Clinical Sessions Research Articles

Verbal interaction pattern analysis in clinical psychology.

Recent developments in pattern analysis research have made this methodology suitable for the study of the processes that are set in motion in psychological interventions. Outcome research, based on the comparison between clinical results from treatment and control groups, has leveraged our empirical knowledge about the efficacy of psychological interventions. However, these methods of research are not precise enough for the analysis of these processes. On the contrary, pattern analysis could be a powerful tool to study moment-to-moment interactions typical of psychological interventions. This is methodology is relevant because clinical psychology is experiencing a paradigm shift from a protocol for syndrome perspective to a principle-based and person-centered intervention. This evidence-based, theory-grounded, and process-oriented paradigm of clinical intervention needs new research methods to thrive (i.e., pattern analysis). The analysis of the therapeutic relationship built into the verbal interaction between the clinician and the client is one of the cornerstones of this new era of research. So, the purpose of this article is three-fold: (1) to discuss the role of the verbal interaction pattern analysis in the clinical context to the development of the principle-based clinical psychology, (2) to analyze the patterns of verbal interaction in a clinical case, and (3) to compare the results using two different methods. To reach these purposes, using the observational methodology, we have coded the verbal interaction of 16 clinical sessions with a person diagnosed with a borderline personality disorder. We have analyzed the data using sequential analysis (GSEQ) and pattern recognition algorithms (i.e., T-Pattern detection). We have been able to detect typical patterns during different phases of psychological intervention (i.e., evaluation, explanation, treatment, and consolidation). Finally, the conceptual, methodological, and empirical implications of this study will be discussed within the realms of pattern analysis research and principle-based clinical psychology.

The Ergonomic Knowledge and Practice of Dental Students in a Tertiary Institution in South Africa.

Proper ergonomic practices are crucial practices to be considered when working on dental patients, and are often neglected during the dental students' training. We aimed to assess the dental students' knowledge of ergonomics as well the prevalence of their musculoskeletal pain. Methods. A cross sectional analytical study was conducted at a dental school in South Africa. The sample included all senior dental, and dental hygiene students registered in the 2021 academic year. A modified questionnaire using an online platform assessed the student's level of practical and theoretical knowledge of ergonomics; their personal assessment of their competency in implementing ergonomics; and their prevalence of musculoskeletal pain. The knowledge scores were calculated to determine the overall scores. Data was analysed using the Statistical Package for the Social Sciences (SPSS). Ethical clearance was obtained from the Faculty Ethical Committee and all information was anonymous. Results. The response rate was 52% (n = 106), the mean knowledge score was 68%, and 53% reported to be able to successfully implement their ergonomic knowledge practically. The prevalence of musculoskeletal pain increased from 32% prior to entering dental school to 78% during dental school. Pain was most commonly reported to be on the back (77%), neck (51%), and shoulders (51%). Conclusion. The majority of students had an average level of knowledge regarding ergonomic principles, however, the practical application was poor. Many students reported to have suffered from back pain which seemed to have started since treating patients. The supervisors should educate and assist students to practice healthy ergonomic postures during clinical and pre-clinical sessions.

Current and future trends in the teaching of removable partial dentures in dental schools in Malaysia: A cross sectional study

