Direct Patient Contact Research Articles

FREQUENCY OF ERB’S PALSY IN ISLAMABAD CAPITAL TERRITORY AND PUNJAB REGION, PAKISTAN

Aim: The aim of the study was to determine the frequency of Erb’s palsy, its associated risk factors and health-related quality of life of these patients in Islamabad and different cities of Punjab. Methodology: A cross-sectional study whereby 242 patients with erb’s palsy were analyzed. Data was collected from different government and private sector hospitals of Islamabad, Rawalpindi, and Lahore, Gujranwala, Okara and D.G khan (Jampur) through direct patient contact and postal and electronic mail during a period of 6 months. Two questionnaires used to assess factors and quality of life, were Questionnaire of Erb’s palsy and WHO Quality of life BREF questionnaire. All patients of erb’s palsy aged below 12 years were included. Results: The frequency of Erb’s palsy recorded in Islamabad and different cities of Punjab is about 1.67% with Okara having the highest frequency rate of 3.13%. Among the Fetal-associated factors; Macrosomia 107(44.2%), among Maternal-associated factors; Multiparity 150(62.0%) and among Obstetric-associated factors; assisted vaginal delivery 134(55.4%) had the highest frequency. Quality of life in patients was found to be moderately affected with mean 3.18±0.47 SD. All the physical, psychological and environmental domains were equally affected with mean 3.19±0.39 SD, mean 3.14±0.56 SD and mean 3.22±0.65 SD respectively. Conclusion: The frequency of Erb’s palsy is highest in Okara among different cities of Punjab and Islamabad, Pakistan. Macrosomia, multiparity and assisted vaginal delivery was the highest associated factors with erb’s palsy. Quality of life was moderately affected in patients with erb’s palsy.

Mobile Phones as a Source of Nosocomial Infection in the Radiology Department of a Teaching Hospital

Background: Mobile phones were first introduced in the United Kingdom and have become an important means of communication among doctors, other healthcare workers, patients and the general public. Objectives: This study was aimed at establishing that mobile phones are sources of nosocomial infections in the radiology department of our teaching hospital and also to determine the pathogens that are responsible for these infections. Methods: This was a prospective study that involved collection of swab samples from radiographers’ mobile phones. Three different samples were collected from each mobile phone. Thirty (30) mobile phones were used for this investigation and ninety (90) samples were totally collected. Samples were collected on arrival of the radiographer to the department, after handling patients and after washing hands. Samples collected were sent to the microbiology department for culture analysis. Descriptive data analysis was performed and results presented in frequency tables. Results: On arrival at the department, samples collected revealed that 22 (73.3%) of the phones were contaminated before commencing work for the day while 8 (26.7%) were not contaminated. With direct patient contact, 27 (93.3%) were contaminated and after washing hands it was observed that 16 (53.3%) of the mobile phones were contaminated. The major cause of contamination was staphylococcus aureus especially noted in swabs obtained after direct patient contact. Pseudomonas aeruginosa and Escherichia coli were also identified as contaminants of the phones. Conclusion: Radiographers’ mobile phones harbour bacteria and could act as a source of nosocomial infection in the radiology department.

Ow back pain and other work-related musculoskeletal disorders among Jordanian physical therapists from Hashemite University

Purpose. Physical therapists (PTs) have direct patient contact, they susceptible to Work-related musculoskeletal disorders (WRMDs), its prevalence among PTs in Jordan has not been reported yet. The significance of this study relies on providing descriptive data about the PTs musculoskeletal disorders in Jordan. Method. A web-based online survey (Google Forms) was used to create the survey; it contained a cover letter, a consent form and a hyperlink that directed the participants to the survey. The questionnaire was based on the Standardized Nordic Questionnaire with some modifications. It was administered to 50 PTs through e-mail messages, 46 PTs returned completed surveys (92% response). The data were analyzed using SPPS version 20 at alpha level of 0.05. Results. Reported 12-month prevalence of WRMDs among Jordanian PTs was 71.7%. WRMDs was significantly higher in female PTs (p = 0.038). The low back 6o.6% was significantly the most commonly affected body part (p > 0.001), followed by the neck 48.5% with (p = 0.002).. More than fifty percent of the PTs with WRMDs were found to be younger than 34 years 51.1%. Treating large number of patients “more than ten” in a day was reported by most 42.4% of the respondents. PTs who had worked at general hospital had high WRMDs prevalence 66.6%. Conclusions. The prevalence of low back pain (LBP) and other WRMDs among PTs in Jordan is relatively high. It affected their performance of daily activities at home and away from home, it is also contributed sometimes to their sick leaves.

