International Hospitals Research Articles

Improving Biomedical Science Literacy and Patient-Directed Knowledge of Tuberculosis (TB): A Cross-Sectional Infodemiology Study Examining Readability of Patient-Facing TB Information.

Tuberculosis (TB) continues be the leading cause of death globally due to an infectious agent. There is a paucity of data describing the readability of patient-facing TB information for service users. The aim of this study was to calculate the readability of multiple global TB information sources. Information on tuberculosis (n = 150 sources) included nine categories, Patient-facing information: WHO publications (n = 17), International governments (n = 19), Hospitals (n = 10), Non-government organisations (NGOs)/charities (n = 20), Cochrane Plain Language Summaries (n = 20); LabTestsOnlineUK (n = 4) and Scientific-facing information: Clinical trials (n = 20), Cochrane abstracts (n = 20), Scientific abstracts (n = 20). Readability was calculated using Readable software, defined by (i) Flesch Reading Ease (FRE), (ii) Flesch-Kincaid Grade Level (FKGL), (iii) Gunning Fog Index and (iv) SMOG Index and two text metrics [words/sentence, syllables/word]. Mean readability values for TB information for the FRE and FKGL were 35.6 ± 1.6 (standard error of mean (SEM)) (US Target ≥60; UK Target ≥90) and 12.3 ± 0.3 (US Target ≤8; UK Target ≤6), respectively, with mean words per sentence and syllables per word of 17.2 and 1.8, respectively. Cochrane Plain Language Summaries had similar readability scores to their matching scientific abstract (p = 0.15). LabTestsOnlineUK yielded a mean FRE score of 51.5 ± 1.2, a mean FKGL score of 10.2 ± 0.5 and text metric scores of 16.7 ± 2.3 and 1.6, for words per sentence and syllables per word, respectively. In descending order, TB information from international governments, hospitals and LabTestsOnlineUK were the most readable (FRE = 57.9, 54.1 and 51.5, respectively), whereas scientific abstracts and Cochrane abstracts were the most difficult to read (13.0 and 30.2, respectively). Patient-facing TB information analysed had poor readability. Effective communication of biomedical science concepts and information relating to TB is vital for service users to enhance their health literacy of tuberculosis, thereby promoting better clinical outcomes. Biomedical scientists are important custodians of scientific information for their service user populations, including other healthcare professionals within the TB multidisciplinary (MDT) team and patient service users. When preparing TB information, this should be checked and modified in real time employing readability calculators, to align with health readability targets.

Social Media Usage for Medical Education and Smartphone Addiction Among Medical Students: National Web-Based Survey.

Social media (SoMe) have taken a major place in the medical field, and younger generations are increasingly using them as their primary source to find information. This study aimed to describe the use of SoMe for medical education among French medical students and assess the prevalence of smartphone addiction in this population. A cross-sectional web-based survey was conducted among French medical students (second to sixth year of study). The questionnaire collected information on SoMe use for medical education and professional behavior. Smartphone addiction was assessed using the Smartphone Addiction Scale Short-Version (SAS-SV) score. A total of 762 medical students responded to the survey. Of these, 762 (100%) were SoMe users, spending a median of 120 (IQR 60-150) minutes per day on SoMe; 656 (86.1%) used SoMe for medical education, with YouTube, Instagram, and Facebook being the most popular platforms. The misuse of SoMe in a professional context was also identified; 27.2% (207/762) of students posted hospital internship content, and 10.8% (82/762) searched for a patient's name on SoMe. Smartphone addiction was prevalent among 29.1% (222/762) of respondents, with a significant correlation between increased SoMe use and SAS-SV score (r=0.39, 95% CI 0.33-0.45; P<.001). Smartphone-addicted students reported a higher impact on study time (211/222, 95% vs 344/540, 63.6%; P<.001) and a greater tendency to share hospital internship content on social networks (78/222, 35.1% vs 129/540, 23.8%; P=.002). Our findings reveal the extensive use of SoMe for medical education among French medical students, alongside a notable prevalence of smartphone addiction. These results highlight the need for medical schools and educators to address the responsible use of SoMe and develop strategies to mitigate the risks associated with excessive use and addiction.

Reference value models for predicting preoperative six-minute walk test in patients scheduled for abdominal and pelvic cancer surgery.