AimsTo investigate, using a validated questionnaire, the teaching of removable partial dentures (RPDs) in dental schools of Malaysia. Materials and methodsA validated questionnaire to investigating trends in the teaching of RPDs in dental schools in Oceania was emailed (in English version form) to Heads of Restorative/Prosthodontics/course coordinators in the 13 dental schools in Malaysia. Follow-up reminders were sent and participants were given six weeks to complete and return the questionnaire. Data was entered into an Excel spreadsheet and results compiled and analyzed. ResultsCompleted questionnaires were received from 13 dental school – a 100% response rate. All schools (n = 13) provided a preclinical technical course in RPD design. In most schools (n = 9, 69.2%), course work was supervised by senior lecturers while rest of the institutions made use of associate professor/professors. There were significant differences (p<0.05) between dental schools in terms of the contact hours dedicated to preclinical teaching. Students received an average of 62 h of instruction. Didactic instruction was the primary focus with practical (78 h) and didactic teaching (32 h). All dental schools (n = 13) provided practical surveyor design teaching (8 h). The staff student ratio for formal lectures (1:61), tutorials (1:29) and lab demonstrations (1:12) were recorded. Majority of the schools (n = 11, 84.6%) employed paired teaching in clinical sessions. All schools (n = 13, 100%) emphasized on increased teaching of RPD design and prescription writing in future clinical RPD courses. ConclusionTeaching of RPDs in Malaysia may be considered sufficient and comparable to the teaching in other parts of the world. Clinical significanceWhilst the teaching of partial dentures at Dental Schools in Malaysia provides the core competencies involved in partial denture design and construction based on sound fundamental, scientific principles they should address the challenges of teaching partial dentures and other areas of dental education including improving working conditions for dental professionals.

Iraqi senior medical students’ attitude toward the effect of COVID-19 on clinical sessions and e-learning

Background: During the pandemic of COVID 19, several colleges throughout the world either delayed or canceled their activities to minimize the risk of virus transmission. However, these measures had high medical and social impacts on both undergraduate and postgraduate students. The aim of the current study was to measure the attitude of medical students at 5th and 6th study levels for e-learning and clinical training during the pandemic. Methods: A cross-sectional study was done from May to June 2021. A multistage sampling technique was used to collect the sample. A self-administered questionnaire was developed through reviewing the literature and was modified to be useful for the local culture. Results: The total number of participants was 417 from different Iraqi universities, females consisted 56.6% of them, and the mean age was 23.94 ± 1.06. The results revealed that 55% of the participants generally agreed with the opinion that combined learning was a collaborative system, which provided a facility of learning through communication skills. About half of the Iraqi medical students stated that “their medical education and training had been significantly disrupted during the pandemic”; 39% of them approved the statement “in comparison to period prior COVID-19 pandemic, my medical performance in final clinical exam was decline”. Conclusion: The pandemic status had a considerable negative effect on medical training, motivation, and intellectual abilities of Iraqi medical students at final study levels. However, online teaching provided a new opportunity of learning for medical students.

Kinematics-Based Lower Limb Rehabilitation Monitoring Following Partial Knee Meniscectomy: Case Study.

Physiotherapy includes treatment to restore and optimize mobility after surgery, injury, disease, and/or degeneration. Based on assessments throughout the recovery process from visual observations of movement, exercises are prescribed to perform at home between clinic sessions. Although technical advances have facilitated remote communication between therapists and patients, accurate assessment of at-home exercises is challenged by a lack of direct observation. The current study advances remote assessment tools to assess key lower body exercises prescribed in a case study following recovery from arthroscopic partial meniscectomy (APM). Using Vicon motion capture, recovery metrics related to range of motion, strength, and gait function were extracted. Peak knee flexion angle on the operated leg during heel slide increased from 91.61° ± 4.17° to 127.42° ± 2.35° (p<0.05), although significant differences were found compared to the non-operated leg at Day 6 (138.19° ± 5.44°, p<0.05). Repetition times in heel slide and leg raise exercises on the affected leg decreased from Day 2 (2.74s) to Day 6 (1.07s), indicating strength recovery. Step length asymmetry decreased by 61.22% and step width asymmetry decreased by 41.75% from Day 2 to Day 6 post surgery, demonstrating improved gait function. This work presents a sample of automated recovery metrics that can be used for therapists to assess rehabilitation and inform the recovery process. Implications of the study findings on remote assessment using wearables are discussed. This work presents kinematics based quantifiable lower limb rehabilitation metrics to assess recovery objectives (e.g., knee flexion angle to assess knee range of motion) used by clinicians to inform recovery remotely.

Health-Related Quality of Life Among Members Using an On Demand Behavioral Health Platform: Pilot Observational Study.

