and assessed differently, each captured the spirit of competency‐based education, which is to provide a flexible learning environment focusing on mastery of academic content through assessments, regardless of time, pace, or place of learning. This paper identifies how a single institution that already provides a variety of alternative delivery modes to meet student needs can successfully develop competency‐based initiatives in two very different ways. The development effort was realized through exemplary partnerships with local businesses, industries, and other educational institutions. Although the development of the content was completed and piloted, events related to the learning management platform's availability along with difficulties in administering the program, due to exceptions in procedure, resulted in an indefinite suspension of the program. The paper further discusses the need for capital, administrative support, and an understanding of processes and approvals of accrediting organizations and the Department of Education.

What matters to people with chronic conditions when accessing care in Australian general practice? A qualitative study of patient, carer, and provider perspectives

BackgroundResearch underpinning the patient experience of people with chronic conditions in Australian general practice is not well developed. We aimed to ascertain the perspectives of key stakeholders on aspects of patient experience, more specifically with regards to accessing general practice in Australia.MethodsUsing a qualitative design, semi-structured interviews were conducted by telephone and face-to-face with people living with one or more chronic conditions, informal carers, and primary care providers between October 2016 and October 2017. Participants were recruited and selected from three demographically representative primary health networks across Sydney, Australia. Interview transcripts and researcher’s reflective fieldnotes were coded and analyzed for key themes of access. Analysis and interpretation of data were guided by Levesque’s model of access, a conceptual framework to evaluate access broadly and from corresponding patient- and provider-side dimensions.ResultsA total of 40 interviews were included in the analysis. Most participants had attended their general practices for 10 years or more and had regular primary care providers. People with chronic conditions reported access barriers predominantly in their ability to reach services, which were related to illness-related disabilities (limited mobility, chronic pain, fatigue, frailty) and limitations in the availability and accommodation of health services to address patient preferences (unavailability of after-hours services, lack of alternative modes of service delivery). While cost was not a major barrier, we found a lack of clarity in the factors that determined providers’ decisions to waive or reduce costs for some patients and not others.ConclusionsPeople managing chronic conditions with a long-term primary care provider experienced access barriers in general practice, particularly in their ability to physically reach care and to do so on a timely basis. This study has important policy and practice implications, as it highlights patients’ experiences of accessing care and possible areas for improvement to appropriately respond to these experiences. Themes identified may be useful in the design of a patient experience survey tool specific to this population. While it incorporates perspectives from patients, carers and providers, this study could be further strengthened by including perspectives from culturally and linguistically underrepresented patient groups and more carers.

Pseudo-Broadcast: An Alternative Mode of Vehicular Communication for Platooning

The platooning application has a significantly higher safety messaging rate requirement that could threaten harmonious coexistence with nearby non-platoon vehicles. We explore an alternative delivery mode for platoon communication in order to address the issue. The proposed mode is called pseudo-broadcast, since it emulates broadcast using unicast. In pseudo-broadcast, the platoon member with the worst reception condition is designated as the destination of the unicast from the leader vehicle. Then other platoon members promiscuously receive the unicast packet. And vice versa, the messages from the platoon followers to the leader are pseudo-broadcast to the leader. The unicast transmission in pseudo-broadcast allows timely retransmission, which is not possible with broadcast. It not only improves the reliability of platoon communication, but also helps minimize the additional beaconing activity in meeting the required latency bound. Consequently, it lessens the abusive bandwidth impact on the non-platoon vehicles in the vicinity, fostering harmonious coexistence. To the best of our knowledge, this is the first work that looks in detail into the question of coexistence between platooning vehicles and others sharing the same channel, and also provides some first insights into its quantitative effects.

Five Years of Successful Inducible Transgene Expression Following Locoregional Adeno-Associated Virus Delivery in Nonhuman Primates with No Detectable Immunity.

Anti-transgene immune responses elicited after intramuscular (i.m.) delivery of recombinant adeno-associated virus (rAAV) have been shown to hamper long-term transgene expression in large-animal models of rAAV-mediated gene transfer. To overcome this hurdle, an alternative mode of delivery of rAAV vectors in nonhuman primate muscles has been described: the locoregional (LR) intravenous route of administration. Using this injection mode, persistent inducible transgene expression for at least 1 year under the control of the tetracycline-inducible Tet-On system was previously reported in cynomolgus monkeys, with no immunity against the rtTA transgene product. The present study shows the long-term follow-up of these animals. It is reported that LR delivery of a rAAV2/1 vector allows long-term inducible expression up to at least 5 years post gene transfer, with no any detectable host immune response against the transactivator rtTA, despite its immunogenicity following i.m. gene transfer. This study shows for the first time a long-term regulation of muscle gene expression using a Tet-On-inducible system in a large-animal model. Moreover, these findings further confirm that the rAAV LR delivery route is efficient and immunologically safe, allowing long-term skeletal muscle gene transfer.