Preoperative assessment of functional capacity with the six-minute walk test (6MWT) allows for estimation of surgical risk and targeted triage to prehabilitation services. Patient with abdominal and pelvic cancers have worse preoperative function compared with the general population. However, six-minute walk distance (6MWD) reference values from cancer patients are unknown, which limits the interpretation of 6MWT in this population. This study aimed to establish an explanatory reference value model for preoperative 6MWD in patients with abdominal or pelvic cancers undergoing elective surgery. Adult patients undergoing surgery for abdominal or pelvic cancers at major international hospitals were included. The 6MWT was assessed before surgery using a standardised protocol. Anthropometric data including age, sex, height, weight and body mass index (BMI) were collected and included in multiple linear regression analysis to model preoperative 6MWD. A total of 742 patients were included. Age, height and BMI were correlated with 6MWD. Six regression models were estimated, including two from the entire cohort, two from the subset of males and two from the subset of females. A sex-neutral model was the most representative, explaining 15% of the variance in 6MWD (6MWD = 761.00-3.00 * Age (years) -2.86 * BMI (kg/m2) - 48.09 * Sex (M1, F2)). The explored regression models, using anthropometric variables, poorly explained the variance between measured and modelled 6MWD, which suggests that these models have no clinical utility in the cancer population. Consideration of additional, non-anthropometric variables may improve regression modelling of preoperative 6MWD in patients in abdominal and pelvic cancers.

Physician perspectives on statin continuation and discontinuation in older adults in primary cardiovascular prevention: a qualitative methods study

ObjectivesIn the context of limited evidence on statin use in primary cardiovascular prevention in older adults, we assessed physician perspectives on decision-making about statin continuation or discontinuation in this population.DesignQualitative...

Patient Safety Culture in Hospital Settings Across Continents: A Systematic Review

Patient Safety Culture (PSC) is the cornerstone of quality healthcare. Prior research has highlighted the critical role of a safety culture in healthcare. The Institute of Medicine (IOM) has emphasized its effectiveness in reducing errors and improving patient care. This systematic review investigated variations in how staff at international hospitals perceive PSC. In addition to assessing the status of patient safety, this investigation offers a comprehensive synthesis of research from multiple countries to inform future research endeavors. It focused on studies published between 2010 and 2024 that used the standardized Hospital Survey on Patient Safety Culture (HSOPSC) tool, versions 1.0 and 2.0. By following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the review identified vital strengths and weaknesses in PSC globally. Despite these variations, two key strengths emerged consistently across studies, particularly in Asia: teamwork within units and a focus on continuous learning. However, healthcare professionals also raised concerns about a punitive environment that discourages error reporting and inadequate staffing levels. Interestingly, nurses held less positive views on some PSC aspects compared to mixed staff. Several PSC areas of concern raised in previous studies have continued to appear in recent studies. These findings highlight the need for a holistic approach to strengthen PSC globally. This includes fostering a just culture that encourages error reporting, addressing staffing shortages, and promoting open communication among all healthcare professionals. Additionally, tailoring interventions to address regional variations is crucial for creating a safer and more supportive environment for patients worldwide.

An e-learning platform for clinical reasoning in cardiovascular diseases: a study reporting on learner and tutor satisfaction

BackgroundMedical students gain essential skills through hospital training and internships, which complement their theoretical education. However, virtual patient platforms have been shown to effectively promote clinical reasoning and enhance learning outcomes. This study evaluates a web-based platform designed for learning clinical reasoning in cardiovascular diseases, detailing its functionalities and user satisfaction.MethodsThe Virtual Patient platform presents medical students with clinically valid scenarios, encompassing stages such as patient description, anamnesis, objective examination, presumptive diagnosis, health investigations, treatment planning, complications, differential and final diagnoses, and prognosis. Scenarios are generated either automatically or manually by professors, based on labeled and annotated clinical data. The Virtual Patient contains two types of medical cases: simple scenarios describing patients with one pathology, and complex scenarios describing patients with several related pathologies. The platform was evaluated by a total of 210 users: 178 medical students, 7 professors, and 25 engineering students, using questionnaires adjusted for each evaluation round to assess satisfaction and gather feedback. The evaluation by medical students was performed in four rounds, each round corresponding to successive enhancements of the platform functionalities and addition of new cases, with a total number of 1,098 evaluation sessions.ResultsThe platform was evaluated at different implementation stages, involving simple and complex scenarios for various heart diseases. The majority of students found the platform very useful (82.58%), with significant appreciation for its features and functionalities, for example the dialogue module supporting natural language interactions in Romanian and English or the feed-back obtained during interaction. Professors highly valued the platform’s flexibility in scenario generation, real-time feedback provision, and data management capabilities. They appreciated the possibility to provide feedback and score student performance in real-time or after the session, though some professors suggested improving the explainability of the scores.ConclusionsThe Virtual Patient platform enables medical students to virtually replicate hospital interactions, diagnose patients, and plan treatments in clinically valid scenarios for cardiovascular diseases. User evaluations demonstrated high satisfaction and appreciation for the platform’s features. Future work will focus on expanding medical cases, enhancing the dialogue module, improving scenario generation for complex cases, and extending the synthetic data generation component to produce additional types of medical investigations.