BackgroundDespite the well-known adverse health conditions and negative economic outcomes associated with mental health problems, accessing treatment is difficult due to reasons such as availability and cost. As a solution, digital mental health services have flooded the industry, and new studies are quickly emerging that support their potential as an accessible and cost-effective way to improve mental health outcomes. However, many mental health platforms typically use clinical tools such as the Patient Health Questionnaire-9 (PHQ-9) or General Anxiety Disorder-7 (GAD-7). Yet, many individuals that seek out care do not have clinical symptomatology and thus, traditional clinical measures may not adequately capture symptom improvement in general well-being. As an alternative, this study used the health-related quality of life (HRQoL) tool from the Centers for Disease Control and Prevention “Healthy Days” measure. This subjective measure of well-being is an effective way to capture HRQoL and might be better suited as an outcome measure for treatments that include both clinical and subclinical individuals.ObjectiveThe purpose of this study was to describe changes in HRQoL in clinical and subclinical members assessing virtual care and to examine the association between text-based behavioral coaching and virtual clinical sessions with changes in HRQoL.MethodsA total of 288 members completed the 4-item HRQoL measure at baseline and at 1 month following use of the Ginger on demand behavioral health platform. Baseline anxiety and depression levels were collected using the GAD-7 and PHQ-9, respectively.ResultsMembers completed on average 1.92 (SD 2.16) coaching sessions and 0.91 (SD 1.37) clinical sessions during the assessment month. Paired samples t tests revealed significant reductions in the average number of unhealthy mental health days between baseline (mean 16, SD 8.77 days) and follow-up (mean 13.2, SD 9.02 days; t287=5.73; P<.001), and in the average number of days adversely impacted (meanbaseline 10.9, meanfollow-up 8.19; t287=6.26; P<.001). Both subclinical members (t103=3.04; P=.003) and clinical members (t183=5.5; P<.001) demonstrated significant improvements through reductions in adversely impacted days over a month. Clinical members also demonstrated significant improvements through reductions in unhealthy mental health days (t183=5.82; P<.001). Finally, member engagement with virtual clinical sessions significantly predicted changes in unhealthy mental health days (B=–0.96; P=.04).ConclusionsTo our knowledge, this study is one of the first to use the HRQoL measure as an outcome in an evaluation of a digital behavioral health platform. Using real-world longitudinal data, our preliminary yet promising results show that short-term engagement with virtual care can be an effective means to improve HRQoL for members with subclinical and clinical symptoms. Further follow-up of reported HRQoL over several months is needed.

Blood oxygen level with long-term use of N95 face mask in dental practice during the coronavirus pandemic “Covid-19”

Wearing a mask for a long time, particularly N95, is sometimes uncomfortable, annoying, and confining, making catching breath difficult and reducing the oxygen level in the blood. The study aimed to investigate the change in blood oxygen level when wearing an N95 mask for three hours among dental practitioners in dental clinics and the impact of low O2 levels on the general status of students while working in a stressful environment. Material and methods . The sample included 82 adult healthy senior dental students attending the student oral surgery clinical sessions. All Participants had their oxygen saturation Spo 2 measured using a portable pulse oximeter before, 1hour, 2hours, and 3 hours after wearing the mask, and were allowed to describe their feeling of discomfort throughout the study. Systolic and diastolic blood pressure (SBP and DBP), and heart rate (HR) were also measured before and 3 hours after wearing the mask. Results . 84.15% (n= 69) of the participants reported some discomfort affecting their general status and clinical performance. There was a statistically significant increase in mean heart rate after three hours ( P -value = 0.001) while there was no statistically significant change in mean systolic/diastolic blood pressure after three hours ( P -value = 0.630) and ( P -value=0.407) respectively. On the other hand, the mean Oxygen saturation after three hours showed a statistically significantly lower value compared with baseline measurement. Conclusion . This study revealed a decrease in the oxygen saturation (SpO2) and a slight increase in pulse rate compared to baseline values in all students three hours after wearing an N95 face mask. In addition, the N95 mask induced discomfort in breathing, a decrease in physical performance, and increased fatigue not related to prolonged standing and stress.

Comparison of the Efficacy of Homeopathic Drug Arnica and Ibuprofen on Postextraction Pain in Children: A Triple-blind Randomized Controlled Trial.

