Minimal Patient Contact Research Articles

Virtual Reality Simulation: Evaluating an Experiential Tool for the Clinical Application of Pathophysiology.

At our medical school, MS3 students experience minimal patient contact. Our research shows that virtual reality simulation (VRS) supports students' transition back to patient care by increasing post-intervention confidence in clinical decision-making, management, and patient communication. VRS shows potential to teach pathophysiology, and bridges clinical and basic science instruction.

Patient Satisfaction with Healthcare Services Among Inpatients in The Covid-19 Isolation Room

Patient care in the isolation room differs from other rooms, including strict hygiene, proper personal protective equipment, and minimal patient contact. Furthermore, this study aims to portray patient satisfaction with healthcare services among inpatients in the COVID-19 isolation room. It was a descriptive study using a retrospective descriptive methodology. The population was inpatients in the COVID-19 isolation room at Surabaya Islamic hospital for January-May 2021. In addition, the sample was 128 respondents with a total sampling method. The authors used a questionnaire portraying patient satisfaction with health care services based on reliability, assurance, tangible, empathy, and responsiveness dimensions. The data was processed descriptively in a frequency distribution table. The results showed that respondents were satisfied with the reliability dimension (the ability of doctors and nurses to explain, listen, and speed up handling complaints). In addition, they were satisfied with tangible (room facilities, cleanliness of rooms, cleanliness of beds and bathrooms); empathy (attention of doctors, the ability of nurses to motivate and communicate well); assurance (friendly and polite healthcare services, safe healthcare services, and good healthcare service), and responsiveness (fast and accurate healthcare treatments, diagnostics, and easy healthcare procedures). Thus, inpatients in the COVID-19 Isolation Room at Surabaya Islamic hospital for January-May 2021 were satisfied with healthcare services based on reliability, assurance, tangible, empathy, and responsiveness dimensions. However, the empathy dimension had the lowest score among the five dimensions. So, emotional intelligence training is essential to improve health workers' empathy for patients.

Explainable COVID-19 Detection on Chest X-rays Using an End-to-End Deep Convolutional Neural Network Architecture

The coronavirus pandemic is spreading around the world. Medical imaging modalities such as radiography play an important role in the fight against COVID-19. Deep learning (DL) techniques have been able to improve medical imaging tools and help radiologists to make clinical decisions for the diagnosis, monitoring and prognosis of different diseases. Computer-Aided Diagnostic (CAD) systems can improve work efficiency by precisely delineating infections in chest X-ray (CXR) images, thus facilitating subsequent quantification. CAD can also help automate the scanning process and reshape the workflow with minimal patient contact, providing the best protection for imaging technicians. The objective of this study is to develop a deep learning algorithm to detect COVID-19, pneumonia and normal cases on CXR images. We propose two classifications problems, (i) a binary classification to classify COVID-19 and normal cases and (ii) a multiclass classification for COVID-19, pneumonia and normal. Nine datasets and more than 3200 COVID-19 CXR images are used to assess the efficiency of the proposed technique. The model is trained on a subset of the National Institute of Health (NIH) dataset using swish activation, thus improving the training accuracy to detect COVID-19 and other pneumonia. The models are tested on eight merged datasets and on individual test sets in order to confirm the degree of generalization of the proposed algorithms. An explainability algorithm is also developed to visually show the location of the lung-infected areas detected by the model. Moreover, we provide a detailed analysis of the misclassified images. The obtained results achieve high performances with an Area Under Curve (AUC) of 0.97 for multi-class classification (COVID-19 vs. other pneumonia vs. normal) and 0.98 for the binary model (COVID-19 vs. normal). The average sensitivity and specificity are 0.97 and 0.98, respectively. The sensitivity of the COVID-19 class achieves 0.99. The results outperformed the comparable state-of-the-art models for the detection of COVID-19 on CXR images. The explainability model shows that our model is able to efficiently identify the signs of COVID-19.