Low Risk of HCW to Patient Transmission of SARS-CoV-2 in a Tertiary Care Cancer Center June 1, 2020-November 20, 2021

BackgroundSince the beginning of the coronavirus disease 2019 (COVID-19) pandemic, several outbreaks have been reported among patients or staff in acute care settings. The highly contagious B.1.617.2 (Delta) variant became the dominant strain in the United States around July 2021, heightening concern for transmission within healthcare facilities. This report outlines the risk of secondary transmission of SARS-CoV-2 from an infected healthcare worker (HCW) to patient, stratified by profession and care setting.MethodsThis study was conducted at a tertiary care cancer center in New York City from June 1, 2020, until December 4, 2021. On March 17, 2020, the study institution offered testing for all staff. Contact tracing was done for patients exposed to a confirmed HCW case of SARS-CoV-2. The exposure period was defined as two days before symptom onset or two days before positive polymerase chain reaction specimen from asymptomatic HCW.ResultsFrom June 1, 2020, to November 20, 2021, 434 HCWs with direct patient contact tested positive for COVID-19. 57% were registered nurses (RN), 11% patient care technicians (PCT), 8% advanced practice providers, 9% physicians, 11% therapists, and 4% in other fields. Most exposures occurred in outpatient clinics (58%). A total of 3,634 patients were contact traced. Among these, 16 (0.44%) tested positive for COVID-19 within two weeks, 7 (0.66%) occurring in patients exposed during admission. 144 (33%) index cases occurred after July 1, 2021, when Delta became the dominant variant, resulting 1,313 patient exposures. 4 transmission events occurred (0.30%) from 4 separate HCWs, 3 of whom were fully vaccinated.ConclusionsThe overall risk of COVID-19 transmission from HCW to patient is low, though increased among RNs and PCTs providing bedside care. Vaccination and implementation of control measures, such as symptom screening and universal masking, mitigates the risk of COVID-19 infection even among immunocompromised patients.

Evaluation of an experiential clinical learning option during pandemic teaching suspensions

BackgroundAs students’ direct patient contact was suspended because of COVID-19-related restrictions, we revised our clinical addiction medicine curriculum for students to learn about the different multidisciplinary clinical models delivered at our hospital and in community settings. Our aim was to provide an overview of clinical modalities and familiarize learners with clinician and patient experiential perspectives.MethodsWe implemented a multi-pronged approach, offering an overview of clinical care programs through remote panels involving care providers at the clinics where students had previously been scheduled for in-person rotations. This included inpatient and office-based addiction services, addiction treatment program for adolescents and young adults, integrated addiction care and HIV primary care clinic, and opioid use urgent care clinic. Beyond having them join outpatient telehealth clinic visits, students also participated in an online panel involving patients in recovery to gain familiarity with their care perspectives; and joined a panel with recovery coaches to get further insights into patient challenges in clinical settings. Students further participated in remote opioid treatment trainings and observed clinical rounds of inpatient addiction consults and adolescent clinic team meetings.ResultsWith this revised curriculum, students learned about the variety of clinical modalities at the height of our hospital’s COVID-19 pandemic burden. The evaluation suggested that students appreciated the authenticity of accounts from patients and providers about their challenges and satisfaction related to clinical care. While in a remote learning setting, students overall wished for more personal interaction with patients and providers. They also noted a lack of group cohesion and connection that they felt would otherwise have been met in an in-person program.ConclusionsRemote learning allowed our program to connect trainees to the multidisciplinary field of addiction medicine despite the COVID-19 pandemic. In future program iterations, we will consider hybrid formats of in-person learning experiences with direct patient and faculty contact where possible, combined with online provider and patient panels possibly, in addition to virtual breakout formats to facilitate more personal student-patient and student-faculty interactions.