AimTo compare the homeopathic drug Arnica with ibuprofen as an analgesic for postextraction pain control in children.Materials and methodsForty-four healthy children between 8 and 12 years of age requiring two clinical sessions of tooth extraction in two different quadrants of the oral cavity were selected for the study. All the children received both the drugs in this crossover trial with a washout of 10 days. Patient-rated and operator-assessed pain was compared to a 10-point validated Visual Analog Scale at baseline, 24, 48, and 72 hours using the paired t-test. Acceptance to taste and frequency of dosing was recorded at the end of three days using a five-point Likert scale and were compared using the Chi-squared test. Kappa statistics were performed to assess intraoperator variability.ResultsPain reduction by Ibuprofen was significantly more than Arnica only at 48 hours with respect to both patient-reported and operator-assessed pain [(t = 3.567, p < 0.05), (t = 2.834, p < 0.05)]. As the age of the child increased, patient-reported pain significantly decreased. Children preferred the taste of Arnica over that of Ibuprofen (x2 = 56.76, p < 0.0001).ConclusionThere was no difference between Arnica and Ibuprofen in the postextraction pain management in 8–12-year-old children.Clinical significanceThe results of this study suggest that Arnica may be considered as an alternative to ibuprofen in managing postextraction pain in 8–12-year-old children, especially those with asthma, COPD, or known allergy to ibuprofen.How to cite this articleThakur JH, Katre AN. Comparison of the Efficacy of Homeopathic Drug Arnica and Ibuprofen on Postextraction Pain in Children: A Triple-blind Randomized Controlled Trial. Int J Clin Pediatr Dent 2022;15(3):332-337.

Blood oxygen level with long-term use of N95 face mask in dental practice during the coronavirus pandemic “Covid-19”

Wearing a mask for a long time, particularly N95, is sometimes uncomfortable, annoying, and confining, making catching breath difficult and reducing the oxygen level in the blood. The study aimed to investigate the change in blood oxygen level when wearing an N95 mask for three hours among dental practitioners in dental clinics and the impact of low O2 levels on the general status of students while working in a stressful environment. Material and methods . The sample included 82 adult healthy senior dental students attending the student oral surgery clinical sessions. All Participants had their oxygen saturation Spo 2 measured using a portable pulse oximeter before, 1hour, 2hours, and 3 hours after wearing the mask, and were allowed to describe their feeling of discomfort throughout the study. Systolic and diastolic blood pressure (SBP and DBP), and heart rate (HR) were also measured before and 3 hours after wearing the mask. Results . 84.15% (n= 69) of the participants reported some discomfort affecting their general status and clinical performance. There was a statistically significant increase in mean heart rate after three hours ( P -value = 0.001) while there was no statistically significant change in mean systolic/diastolic blood pressure after three hours ( P -value = 0.630) and ( P -value=0.407) respectively. On the other hand, the mean Oxygen saturation after three hours showed a statistically significantly lower value compared with baseline measurement. Conclusion . This study revealed a decrease in the oxygen saturation (SpO2) and a slight increase in pulse rate compared to baseline values in all students three hours after wearing an N95 face mask. In addition, the N95 mask induced discomfort in breathing, a decrease in physical performance, and increased fatigue not related to prolonged standing and stress.

Analysis of the Verbal Behaviour of the Physiotherapist in the First Clinical Session

Objective: This paper presents a preliminary study about verbal behaviour of a physiotherapist exploring possibilities of a system of coding verbal behaviour developed before to study verbal behaviour of psychologists Methods: Principal variable verbal behaviour of physiotherapist was coded using Frojan’s the categorization system of the therapist's verbal behaviour (SISC-CVT) that includes several different types of verbal behaviours: discriminative, evocative, reinforcement, punishment, informative, instructional, motivational. Record during a first clinical session of Physical Therapy sample compress seven physiotherapists Results: Regarding inter-rater reliability, Kappa values were modest: very good (1), good (1), moderate (6), weak (7), poor (2). The discriminative category was the most repeated with an average of 71.20 interventions per session, followed by the reinforcement category with an average of 59.05 interventions per session. The less frequency appeared in the results of the evocative category, with an average of 4.4 interventions per session, and of the punitive category, appearing twice for every first 5 clinical sessions Conclusions: This paper presents some preliminary results from a different approach to research verbal behaviour of physiotherapists. Future research need more training of coding to increase reliability. SISC-CVT reveals differences between several physiotherapist We encourage other researchers to continue exploring verbal behaviour of physiotherapists.