Novel behavioural approaches and implementation science for mitigating genetic risk of cardiovascular disease due to elevated lipoprotein(a)

Elevated lipoprotein(a) [Lp(a)] is a genetic trait that indicates higher risk of atherosclerotic cardiovascular disease (ASCVD). We review novel strategies to mitigate behavioural risk-factors in this genetic condition. Pharmacological and biological interventions are available for lowering Lp(a). However, the acceptability and feasibility of these approaches are questionable due to cost and lack of clinical evidence for their efficacy. A number of low-cost, minimal patient contact interventions are available for modifying behavioural risk-factors that are associated with increased risk of ASCVD familial hypercholesterolaemia and diabetes. These include lifestyle interventions designed to improve diet and physical activity. These interventions may be particularly important among individuals with elevated Lp(a) to manage their higher risk of diabetes and ASCVD. The following article outlines recent research that has examined such low-cost, minimal patient contact interventions. The current research indicated that such interventions, which are grounded in psychological theory, can assist individuals to improve their diet and physical activity. These findings have implications for developing and implementing similar interventions for individuals with elevated Lp(a), so as to assist in reducing behavioural risk-factors associated with ASCVD.

The impact of COVID-19 on pharmacy transitions of care services.

COVID-19 has necessitated alterations to the delivery of healthcare services. Modifications include those made to improve patient and healthcare worker safety such as the use of personal protective equipment. Pharmacy services, specifically pharmacy transitions of care services have not been immune to change which have brought along their own set of unique challenges to consider. This paper discusses how COVID-19 has impacted the delivery of pharmacy transitions of care services with real world examples from Sharp Grossmont Hospital and Hoag Memorial Hospital Presbyterian. Procedures implemented to minimize the spread and contraction of COVID-19 such as minimized patient contact and altered visitor policies have made it more challenging to obtain a best possible medication list the patient was taking prior to arrival to the hospital which has lead to an increased reliance on secondary sources to complete medication histories. Regarding discharge prescriptions, preference has shifted to the use of electronic vs. hard copy prescriptions, mail order, and utilization of med to bed programs and other hospital medication delivery services to limit patient contact in outpatient pharmacies. An improved effort to resolve medication acquisition issues prior to discharge utilizing patient assistance programs and other hospital programs to cover the cost of medications for COVID positive patients under certain circumstances has been seen. This paper highlights the important role pharmacists can play in providing effective communication, supporting continuity of care, and advocating for patient engagement and empowerment during transitions of care in the COVID-19 pandemic.

S0590 Video Capsule Endoscopy as First Procedure for Acute Gastrointestinal Bleeding: An Approach to Minimizing Exposure to SARS-CoV-2 and Conserving Resources

INTRODUCTION: Video capsule endoscopy (VCE) has been proposed as an alternative triaging tool for diagnosis of hematemesis and non-hematemesis (GIB). Randomized controlled trials have shown higher detection rates of bleeding with VCE when used as the first procedure compared with standard of care (SOC). This approach been shown to be safe, and well tolerated. VCE is particularly suitable for the diagnosis of GIB in suspected/established SARS-CoV-2 (COVID) patients as it requires minimal patient contact (one staff person) to set up, and it avoids aerosolization and sedation. We used VCE as the first diagnostic modality in hemodynamically stable patients with GIB. Here we report the outcomes of the first 50 patients undergoing VCE in the COVID era as compared to 57 historical controls in the pre-COVID era. METHODS: Hemodynamically stable patients with suspected GIB/severe anemia admitted to our hospital between March and May 2020 and who underwent VCE as the first line diagnostic modality composed the experimental group. Demographic, clinical, and outcome data was collected and analyzed. The control group comprised of patients undergoing evaluation for GIB by SOC at our hospital in January 2020. Continuous variables were compared using Student t-test. Categorical variables were compared using Fisher’s exact test. RESULTS: Patients in both groups had similar baseline characteristics, except COVID cohort was slightly older. More patients in the COVID cohort presented with melena and fewer presented with hematochezia as their manifestation of their GIB. This difference was only significant for hematochezia. Bleeding could be localized in 38 (76%) of the COVID cohort patients as compared to 36 (63%) of the historical controls using the first diagnostic modality, P > 0.05 significant. Only 22 (44%) of the VCE patients underwent additional invasive diagnostic/therapeutic maneuvers and the majority were spared more invasive testing. Only 13 (26%) of the VCE patients, as compared to 47 (82%) of the historical controls underwent upper endoscopy for evaluation of GIB. There was no significant difference in transfusion requirements, degree of hemoglobin drop, in-hospital mortality, re-admission or rebleeding rates between the two groups. CONCLUSION: VCE appears to be a safe alternative to traditional diagnostic evaluation of GIB in the era of COVID. It reduced risk of exposure of staff to endoscopic aerosols, conserved personal protective equipment and reduced staff utilization.Table 1Table 2

Sprayable and biodegradable, intrinsically adhesive wound dressing with antimicrobial properties.