Prospective assessment of stress and health concerns of radiation oncology staff during the COVID-19 pandemic

Introduction and backgroundThe COVID-19 pandemic has required rapid and repetitive adjustment of radiotherapy practice, hospital-level and department-level organization and hygiene measures. To prospectively monitor and manage stress levels and health concerns, employees of a radiation oncology department were invited to participate in weekly online surveys during the first year of the pandemic. Materials and methodsStarting March 31st, 2020, cross-sectional online surveys were distributed to all employees of the Department of Radiation Oncology, University Hospital Zurich. The survey included questions about the profession, the work setting, the global stress level as well as the health concerns during the past work week. Stress levels and health concerns were assessed on a 10-point scale. SurveyMonkey® was used to conduct the survey. Distribution was performed via email. Participation was anonymous and voluntary. ResultsBetween March 2020 and February 2021, 50 weekly surveys were distributed to 127 employees on average and resulted in 1,877 individual responses. The average response rate was 30%. The mean global stress level varied significantly by profession, ranging from 2.7 (±2.5) points for administrative staff to 6.9 (±2.3) points for radiation therapy technicians (p < 0.001). The mean global stress level was highest with 4.8 (±2.9) points for in-hospital work with direct patient contact. Health concerns were highest regarding family and friends with 4.0 (±3.1) points on average. Changes of the stress level varied in correlation with infection waves. ConclusionWeekly online surveys for prospective assessment of stress levels and health concerns were successfully conducted during the first year of the COVID-19 pandemic, indicating their feasibility and value to monitor profession and workplace specific stress patterns and to allowed for tailored interventions. The physical and mental health of frontline healthcare workers in radiation oncology should remain a top priority for departmental leadership beyond the COVID-19 pandemic.

Impact of COVID-19 to Neurosurgical Education: A Systematic Review

BACKGROUND: Coronavirus disease (COVID-19) has disrupted many aspects of healthcare and health education including medical education. Given that neurosurgical training requires direct patient contact, the social distancing policy due to COVID has impacted global neurosurgical education. AIM: We are conducting a systematic review to determine the impact of COVID-19 on global neurosurgical education. METHODS: This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-analyses. The literature search was conducted on three repositories (PubMed, MedRxiv, and bioRxiv) which subsequently screened by two independent reviewers. RESULTS: Thirteen articles were processed for the systematic review. The impact of COVID-19 has been mainly negative to academic activity due to reduced case number and physical contact hours. Residents were also deployed to provide care for COVID-19-related workload. However, several studies reported a positive impact of COVID-19 on residents’ well-being such as increased personal time. Besides current residents, prospective medical students were also affected by COVID-19. CONCLUSION: Neurosurgical program directors should initiate the introduction of a flexible policy to accommodate case reduction to meet the board standard and guard residents’ safety and well-being are required to ensure the sustainability of high-quality neurosurgical education.