PB2361: PREDIGA, EDUCATIONAL AND DIAGNOSIS PROJECT IN ACID SPHINGOMYELINASE DEFICIENCY DISEASE (ASMD) AND GAUCHER DISEASE (GD): RESULTS TO THE OBJECTIVE ACHIEVED OF 200 PATIENTS ANALYZED.

Background: Acid sphingomyelinase deficiency disease (ASMD) and Gaucher disease (GD) are lysosomal disorders caused by deficiency of lysosomal enzymes acid beta-glucosidase and acid sphingomyelinase. These enzyme deficiencies cause accumulation of glucocerebroside and sphingomyelin, respectively, mainly in macrophages, inducing deterioration of the organs in which they accumulate. Theoretical prevalence of ASMD is 0.4 per 100,000 and GD is 1 per 40,000. The absence of epidemiological studies in Spain leads us to believe that ASMD is highly underdiagnosed, and that the incidence of GD data is still to be defined. The consequences of undertreatment and the availability of effective therapies make it increasingly necessary to promote awareness and knowledge of these diseases and their diagnostic algorithms. Aims: The main objective of this study is to identify patients with idiopathic splenomegaly or splenectomy as well as to promote awareness and knowledge of ASMD and GD and their diagnosis algorithm through a national medical education program. Prevalence of ASMD and GD in patients with idiopathic splenomegaly or splenectomy will be also established. Methods: Regarding educational program, the participating centers lead clinical sessions as part of the PREDIGA education program. It was planned to impart about 100 clinical sessions within the medical education program and reach 200 patients fulfilling diagnostic criteria for ASMD and GD in the recruitment process. In addition, PREDIGA project included an epidemiological, clinical, observational, non-interventional, multicenter, retrospective and prospective, cross-sectional with a single cohort study. The study population included adults and children with idiopathic splenomegaly or splenectomy. We performed a retrospective (5 years) and prospective review (2 years) of medical records to detect sustainable patients. In a single visit, the informed consent form was signed and the patient’s clinical data were recorded. We used the usual clinical procedures to collect a blood sample for Dry Blood Spot (DBS) to perform enzymatic, genetic, and biomarkers analyses. The analysis of the samples was performed in the Archimed laboratory using ArchimedLife platform. The diagnostic algorithm for the analysis of the samples included two steps: first, enzymatic analysis was performed and if the result was positive or doubtful, genetic analysis was performed to confirm the positive result for ASMD or GD. In addition, samples which results were positive for ASMD or GD were subjected to analysis of the biomarkers Lyso-Gl1 or Lyso-SM. Results: 52 HCPs (22 Hematologists/ 18 Internal Medicine/ 12 Pediatricians) from 34 hospitals had implemented the medical education program and epidemiological searching in their health area of influence for 2 consecutive years. To date, 49 educational sessions, on-site and virtual, have been held by research team with 1000 assistants. A total of 206 patients’ blood samples have been collected to perform a DBS. Results to date have revealed the diagnosis of 2 ASMD and 4 GD patients derived from the epidemiological program. Thanks to implementation of this educational program 2 ASMD and 1 GD patients were diagnosed. Therefore, in this study the prevalence of ASMD and GD in patients with idiopathic splenomegaly or splenectomy is 0.97% and 1.9% respectively. Summary/Conclusion: The medical educational plan and the epidemiological study derived of this project have increased awareness of these conditions allowing the diagnosis of new ASMD and GD patients and better define the prevalence of these diseases in this cohort.

Predicting the Outcome of a Pregnancy of Unknown Location: What Can the Endometrial Stripe Thickness Reveal?