Optimizing the Application of International Classification Standards of Function, Disability &amp; Health (ICF) Cases Musculosceletal Disorders in Employees Permata Hospital Bekasi

Optimal health services are an absolute requirement for government administrators and private parties. Optimizing health services can be done through innovation, to bring services closer to the community, more easily accessible, higher quality and cheaper. The application of innovation is expected to make communication between medical personnel better, each individual is encouraged to work more quickly, precisely and carefully, and innovation is expected to give birth to a better work culture. The direct service to the community that is quite highlighted is health services. On this basis, we carry out service interventions in the form of workshops and mentoring for PERMATA BEKASI Hospital employees to further optimize service innovation. The workshops carried out included the latest ICF (Japan) international standard assessment system that can be applied in Indonesian health services, Optimizing Employees in preventing Musculosceletal disorder problems and Implementing and optimizing the addition of Dry needle services for Musculosceletal disorder cases. The activity was carried out on June 29 2024. Before conducting the workshop, service innovations that had been implemented were identified. As a result, the residency, which previously had been appealed to several international hospitals, including Japan and Thailand, is still in the process of standardization efforts carried out by countries whose index of health services or hospitals can be an example and motivation.

Formation des étudiants en pharmacie conduisant des entretiens ciblés sur les anticoagulants oraux : élaboration et évaluation d’une formation par la simulation en santé

Pharmaceutical care for patients receiving oral anticoagulants (OACs) should be performed by trained healthcare professionals to prevent adverse effects and improve patient adherence. Before meeting patients, all pharmacy students in our department (in a one-year hospital internship program) experienced a theoretical training for several years. It was decided to add a practical component based on simulation training. The study reports the simulation program conception and the assessment of the simulation-based training for pharmacy students involved in conducting interviews with patients receiving ACOs. Organization and content of the training course were defined by two hospital pharmacists and one pharmacy resident. Skills' assessment was measured in pharmacy students in 3 steps: (1) initial assessment by individual interview, (2) group training by simulation, (3) final assessment by individual interview. Student satisfaction was also assessed at the end of the training. Four scenarios and one assessment form were developed and 16 pharmacy students experienced the training. An improvement in skills after the simulations courses was observed in all parts of the process: the pre-interview (mean +15%), the interview itself (+16%) and the post-interview (+18%). All students felt more comfortable and motivated to conduct interviews and recommended that this training be continued. The study underlines the impact of the simulation training on students' skills and their satisfaction with the overall training program. The simulation training is now fully added to the program. Further studies should explore the skills improvement in real life during the first patient interview.

Evaluation of the effect of death education based on the Peace of Mind Tea House: a randomized controlled trial of nursing trainees at Xiamen University, China