Pseudoresistance in idiopathic/genetic generalized epilepsies – Definitions, risk factors, and outcome

ObjectiveThe aim of the study was to determine risk factors associated with pseudoresistance in a large, representative cohort of patients with Idiopathic/Genetic Generalized Epilepsy (IGE) and the impact of pseudoresistance on socioeconomic parameters. MethodsWe performed a literature review on definitions of pseudoresistance in IGE. In an established cohort of patients with IGE from Funen, patients with current or previous pseudoresistant seizures were retrospectively identified based on a comprehensive evaluation of the patients’ medical records and direct patient contact, if required. In addition, clinical characteristics, socioeconomic, and demographic data were assessed. Personal interviews were used to determine the brief version of Barratts (BIS-8) impulsivity score. ResultsThe literature review provided the following definition of pseudoresistance: Seizures due to (I) lacking adherence to antiseizure medication (ASM), (II) incompliance to general rule of conduct, (III) psychogenic nonepileptic seizures (PNES), (IV) inadequate choice of ASM/dosage, and (V) incorrect classification of epilepsy. Applying criteria I-III to a cohort of patients with IGE (n = 499), 73 patients (14.6%) were currently pseudoresistant and 62 (12.4%) were previously pseudoresistant, but currently seizure free. Current pseudoresistance was associated with younger age, drug/alcohol abuse, lower rate of full-time employment, and higher BIS-8 scores. We found no associations of pseudoresistance with juvenile myoclonic epilepsy, psychiatric disease, specific seizure types, or number of seizure types. Patients with previously pseudoresistant seizures have tried more ASMs and were characterized by male preponderance, higher BIS-8, and higher rates of abuse. Surrogate markers for social outcome did not differ. SignificanceIn IGE, pseudoresistance may be defined as PNES or insufficient adherence to medication/conduct and is associated with younger age, drug/alcohol abuse, and higher scores for impulsivity. If transient, its impact on socioeconomic status remains limited but may be associated with a risk of overtreatment with ASM.

Randomised controlled trial of active case management to link hepatitis C notifications to treatment in Tasmania, Australia: a study protocol

IntroductionBy subsidising access to direct acting antivirals (DAAs) for all people living with hepatitis C (HCV) in 2016, Australia is positioned to eliminate HCV as a public health threat. However,...

Prevalence of Antibodies to SARS-CoV-2 Following Natural Infection and Vaccination in Irish Hospital Healthcare Workers: Changing Epidemiology as the Pandemic Progresses.

BackgroundIn October 2020 SARS-CoV-2 seroprevalence among hospital healthcare workers (HCW) of two Irish hospitals was 15 and 4. 1%, respectively. We compare seroprevalence in the same HCW population 6 months later, assess changes in risk factors for seropositivity with progression of the pandemic and serological response to vaccination.MethodsAll staff of both hospitals (N = 9,038) were invited to participate in an online questionnaire and SARS-CoV-2 antibody testing in April 2021. We measured anti-nucleocapsid and anti-spike antibodies. Frequencies and percentages for positive SARS-CoV-2 antibodies were calculated and adjusted relative risks for participant characteristics were calculated using multivariable regression analysis.ResultsFive thousand and eighty-five HCW participated. Seroprevalence increased to 21 and 13%, respectively; 26% of infections were previously undiagnosed. Black ethnicity (aRR 1.7, 95% CI 1.3–2.2, p < 0.001), lower level of education (aRR 1.4 for secondary level education, 95% CI 1.1–1.8, p = 0.002), living with other HCW (aRR 1.2, 95% CI 1.0–1.4, p = 0.007) were significantly associated with seropositivity. Having direct patient contact also carried a significant risk being a healthcare assistant (aRR 1.8, 95% CI 1.3–2.3, p < 0.001), being a nurse (aRR 1.4, 95% CI 1.0–1.8, p = 0.022), daily contact with COVID-19 patients (aRR 1.4, 95% CI 1.1–1.7, p = 0.002), daily contact with patients without suspected or confirmed COVID-19 (aRR 1.3, 95% CI 1.1–1.5, p = 0.013). Breakthrough infection occurred in 23/4,111(0.6%) of fully vaccinated participants; all had anti-S antibodies.ConclusionThe increase in seroprevalence reflects the magnitude of the third wave of the pandemic in Ireland. Genomic sequencing is needed to apportion risk to the workplace vs. the household/community. Concerted efforts are needed to mitigate risk factors due to ethnicity and lower level of education, even at this stage of the pandemic. The undiagnosed and breakthrough infections call for ongoing infection prevention and control measures and testing of HCW in the setting of close contact. Vaccinated HCW with confirmed infection should be actively assessed, including SARS-CoV-2 whole genome sequencing (WGS), serology testing and assessment of host determinants, to advance understanding of the reasons for breakthrough infection.