Objective: To investigate the role of the uterine endometrial thickness and sonographic pattern as potential predictors for a pregnancy with an unknown location (PUL) and its possible outcomes. Materials and Methods: A convenient sample of 330 symptomatic extra preposition female patients were enrolled in this study with a diagnosis of PUL. The clinical variables of endometrial stripe thickness and endometrial sonographic pattern were determined with transvaginal sonography. These sonographic examinations (it seems that examination in this context is a countable noun) were conducted during the first 24 hours of referral, and their predictive values for PUL outcomes (normal intrauterine pregnancy (IUP), ectopic pregnancy (EP), and pregnancy loss) were assessed after clinical follow-up sessions provided a definite outcome. The statistical significance was set a priori at a P value &lt; .05. Results: The mean initial endometrial stripe thickness among participants, with a normal IUP, was more than those patients with an abnormal pregnancy outcome ( P &lt; .05). The optimum cut-off value for predicting a an EP, compared to a normal IUP was 11 mm and had a sensitivity of 73.3% and specificity of 39% ( P &lt; .001). These results also demonstrated no statistically significant relationship between the PUL outcome and the categories of endometrial sonographic pattern ( P = .15). Conclusion: In this large cohort of patients, the endometrial stripe thickness of more than 11 mm, among those who were symptomatic and deemed as PUL, had the potential to predict ectopic pregnancy as an unlikely diagnosis.

Changing the landscape of European School of Oncology–European Society for Medical Oncology masterclasses in clinical oncology during the COVID-19 pandemic

Aims: This study aimed to assess the participants' evaluation of the European School of Oncology–European Society for Medical Oncology virtual masterclasses in clinical oncology (MCOs) organized during the pandemic in 2021. Materials & methods: The participants answered an online evaluation questionnaire at the end of each MCO to evaluate the content and organization of the MCO. Results: The clinical session and case presentation scores ranged between 4.6 and 4.8 over 5. The participants strongly agreed that the MCOs offered updates to improve their knowledge and practice in 68–83% and 52–76%, respectively; 74–90% of the participants considered the quality of the meetings to be excellent. Conclusion: The participants were satisfied with the virtual MCOs during the COVID-19 pandemic. Virtual MCO may be an acceptable alternative educational modality in specific circumstances.

CLINICAL SKILLS TEACHING USING PATIENT EXAMINATION VIDEO DURING THE COVID-19 PANDEMIC

Background: The current situation of the COVID-19 pandemic has changed the clinical learning system, which was originally fully face-to-face or blended, to be fully online. Skills lab, as one of the most routine medical skills education methods in the undergraduate medical education phase, must also adapt its implementation by optimizing the full-online approach. The purpose of this review was to investigate how patient examination videos can be used as clinical skills educational tool during the COVID-19 pandemic.Learning Media Review: The selected patient video is an unedited, soundless recording of a neurologist doing a pathological reflex test at Bethesda Hospital Yogyakarta. During clinical skills laboratory sessions, videos are displayed concurrently with introductory lectures to examine abnormal reflexes.Conclusion: This study demonstrates that using actual patient videos in clinical skills sessions is acceptable and well-implemented. This is an excellent alternative method of acquiring clinical competencies during the COVID-19 pandemic era.

Synchronised Video-assisted Clinical Skill Lab Sessions (SVCSLSs). Can SVCSLSs fill some gaps in virtual medical education? A mixed-method study

Despite the recent advancement of virtual education during the last pandemic, mastering clinical competencies remains challenging. The current study endorsed Synchronised Video-assisted Clinical Skill lab Sessions (SVCSLS) as a novel instructional design aiming to improve medical students' clinical competencies during virtual learning. The current study is a mixed-method study that was carried out among 210 medical students at a medical college in Saudi Arabia. It was revealed that students viewed SVCSLSs as an effective and safe tool during times of crisis. Students' performance did not show significant variations in all program phases compared with face-to-face learning. SVCSLSs has many advantages, including enjoyment, continuous access to learning material, Self-Directed Learning, fostering recall and memorisation, and enhancing higher cognitive skills. Students suggested that the sessions' content be updated, that workplace-related videos be added, and that constructive feedback is provided. Students recommended updating the contents of the sessions, enriching them with workplace-based videos, and providing constructive feedback. Though SVCSLSs have been proven to be an effective tool, we recommend using them during a crisis rather than replacing the face-to-face mode of learning in normal circumstances.