Feasibility of a mindful yoga program for women with metastatic breast cancer: results of a randomized pilot study.

Patients with metastatic breast cancer (MBC) experience high levels of symptoms. Yoga interventions have shown promise for improving cancer symptoms but have rarely been tested in patients with advanced disease. This study examined the acceptability of a comprehensive yoga program for MBC and the feasibility of conducting a randomized trial testing the intervention. Sixty-three women with MBC were randomized with a 2:1 allocation to yoga or a support group comparison condition. Both interventions involved eight weekly group sessions. Feasibility was quantified using rates of accrual, attrition, and session attendance. Acceptability was assessed with a standardized self-report measure. Pain, fatigue, sleep quality, psychological distress, mindfulness, and functional capacity were assessed at baseline, post-intervention, and 3 and 6months post-intervention. We met goals for accrual and retention, with 50% of eligible patients enrolled and 87% of randomized participants completing post-intervention surveys. Sixty-five percent of women in the yoga condition and 90% in the support group attended ≥ 4 sessions. Eighty percent of participants in the yoga condition and 65% in the support group indicated that they were highly satisfied with the intervention. Following treatment, women in the yoga intervention had modest improvements in some outcomes; however, overall symptom levels were low for women in both conditions. Findings suggest that the yoga intervention content was highly acceptable to patients with MBC, but that there are challenges to implementing an intervention involving eight group-based in-person sessions. Alternative modes of delivery may be necessary to reach patients most in need of intervention.

Formal versus informal: Insights into the credit transactions of small-scale fishers along the south west coast of India

This paper closely scrutinizes the diverse credit transactions undertaken by small-scale fishers along the South West coast of India, based on a field-level survey carried out in the maritime State of Kerala. The study describes alternative modes of fishery credit delivery in the State and explores the tangled inter-linkages in the formal and informal credit contracts. Further, empirical assessment of borrowing pattern of small-scale fishers is conducted by taking the case of ring seiners who constitute an important segment in the local fishery. The main determinants of their borrowing behavior from institutional credit sources are identified using a fractional logit regression approach. The findings point to continuing dominance of the informal financial sector over the institutional credit sector. In the light of the findings, measures such as reforming the fish auction system, linking insurance with formal credit, further strengthening of fishery co-operative societies and exercising stringent state control to curb exploitative lending practices are suggested.

EFFICACY OF A TECHNOLOGY-ENABLED, HOME-BASED CARDIAC REHABILITATION PROGRAM

Despite strong evidence for cardiac rehabilitation (CR) in secondary prevention of CVD, uptake rates are poor and long-term adherence rates are low. Home-based, technology enabled, CR has been advocated as an alternative mode of delivery for community-based CR. PATHway (Physical Activity Towards

Advancing the Use of CGM Devices in a Non-ICU Setting.

Improvements in glycemic control using continuous glucose monitoring (CGM) systems have been demonstrated in the outpatient setting. Among hospitalized patients the use of CGM is largely investigational, particularly in the non-ICU setting. Although there is no commercially available closed-loop system, it has recently been evaluated in the non-critical care setting. Both CGMs and closed-loop systems may lead to improved glycemic control, decreased length of stay, reduced risk of adverse events related to severe hypoglycemia or hyperglycemia. Limitations of inpatient use of CGM and closed-loop systems include lack of FDA approvals, inexperience with this technology, and costs related to supplies. Significant investment may be necessary for hospital staff training and for development of infrastructure to support inpatient use. Additional limitations for CGM systems includes potential inaccuracy of interstitial glucose measurements due to medication interferences, sensor lag, or sensor drift. Limitations for closed-loop systems also includes need for routine monitoring to detect infusion site issues as well as monitoring to ensure adequate insulin supply in reservoir to avoid abrupt cessation of insulin infusion leading to severe hyperglycemia. Hospital staff must be familiar with trouble-shooting and conversion to alternative mode of insulin delivery in the event of insulin pump malfunction. Given these complexities, implementation of closed-loop systems may require involvement of an endocrinology team, limiting widespread adoption. This article reviews current state of CGM and closed-loop system use in the non-ICU setting, available literature, advantages and limitations, as well as suggestions for future CGM design, specifically for the inpatient setting.

Factors influencing use of telegenetic counseling: perceptions of health care professionals in Sweden

Genetic counseling services are increasing in demand and limited in access due to barriers such as lack of professional genetic counselors, vast geographic distances, and physical hurdles. This research focuses on an alternative mode of delivery for genetic counseling in Sweden, in order to overcome some of the mentioned barriers. The aim of this study is to identify factors that influence the implementation and use of telegenetic counseling in clinical practice, according to health care professionals in Southeast Sweden. Telegenetic counseling refers to the use of video-conferencing as a means to provide genetic counseling. Qualitative, semi-structured interviews with 16 genetic counseling providers took place and phenomenographic analysis was applied. Significant excerpts were identified in each transcript, which led to sub-categories that constructed the main findings. Three categories emerged from the data: (1) requirements for optimal use, (2) impact on clinical practice, and (3) patient benefits. Each category consists of two or three sub-categories, in total seven sub-categories. These findings could potentially be used to improve access and uptake of telegenetic counseling in Sweden and in other countries with a similar health care system. This could benefit not only remote patient populations, as described in previous research, but also large family groups and patients experiencing obstacles in accessing genetic counseling, such as those with a psychiatric illness or time constraints, and be a useful way to make genetic counseling available in the new era of genomics.