SARS-CoV-2 Transmission Among Healthcare Workers in Iran: An Urgent Need for Early Identification and Management.

With the increasing rate of COVID-19, particularly in developing countries such as Iran, a high number of frontline service providers, including doctors and nurses, have died, making frontline healthcare workers (HCWs) more vulnerable to psychological disorders and fear and anxiety of secondary transmission to others, especially their family members. In this study, we aimed to report the incidence of COVID-19 infection among HCWs in an Iranian referral pediatrics hospital between April 2020 and July 2020. In this retrospective cross-sectional study, HCWs and hospital staff working at Children's Medical Center, Tehran, Iran, with positive SARS-CoV-2 real-time polymerase chain reaction (RT-PCR) test results were evaluated between April 2020 and July 2020. Sixty-one out of the 1085 personnel (5.6%) including 14 pediatricians (23%), 24 nurses (39%), 9 paramedics (15%), and 14 HCWs without direct patient contact (23%) had a nasopharyngeal specimen positive SARS-CoV-2 RT-PCR test. The mean age was 39.8±10.6 years. Eleven cases (18%) had underlying diseases such as hypertension and asthma. The most common symptoms were fatigue (67%, n=41), dry cough (61%, n=37), fever (52%, n=32), headache (46%, n=28), dyspnea (43%, n=24), anosmia (28%, n=17), chills (26%, n=16), sore throat (26%, n=16), gastrointestinal symptoms (23%, n=14), and productive cough (3%, n=2). Eleven cases (18%) showed lung involvement in their chest X-rays and/or CT scans. Eighteen cases (29.5%) had lymphopenia, and 20 individuals (33%) had a high level of C-reactive protein. In conclusion, in the early phase of the COVID-19 outbreak, a substantial proportion of HCWs with fever, respiratory, and other prevalent symptoms including fatigue and headache were infected with SARS-CoV-2. Therefore, implementation of infection prevention measures, isolation of confirmed HCWs, disinfection of the environment, and regular COVID-19 prevention training for HCWs are strongly recommended for the wellbeing of health workers and minimizing the spread of infection.

Optimizing surgical training in the time of COVID-19-Victorian regional teaching hospital experience.

Reductions in elective surgery due to the COVID-19 pandemic led to a paralleled reduction in patient based surgical training opportunities. To quantify the impact of COVID-19 on surgical training, we completed a retrospective audit of the Urology Department activity during Victorian pandemic waves in 2020 at our large regional teaching hospital. Corresponding weeks in the year prior were used as the control. Interviews with department members illustrated the adaptive approach to surgical training used at our institution. A State of Disaster Surgical Triage Team was assembled and surgical operations were split between one public and two private hospitals. A pandemic triaging protocol was established and 335 Category-2 patients were re-triaged. The first wave saw a 13.8% reduction in clinic reviews, with the second wave having an overall increase of 8.8% with 56% being telehealth. The second wave saw an 11.0% reduction in overall operating, with reduced emergency operating in both the first and second wave of 17.4% and 45.5%, respectively. Reductions impacted surgical technical skill training, resulting in surgical education provided through technology platforms including webinars, podcasts and pre-recorded operative videos. The unique challenges trainees were faced with due to the pandemic encouraged development of non-technical RACS competencies. The COVID-19 pandemic presented significant challenges for service delivery and training. Reduced direct patient contact and procedures, but opportunities to develop the non-technical skills required to respond to the pandemic. The use of variable educational opportunities and tools ensured our trainees continued to progress through their training.