Redistribution of Doctors and Decentralization of Clinics Improved Utilization of Services, Demand, and Capacity of Hamad Medical Corporation's Staff Clinic.

Background: The Staff Medical Clinic (SMC) of the Hamad Medical Corporation (HMC) serves the staff members who require healthcare services, but in a crowded environment, the SMC can only meet 75% of that demand. Overcrowding reduces productivity and service quality and increases waiting time. Furthermore, overcrowding in healthcare facilities decreases the experience and satisfaction of patients and healthcare providers.Aim: The main objective of this study was to use simulation modeling to evaluate interventions that could improve SMC waiting time and efficiency.Method: Eighteen months of data on SMC patient flow, staffing, and clinical sessions were collected (January 2018 to June 2019). The patient's journey through the SMC was modeled as a series of processes with assigned durations defined mathematically using the appropriate probability distribution. A simulation flow model was developed considering the locations of the staff and nearby main hospital facilities. An intervention was proposed and evaluated through a simulation. The intervention involved redistributing 25% of the SMC staff into three main satellite clinics located at the facilities where most of the SMC patients came. Results: The proposed intervention decreased crowding by 37%, reduced staffing requirements by 28%, and increased the number of patient slots by 22%, resulting in a net increase in the number of patients served by an average of 1250 monthly, without the need for hiring new additional staffing.Conclusion: Redistribution of the available medical staff to three new satellite clinics reduces workload pressure at all sites and increases clinic capacity without additional costs.

A Novel Homomorphic Approach for Preserving Privacy of Patient Data in Telemedicine.

Globally, the surge in disease and urgency in maintaining social distancing has reawakened the use of telemedicine/telehealth. Amid the global health crisis, the world adopted the culture of online consultancy. Thus, there is a need to revamp the conventional model of the telemedicine system as per the current challenges and requirements. Security and privacy of data are main aspects to be considered in this era. Data-driven organizations also require compliance with regulatory bodies, such as HIPAA, PHI, and GDPR. These regulatory compliance bodies must ensure user data privacy by implementing necessary security measures. Patients and doctors are now connected to the cloud to access medical records, e.g., voice recordings of clinical sessions. Voice data reside in the cloud and can be compromised. While searching voice data, a patient’s critical data can be leaked, exposed to cloud service providers, and spoofed by hackers. Secure, searchable encryption is a requirement for telemedicine systems for secure voice and phoneme searching. This research proposes the secure searching of phonemes from audio recordings using fully homomorphic encryption over the cloud. It utilizes IBM’s homomorphic encryption library (HElib) and achieves indistinguishability. Testing and implementation were done on audio datasets of different sizes while varying the security parameters. The analysis includes a thorough security analysis along with leakage profiling. The proposed scheme achieved higher levels of security and privacy, especially when the security parameters increased. However, in use cases where higher levels of security were not desirous, one may rely on a reduction in the security parameters.

Design and Evaluation of a Virtual Urology Sub-Internship During the COVID-19 Pandemic

ObjectiveTo offer learning opportunities to medical students during the pandemic and address technical challenges for operating room involvement, the Scott Department of Urology at the Baylor College of Medicine designed and evaluated a 2-week virtual elective course.Materials and MethodsA manual for a virtual sub-internship was created by members of the Society of Academic Urologists, structured around core competencies. Our curriculum incorporated the manual to design a virtual experience. The course combined live surgical case streaming, one-on-one didactics, and virtual participation during in-person clinic sessions. The surgical streaming was enabled through a nominal investment of $150 for equipment. A post-course evaluation was distributed to participating students.ResultsThe course evaluation received a 91% response rate from 11 enrolled fourth-year medical students. There was a very high level of satisfaction with the quality of the educational experience (M=5.8 +/-0.4). Open comments on course strengths highlighted the surgical streaming aspect of the experience, and 80% of evaluation respondents reported that one-on-one time with physicians was a strength of the virtual format.ConclusionsOur curriculum effectively engaged medical students during a 2-week virtual urology elective. The surgical video streaming format is unique even among virtual rotations nationwide and may be adapted for any learners within or beyond an institution. Our curriculum provides an example for programs to incorporate these inexpensive streaming techniques and for students to gain exposure in their surgical areas of interest.