Post-surgical continuity of care from home using social media in a resource limited country

This study was conducted to analyse if in a resource constraint country, social media can provide a feasible, acceptable and cost effective mode of surgical care in post-operative period? This was a prospective study conducted at Department of Endocrine Surgery, SGPGIMS, Lucknow, India. Total 102 post thyroidectomy patients were offered to choose follow up care either by conventional face to face follow up or remotely through social media (Skype®). Data was analysed using IBM SPSS statistics version 22.0. 76 (74.5%) patients had internet facilities. Out of these 51 (50%) patients opted for conventional follow up whereas 25 (24.5%) patients consented for tele-follow up using social media. Distance from the treating hospital was the significant factor for acceptance of tele-follow up. In tele-follow up group majority of patients (84%) possessed graduate or postgraduate degree, postulating role of education. Average cost and work days saving per visit was $68 and 4.4 days respectively with mean satisfaction score of 4.51 ± 0.601. Even in resource constrained countries, social media can provide an alternative mode of healthcare delivery.

Post-surgical continuity of care from home using social media in a resource limited country

This study was conducted to analyse if in a resource constraint country, social media can provide a feasible, acceptable and cost effective mode of surgical care in post-operative period? This was a prospective study conducted at Department of Endocrine Surgery, SGPGIMS, Lucknow, India. Total 102 post thyroidectomy patients were offered to choose follow up care either by conventional face to face follow up or remotely through social media (Skype®). Data was analysed using IBM SPSS statistics version 22.0. 76 (74.5%) patients had internet facilities. Out of these 51 (50%) patients opted for conventional follow up whereas 25 (24.5%) patients consented for tele-follow up using social media. Distance from the treating hospital was the significant factor for acceptance of tele-follow up. In tele-follow up group majority of patients (84%) possessed graduate or postgraduate degree, postulating role of education. Average cost and work days saving per visit was $68 and 4.4 days respectively with mean satisfaction score of 4.51 ± 0.601. Even in resource constrained countries, social media can provide an alternative mode of healthcare delivery.

The Effectiveness of Adopting E-learning as a Model of Education in Higher Education: Evaluation Study

E-Learning arises as one of the alternate modes of instruction delivery. Therefore, connecting e-learning with traditional modes of learning become a priority for higher educational institutions. Hence, it is of prior importance for researchers to determine the student’s perception of e-Learning in order to assess the effectiveness of such a new education model. This study aims at investigating the effectiveness of adopting e-learning as a model of education in higher education by evaluating the readiness, advantages, and disadvantages from student’s perception. Reviews of research efforts in the field of e-learning within the context of its effectiveness are given. Next, the methodology to be used is proposed. This is followed by a summary of the data analysis and finally the conclusions. The study was conducted in the college of business at Umm Al-Qura University, Saudi Arabia. The study adopted a descriptive methodological approach to aim its methodology. Research findings revealed that students’ skills in dealing with MS office application are the most important parameter that measuresstudent’s readiness to accept the e-learning model of education. Also, students find that natural interaction with professors is the most significant advantage. Finally, respondents agreed that the worst disadvantage of e-learning was the unfair opportunity to those students who are good in presenting themselves orally but lack the ability to express their opinions in writing.

Symposium report on "Examining the Changing Landscape of Course Delivery and Student Learning": Experimental Biology 2017.

An APS Teaching Section symposium entitled "Examining the Changing Landscape of Course Delivery and Student Learning" was offered at the Experimental Biology conference on April 24th, 2017, in Chicago, IL. The symposium focused on alternative delivery modes of physiology education, from undergraduate to professional programs. Lecture used to be the gold standard and proven method by which students learned, but the course delivery method is rapidly changing. While there is still significant skepticism about the quality and level of student engagement in online learning, it is being offered widely due to increased demand and due to other benefits, such as the flexibility and convenience. Universities with several campuses may now synchronize lectures between campuses, utilizing video conference technology, thus bypassing the need for instructors on each campus. Other modes of delivery include online lectures with laboratories scheduled on campus. Offering biology laboratories online is on the rise but to counter skepticism, more studies are needed to demonstrate that online laboratories effectively meet laboratory objectives. The Massive Open Online Course (MOOC) offers many courses for free and challenges the role of universities. Assessment of the effectiveness of MOOCs and online courses is critical, as some of the concerns raised about them include level of student engagement in learning and the social aspect of interaction with peers and faculty.