P273 Inflammatory Bowel Disease and COVID-19 vaccine

BackgroundOwing to the COVID-19 pandemic, inflammatory bowel disease (IBD) patients are strongly encouraged to vaccinate against SARS-COVID-19. In fact, the uptake of this vaccine in IBD cohorts has been greater than the general population. The adverse events of this vaccine are predicted to be low. The aim of this study was to assess the percentage of IBD patients who took the COVID-19 vaccine- including booster- and any significant adverse events. Any possible correlation with lifestyle habits, treatment and disease activity was also established.MethodsData was collected prospectively. 200 patients with a histological diagnosis of IBD were randomly recruited through our local database. Data was gathered using electronic case summaries and direct patient contact. Data collected included; diagnosis, type and number of COVID-19 vaccines taken, demographics, lifestyle habits, treatment and any adverse events to the vaccine. Patients were also asked about any concerns regarding this vaccine.Results187 patients (57.8% male) were recruited. 73.8% of which had Crohn’s disease (CD), 25.7% had Ulcerative colitis (UC) and 0.5% were unclassified. Mean age was 41.96 (SD ±16.56). 37.8% were on Azathioprine/6- Mercaptopurine, 93.5% were on biologicals and 33.2% were on both. 61% had quiescent IBD while 2.1% had severe IBD. 19.7% were current smokers while 15.8% were ex-smokers. 98.9% received at least one COVID-19 vaccine.Table 1 illustrates the type of vaccine administered to IBD patients. 17% of patients were concerned regarding the effectiveness of the vaccine due to IBD treatment. 19.8% of IBD patients believed that the vaccine may trigger a flareup of their disease. 11.8% of patients felt that not enough information was available to make an informed choice. 7.1% of IBD patients had treatment altered in response to the COVID-19 vaccine.Graph 1 shows the percentage of both local and systemic adverse events to 1st, 2nd and 3rd Covid-19 vaccine in IBD patients. ConclusionThis study demonstrates that the uptake of COVID-19 vaccine in IBD patients was high. The most commonly report adverse events were pain at the injection site and fever. Increased in temperature at the injection site occurred more frequently with the 3rd dose. A number of patients had a change in their medication in response to at least one the vaccines. Larger studies are needed to decipher whether data can be extrapolated on a larger scale.

Work absences among hospital cleaning staff during the SARS-CoV-2 (COVID-19) pandemic.

Introduction:Absenteeism justified by sick leaves are valuable indicators of workers’ health conditions.Objectives:To analyze hospital cleaning staff sick leaves during the COVID-19 pandemic.Methods:This retrospective cohort study included employees who presented a medical sick leave certificate justifying at least 1 missed day of work during the first wave of the COVID-19 pandemic. Data were collected from March 24 to December 31, 2020 at a teaching hospital.Results:A total of 199 workers who presented 689 medical certificates were included in the sample. The sample was 88.4% women. The mean ages for suspected COVID-19 cases and all other cases were 39.7 years and 40.9 years, respectively. Suspected COVID-19 cases involved longer leaves (mean 5.82 [SD, 3.35] days missed) and more medical sick leave certificates (mean 4.25 [SD, 3.13] certificates per worker) than other causes. Among suspected cases, 32.1% worked in critical areas of the hospital. Of the 83 RT-PCR tests performed, 24.1% were positive, with 80% of these employees working in semi-critical or administrative areas; 15% of workers who tested positive developed the severe form of the disease.Conclusions:Among workers who underwent RT-PCR testing, the rate of positive results was low. Most positive cases occurred in younger women who worked in non-critical units (ie, units involving no direct patient contact or without aerosol-generating procedures). The mean number of missed days was higher among suspected COVID-19 cases (7.85 days [SD, 4.05]). The use of individual protective equipment was common among these employees, and they were continuously trained.