BackgroundThere are few studies on death education models for nursing students in China. It is of great significance to construct a model of nursing students’ death education combined with clinical practice. This study aims to evaluate the effect of death education on nursing students based on the Peace of Mind Tea House.MethodsThe randomized controlled trial commenced from February 7 to March 18, 2021,featuring a two-month intercession at a hospital situated in Xiamen, China. The research subjects were chosen using a convenient sampling approach with nursing students from the hospital's internship program. Ninety-two participants were enrolled, with 46 in each group. Thirteen participants were lost to follow-up, corresponding to 14% of the total study population. The samples were then allocated randomly into either the intervention group or the control group. In addition to their hospital internship, the intervention group participated in six death education courses that focused on cognitive, emotional, and motor skills as well as the “Peace of Mind Tea House” program. Control participants will undergo regular internships. Before and two weeks after the course, both groups were evaluated for death anxiety, attitude towards death, and the meaning of life to assess the intervention's effectiveness.ResultsIn the fear of death item of the Death Attitude Scale and the meaning of life section, the post-test score minus the pre-test score of the intervention group were 2.50 ± 3.90 (p = 0.011), and 8.90 ± 11.07 (p = 0.035), respectively. During the communication and sharing session of the reassurance card activity, 41 participants (95.3%) found the activity meaningful.ConclusionOur data analysis demonstrates that nursing students have accepted and acknowledged the Peace of Mind Tea House-based education on death, which positively impacted their attitudes towards deathand the meaning of life. The content of death education should be integrated with traditional culture, and a new model of death education should be constructed with the Heart to Heart cards as its core. This research presents proof of the efficacy of implementing appropriate death education for nursing students, and provides a successful intervention plan to alleviate their future death anxiety and develop a positive outlook on death.Trial registrationThis study was approved by the Ethical Committee of Xiamen University School of Medicine (No. XDYX202304K21)(Date:18/01/2021). Written consent to participate was obtained from all the students.

The challenge of customer-oriented and emotional labor demand for hospitality internship students

The challenge of customer-oriented and emotional labor demand for hospitality internship students

Internship gamification system for generation Z in the hospitality industry

ABSTRACT Internships are crucial for enhancing the quality of talent in the hotel industry. However, it is essential to incorporate innovative internship activities with the current tech-savvy workforce. This research aims to develop gamification elements that can be integrated into hotel internship programs. The study utilizes Kolb’s theory and the M.D.A. (Mechanic, Dynamic, and Aesthetic) Framework to understand internship gamification. Through a comprehensive literature review, the study presents the Gamification Hospitality Internship System (G.H.I.S.) concept, wherein the M.D.A. framework elucidates the stages of experiential learning. The findings offer a comprehensive understanding of how gamification components can be effectively utilized to meet Generation Z preferences in hotel internship programs.

The Anchor of Traditional Culture and Medical Students' Knowledge, Attitudes, and Willingness Towards Organ Donation during Internships: A Cross-Sectional Descriptive Study

ObjectivesThe purpose of this study was to understand the knowledge, attitudes, and willingness of medical students in their clinical internships towards organ donation and to assess how traditional oriental culture plays a role. MethodsThis study conducted an online cross-sectional survey using a cell phone application with a self-designed questionnaire based on the Delphi method. This study was conducted among medical students in their internships in hospitals in nearly 20 provinces of China. The questionnaire consisted of 17 main questions and a knowledge quiz. The results were analyzed with descriptive statistics using the softwares Microsoft Excel 2021 and SPSS 26. ResultsA total of 225 medical students participated in this study, distributed among college, undergraduate, and postgraduate clinical internships.96% of the medical students agreed with the value of organ donation, but the highest willingness to donate the whole body was only 38.22%. Among them, traditional culture, family values, and religious factors played important both positive and negative roles. ConclusionMedical students have better knowledge about organ donation, but it rarely comes from professional education. Traditional concepts, family values, and religious factors play both a facilitating and hindering role, which can easily lead to moral dilemmas. Although it is not possible to make productive changes in the short term, we could still make improvements through educational changes, research breakthroughs, and institutional improvements.

Bundle Implementation to Prevent Surgical Site Infections - A Study of SRN Hospitals

Background: Guidelines recommend bundles with multiple infection control elements to prevent surgical site infections (SSI). Although effective in multiple research studies, little is known about the implementation of such complex bundles in the real-world clinical setting. Methods: A survey was distributed to the SHEA Research Network (SRN) hospitals during November 2022 – December 2023, to assess processes related to the implementation of SSI prevention bundles in colorectal surgery. Results: Of the 93 US and international hospitals within SRN, 49 completed the survey (53% response rate). The mean volume of colorectal surgeries per year was 377 (median 400). Figure 1 shows the individual elements of SSI prevention bundle reported as consistently used in most surgeries. There were no significant differences between hospitals with high vs. low volume (cut-off 400 surgeries), except for wound protectors or retractors, more likely to be used in high-volume hospitals (P = 0.047). A formal process for auditing adherence was reported by 71% of respondents for antibiotic prophylaxis, and 51% for skin prep, with the remaining elements audited &lt; 50% of the time. Feedback of audited adherence to surgeons occurred &lt; 50% of the time for all bundle elements, except antibiotic prophylaxis (59%). Table 1 shows the most common barriers reported as either successfully mitigated or still persistent at the time of the survey. High-volume hospitals were more likely to report persistent clinicians’ low bundle adherence (P = 0.016) and inadequate bundle adherence audit and feedback (P = 0.0016). Conclusion: Implementation of guideline-recommended colorectal SSI Prevention bundles remains highly variable. Further research aiming to develop strategies that optimize implementation and adherence is needed.