648-P: Lag Times in a Seventh-Generation Continuous Glucose Monitoring System

Background: Glucose transport from blood to interstitial fluid impacts performance of interstitially-placed continuous glucose monitoring (CGM) sensors. We examined time series offsets (“lag times”) of the G7 CGM system (Dexcom) . Methods: In a pivotal accuracy study conducted in the US, 316 adults with diabetes wearing 6sensors participated in clinic sessions that included glucose manipulations and frequent venous plasma glucose (YSI) determinations. G7 values were obtained every 5 min and interpolated to provide values at 1-min intervals. Each YSI value was associated with 21 G7 values obtained from min before to min after. The absolute relative difference (ARD) was calculated for each YSI:G7 pair and each sensor’s lag was estimated as the time with the lowest mean ARD. Results: A lag time of 2 minutes provided the lowest mean ARD of 8.6% and the highest %20/20 agreement rate of 94.4%. The Figure shows summary statistics for the distribution of sensor-specific lag times. Lag times of ≤0 min (where interstitial glucose leads blood glucose) were observed for 2 (33.0%) of the sensors. Conclusions: The distribution of G7 time series offsets suggests that CGM values may most accurately reflect previous or upcoming blood glucose values. This finding is likely due to technological innovations in G7’s hardware and algorithm. The minimal lag time observed should provide users with confidence in using CGM to manage their diabetes. Disclosure X.Zhang: Employee; Dexcom, Inc. J.L.Reid: Employee; Dexcom, Inc., GenMark Diagnostics. T.C.Walker: Employee; Dexcom, Inc., Stock/Shareholder; Dexcom, Inc. J.Welsh: Employee; Dexcom, Inc. A.Balo: Employee; Dexcom, Inc. Funding Dexcom, Inc.

Explicit versus implicit lower extremity sensory retraining for post-stroke chronic sensory deficits: a randomized controlled trial

Purpose Sensory impairment post-stroke limits rehabilitation of balance and gait. This study aims to compare the effect of explicit sensory retraining (ESR) versus implicit repeated exposure (IRE) to stimuli of the lower extremity, assessing their effects on sensation, balance, and gait in individuals with chronic post-stroke sensory impairment. Materials and methods A two-arm parallel double-blind multicenter randomized controlled trial was conducted in physical therapy outpatient clinics. Volunteers with chronic sensory impairment post-stroke participated in 10 sessions of 45 min ESR or IRE, according to a detailed protocol. Outcome measures assessed sensation, balance, mobility, and participation. Results A total of 64 participants were recruited (ESR, n = 34; IRE, n = 30). The intention-to-treat pre-post analysis demonstrated clinically meaningful changes for both interventions (10–31% improvement for the various measures), with no between-group difference or time × group interaction. The effect size for the time effect varied, with the largest being 0.63 for the miniBEST. Conclusions Sensory rehabilitation treatment by either ESR or IRE led to similar clinically significant changes in the performance of the lower extremity and participation in subjects with sensory loss post-stroke. Both treatment protocols are easy to implement in an outpatient clinic. ClinicalTrials.gov registration: NCT01988220. Implications for rehabilitation Standardized, structured, sensory-focused training can improve balance and gait in subjects with chronic post-stroke sensory impairment. Both explicit and implicit learning-based sensory protocols focused on the lower extremity effectively improved balance, mobility, and gait abilities, resulting in enhanced participation of individuals in the chronic post-stroke phase. A series of ten 45-minute treatment sessions in outpatient clinics lead to clinically significant improvements.