Prevention of Work-Related Musculoskeletal Disorders in Physiotherapist - A Review

Introduction: Healthcare professionals, especially those with in direct contact of patient are at the highest risk of work-related musculoskeletal disorders (WMSDs), physical therapists being one of them. Aim: Our aim was to review current knowledge relating to the prevalence, risk factors and prevention of WMSDs among physiotherapists. Method: Google Scholar and PubMed were searched for terms relating to WMSDs in Physiotherapists from inception to 2021. Result: The prevalence of WMSDs among Physiotherapist was high, with the lower back as the most frequently affected followed most often by the neck, upper back and shoulders. Knee joint was commonly affected joint in lower extremity. Multiple risk factors have been found responsible for WMSDs in physiotherapist and some of them are modifiable. Conclusion: Implementing preventive strategies for WMSDs in early stage of a physiotherapist’s career may help to prevent WMSDs and maintain good quality of treatment for patients. Keywords: Pain, Musculoskeletal disorders, Ergonomics, Prevention.

The University of Colorado Virtual Physical Examination for Spine Surgeons: A Preliminary Study.

As coronavirus disease 2019 (COVID-19) reached pandemic status, in-person orthopedic clinics across the United States were forced to close as many states adopted stay-at-home orders. Previously, the use of telemedicine in orthopedic practices was minimal for a variety of reasons, one being the inability to perform a physical examination in a specialty reliant on direct patient contact for diagnosis and treatment. A prospective cohort of 52 patients consented to participate in a novel virtual physical examination protocol during routine telemedicine visits at a large, tertiary orthopedic spine practice. Participants were asked to perform a series of carefully designed physical maneuvers using readily available household objects to allow their provider to better assess sensory and motor function in the tele-medicine setting. Patients were then asked to complete a short satisfaction survey. In total, 52 patients completed the physical examination and survey. Males and females were distributed evenly among the cohort at 50%. The mean age was 52.1±15.5 years. The average score for ease of understanding the examination (1=easiest, 5=hardest) was 1.1, while the average score for ease of performance was 1.5. Most participants (97.56%) felt their provider was better able to understand their condition using the virtual examination findings. This study highlights the utility of a virtual physical examination for assessment of spine patients in the telemedicine setting. Furthermore, this study illustrates the ease with which such an examination can be implemented and performed to improve patient evaluation and satisfaction. [Orthopedics. 2022;45(1):e7-e10.].

Ethical Issues in Mandating COVID-19 Vaccination for Health Care Personnel

Frontline health care personnel (HCP) were among the first to receive the COVID-19 vaccines. Physicians, nurses, allied health professionals, and others with direct patient contact or who handle biological materials are at high risk of exposure and illness and have duties of care and protection to patients, coworkers, and communities. Yet well into 2021, some HCP remain vaccine hesitant, an obstacle to needed immunization coverage, disease prevention, and public health. In response to inadequate coverage due to persistent vaccine hesitancy and rapid spread of the highly transmissible Delta variant, nearly 60 leading medical and health care organizations have taken the extraordinary step of advocating vaccine mandates for hospitals and nursing homes.

Teaching during the COVID-19 pandemic: how do medical students evaluate interactive video-based distance bedside teaching in otorhinolaryngology?