Impact of hospital internships on success in university summative objective structured clinical examinations: Large-scale experience in a French medical school.

Objective structured clinical examinations (OSCEs) are extensively used in many medical schools worldwide with the stated objective to assess students' clinical skills acquired during internships. The objective of the present study was to assess the factors associated with success in university summative OSCEs, especially the impact of previous hospital internships in corresponding disciplines and supervision during internships. This was a cross-sectional study assessing the results in the summative OSCEs of 4th year medical students during the 2021-2022 academic year in a French medical school. The summative OSCEs included five stations for each student. Each student answered a survey at the end of summative OSCEs about previous internships, the supervision they had and perceived difficulty levels for each station. The scores in each station were assessed according to previous hospital internships in the corresponding discipline. Analysis of predictive factors of success in OSCEs, defined by a score ≥ 10/20 at each station, were performed using univariate and multivariate logistic regression. Out of the 220 students participating in the summative OSCEs, 182 (83%) answered the survey. One hundred and forty-four (79%) of these students had carried out hospital internships in at least one of the disciplines evaluated during the OSCEs. Students having completed an internship in the corresponding discipline had significantly higher OSCEs scores for interrogation, communication, therapeutic education and procedure stations compared to those who had not. Previous internship in corresponding disciplines was independently associated with success in OSCEs in interrogation (OR 9.45 [1.34-66.8] p = 0.02), clinical examination (OR 6.93 [1.88-25.57] p = 0.004, and therapeutic education (OR 3.09 [1.22-7.82] p = 0.02) stations. Previous hospital internships in the discipline evaluated by the OSCEs are associated with success in summative OSCEs. This reinforces the importance of student involvement during their hospital internships.

Surgical optomics: hyperspectral imaging and deep learning towards precision intraoperative automatic tissue recognition-results from the EX-MACHYNA trial.

Hyperspectral imaging (HSI), combined with machine learning, can help to identify characteristic tissue signatures enabling automatic tissue recognition during surgery. This study aims to develop the first HSI-based automatic abdominal tissue recognition with human data in a prospective bi-center setting. Data were collected from patients undergoing elective open abdominal surgery at two international tertiary referral hospitals from September 2020 to June 2021. HS images were captured at various time points throughout the surgical procedure. Resulting RGB images were annotated with 13 distinct organ labels. Convolutional Neural Networks (CNNs) were employed for the analysis, with both external and internal validation settings utilized. A total of 169 patients were included, 73 (43.2%) from Strasbourg and 96 (56.8%) from Verona. The internal validation within centers combined patients from both centers into a single cohort, randomly allocated to the training (127 patients, 75.1%, 585 images) and test sets (42 patients, 24.9%, 181 images). This validation setting showed the best performance. The highest true positive rate was achieved for the skin (100%) and the liver (97%). Misclassifications included tissues with a similar embryological origin (omentum and mesentery: 32%) or with overlaying boundaries (liver and hepatic ligament: 22%). The median DICE score for ten tissue classes exceeded 80%. To improve automatic surgical scene segmentation and to drive clinical translation, multicenter accurate HSI datasets are essential, but further work is needed to quantify the clinical value of HSI. HSI might be included in a new omics science, namely surgical optomics, which uses light to extract quantifiable tissue features during surgery.

Factors Associated with the Perception of Prehospital Internship Training of Dental and Other Health Sciences Students in the COVID-19 Context

During the COVID-19 pandemic, pre-internship training of Health Sciences students took on an essential role. The shift to virtual practices and a project-based learning approach brought challenges, but also opened doors for adaptation and learning in a constantly evolving healthcare landscape. To determine the factors associated with the perception of Peruvian health sciences students during the period of isolation due to the COVID-19 pandemic regarding their training prior to hospital internship. A Cross-sectional analytical study was performed. Students from professional schools of health sciences who entered the hospital internship 2022 and students from the year prior to the internship from a Peruvian public university were evaluated. Data collection was performed with a 49-question questionnaire. Female participants were more prevalent with 384 (70.98%) students while the medical career had the highest participation with 152 respondents (28.1%) followed by the dental career with 134 (24.77%). In the adjusted logistic regression model no influence of associated factors on students' perception of their preparedness for hospital internship in the isolation period due to the COVID-19 pandemic was found. Peruvian Health Sciences students self-perceive themselves prepared for hospital internship in Comprehensive Care, Prevention, Collaboration and Self-Learning, but less so in Practical Skills, Understanding Science, Interpersonal Skills and Confidence.

An In-Depth Exploration of the Impact of COVID-19 on Hospitality Interns' Career Choices and Experiences: Insights for Educators, Industry Professionals, and Policymakers

Purpose of the study: The study explores how COVID-19 impacts hospitality interns' career choices and experience. Through a comprehensive literature review, key findings emerge regarding the effects of the pandemic on internship programs, the challenges interns face, and the factors influencing their post-pandemic career decisions. Methodology: The first step of the study is a comprehensive literature review, which establishes a qualitative approach to gathering information from existing research, articles, and publications. Principal Findings: COVID-19 has heavily affected hospitality internships, resulting in cancellations and remote work. However, interns have shown resilience by adapting to new learning methods and career exploration. Employers in the hospitality industry are hopeful about interns' job prospects after the pandemic, emphasizing the need to support students and address their career concerns for industry recovery. Applications of the study: This study offers valuable insights that empower educators, industry professionals, and policymakers to adapt internship programs, support intern resilience, and understand evolving career preferences in hospitality. By understanding COVID-19's impact on interns, stakeholders can make informed decisions to aid industry recovery. Novelty/Originality of the study: This study examines the impact of COVID-19 on hospitality internships, emphasizing both challenges and intern resilience. It offers insights for interns, industry recovery, and guidance to educators, professionals, and policymakers.

Effects of virtual reality OSCE on nursing students’ education: a study protocol for systematic review and meta-analysis

IntroductionVirtual objective structured clinical examination (OSCE) has been shown to influence the performance of nursing students. However, its specific effects, particularly students’ competence, stress, anxiety, confidence, satisfaction with virtual reality...

The impact of internship job characteristics on students’ hospitality career: students’ and employers’ perspectives

ABSTRACT Hospitality student interns are an important source of quality human resources (HR) to cope with serious labour shortage and sustain the future development of the hospitality industry. This study drew on job characteristics theory to examine the impact of job characteristics (JC) in hospitality internship on job satisfaction (JS) and job involvement (JI), and to assess how both work attitudes affect students’ future career intention (FCI) and their job performance (JP) as perceived by their managers. JC was found to positively influence JS and JI. The relationships of JS and JI with FCI were significant but those with JP were insignificant. The full mediating effect of interns’ JI was shown in this study. Moreover, this research specifically engaged HR professionals to discuss the survey results. The main findings and professional HR opinions were incorporated in the recommendations on internship enhancement to motivate and sustain interns’ aspirations towards their hospitality career.

Global Surgery: Burn Outreach by Shriners Children's Texas.

Global surgery describes a rapidly developing field that seeks to improve surgical treatment internationally, specifically in those specialized treatments that are not readily accessible, considered complex and expensive. Burns cause 300,000 deaths annually, 90% of which occur in low- and middle-income countries (LMICs). Burns are a public health problem since they can cause disability and death. Shriners Children's Texas is a unique model of global surgery for an important number of countries in Central and South Americas and Mexico, providing specialized acute burn care with low mortality for burned children. Survivors of severe burns may face devastating sequelae due to burn scar contractures and hypertrophic burn scars that may limit the social reintegration. Burn reconstruction is not easily accessible to patients in LMICs. After discharge from acute burn treatment at our hospital, patients may return every 6 months for in-person follow-up to assess any surgical, psychological, or rehabilitative needs. Telemedicine allows for monitoring of postoperative results and evaluation for new surgical procedures. Follow-up clinic visits called outreach clinics held in international hospitals or international Shriners Temples allow for evaluation of follow-up patients and new patients with reconstructive needs that may benefit from a treatment in Shriners Children's Texas in Galveston, Texas.