HintergrundDer Beginn der ersten SARS-CoV-2-Pandemie-Welle im März 2020 erforderte erhebliche Umstellungsmaßnahmen in der medizinischen Lehre mit vollständigem Verzicht auf direkten Kontakt von Studierenden und Patienten. Vor diesem Hintergrund wurde das Lehrformat „Unterricht am Patienten“ (UaP) als interaktiver, videobasierter Distanzunterricht am Patienten etabliert und durchgeführt.FragestellungZiel der Studie war die Erfassung der studentischen Beurteilung dieses Lehrkonzeptes im Fach Hals-Nasen-Ohren-Heilkunde.Material und MethodenDie Live-Übertragung erfolgte aus einem HNO-Untersuchungsraum zu den im Hörsaal befindlichen Studierenden, welche mit den Patienten interagieren konnten. Makro-, mikro- und endoskopische Untersuchungsbefunde wurden in Echtzeit in den Hörsaal übertragen. Die Evaluation erfolgte anhand eines Online-Fragebogens, welcher 13 geschlossene Fragen (Likert-Skala) beinhaltete, sowie als offenes Feedback in freier Textform.ErgebnisseDie Rücklaufquote lag bei 16,8 % (42 von 250 Studierenden). Davon hatten 85,7 % einen positiven Gesamteindruck, und Tenor war, dass das Konzept angesichts der Umstände gut umgesetzt wurde. Dennoch könne auf einen direkten Patientenkontakt eher nicht verzichtet werden, auch wenn eine teilweise Kompensation durch Videoschaltung möglich sei. Insgesamt wurde das Lehrkonzept als lehrreich empfunden, und die Studierenden konnten sich vorstellen, zukünftig häufiger auch ein solches UaP-Lehrkonzept zu nutzen.SchlussfolgerungDieses Lehrkonzept kann den direkten Patientenkontakt nicht ersetzen, stellt jedoch speziell im HNO-Gebiet eine gute Alternative dar, wenn durch pandemiebedingte Umstände ein „klassischer“ UaP nicht möglich ist. Aspekte des interaktiven, videobasierten Distanzunterrichts am Patienten könnten auch zukünftig in andere Lehrformate integriert werden.

Cervical Spine Evaluation by Telephone and Video Visit.

As telecommunication technologies advance, efforts are being made to mitigate direct patient contact in the COVID-19 pandemic due to the risk of contagion. The ability to host telephone and video visits within patient portals within health care institutions will only become increasingly valuable. Neck pain, a common complaint seen in primary care clinics, is well-suited to telemedicine evaluation, as related etiologies are often comparatively straightforward. A good assessment of the cervical spine by telephone or video is possible with the right knowledge and practice.The purpose of this article is to propose questions and maneuvers that can be used to evaluate the cervical spine via telephone or video, as well as likely diagnoses that can be reached through these.Phone and video evaluation of the cervical spine can result in valuable data regarding symmetry, range of motion, functional movement patterns, modified strength testing, and provocative testing. The skill set necessary to do telephone and video visits should be included in the curriculum of physician learners.

Improved preventive care clinical decision-making efficiency: leveraging a point-of-care clinical decision support system

BackgroundElectronic medical records are widely used in family practices across Canada and can improve health outcomes. However, recent reports indicate that physicians using electronic medical records work longer and have less direct patient contact which may contribute to burnout. Therefore, new and innovative digital tools are essential to reduce physician workloads and improve patient-physician interaction to address physician burnout. The objective of this study was to assess the efficiency and accuracy of clinical decision-making when using a new preventive care point-of-care clinical decision support system (CDSS). An estimate of the potential annual time savings was also determined. This study also assessed physician reported perceived usefulness and ease of use of the CDSS.MethodsQuantitative and qualitative data were collected during this study. Each participant evaluated two simulated patient charts and identified which preventive care metrics were due. The participants recorded their decisions and the time required to assess each chart. Participants then completed a Technology Acceptance Model survey regarding the perceived usefulness and ease of use of the CDSS, which included qualitative feedback. The amount of time saved was determined and participants’ clinical decision-making accuracy was scored against current Canadian preventive care guidelines. The number of preventive care specific visits completed per year was determined using clinic billing data.ResultsThe preventive care CDSS saved an average of 195.7 s of chart review time (249.5 s vs 445.2 s; P < 0.001). A total of 1520 preventive visits were performed at Primrose and Bruyère Family Medicine Centres. Extrapolated across the organization, implementation of the new tool could save 82.6 h per year. Decision-making accuracy was not affected by the new tool (78.4% vs 80.9%, P > 0.05). Participants rated the perceived ease of use and usefulness to be very high.ConclusionsNew digital tools may reduce providers’ workload without impacting clinical decision-making accuracy. Participants indicated that the preventive care CDSS was useful and easy to use. Further software development and clinical studies are required to further improve and characterize the effect this new CDSS has when implemented in clinical practice.