Conventional wound dressings are difficult to apply to large total body surface area (TBSA) wounds, as they typically are prefabricated, require a layer of adhesive coating for fixation, and need frequent replacement for entrapped exudate. Large TBSA wounds as well as orthopedic trauma and low‐resource surgery also have a high risk of infection. In this report, a sprayable and intrinsically adhesive wound dressing loaded with antimicrobial silver is investigated that provides personalized fabrication with minimal patient contact. The dressing is composed of adhesive and biodegradable poly(lactic‐co‐glycolic acid) and poly(ethylene glycol) (PLGA/PEG) blend fibers with or without silver salt (AgNO3). in vitro studies demonstrate that the PLGA/PEG/Ag dressing has antimicrobial properties and low cytotoxicity, with antimicrobial silver controllably released over 7–14 days. In a porcine partial‐thickness wound model, the wounds treated with both antimicrobial and nonantimicrobial PLGA/PEG dressings heal at rates similar to those of the clinical, thin film polyurethane wound dressing, with similar scarring. However, PLGA/PEG adds a number of features beneficial for wound healing: greater exudate absorption, integration into the wound, a 25% reduction in dressing changes, and tissue regeneration with greater vascularization. There is also modest improvement in epidermis thickness compared to the control wound dressing.

Perception of pathology as a career among undergraduate medical students.

The choice of a postgraduate specialization in medicine is influenced by many factors. What motivates students to take up pathology as a career option or to reject the same remains unexplored. This study aimed to understand the perceptions of medical students from a college in southern India regarding the role played by pathologists in clinical practice and how this influenced their choice of pathology as a career. This qualitative study conducted personal interviews with 15 participants (13 undergraduates and 2 postgraduates in pathology) using a semi-structured interview guide. The data were transcribed and thematically analysed. Although most of the participants acknowledged that pathologists play an important role in diagnosis, they were of the view that pathologists have minimal patient contact and do not play the main role in treating patients. They were also of the opinion that the undergraduate course and curriculum in pathology was inadequate in exposing them to the actual practice of pathology. Lower social status and earning potential were also stated as deciding factors in choosing a career in pathology. Pathology residents cited stress-free lifestyle as a motivating factor in choosing pathology as a career. A career in pathology can be rewarding and intellectually stimulating. The fact that a pathologist plays an important role in diagnosis and also patient management must be emphasized in the undergraduate medical curriculum. The medical student will then be able to take an informed decision about his or her career.

Factors contributing to declination of annual influenza vaccination by healthcare workers caring for cancer patients: An Australian experience

Healthcare workers (HCWs) at an Australian cancer centre were evaluated using a voluntary declination form program to determine factors contributing to declination of annual influenza vaccination. Overall, 1835/2041 HCWs (89.9%) completed a consent or declination form; 1783 were vaccinated and 52 declined. Staff roles with minimal patient contact were significantly associated with lower vaccine uptake (adjusted odds ratio 0.48, 95% confidence interval 0.23–0.99). Reasons for vaccine refusal included personal choice (41%), previous side-effect/s (23.1%), and medical reasons (23.1%). Of these, a large proportion may not be amenable to intervention, and this must be considered in setting threshold targets for future campaigns.

Physiologic, microbiologic, and seasonal effects of handwashing on the skin of health care personnel

The handwashing practices of 22 personnel on an oncology unit in an urban medical center were studied for 2 months. During 891 person-hours of observation, 986 handwashes were observed. Subjects washed a mean of 1.1 times an hour for a mean of 13.2 seconds. Reported and observed handwashing behavior was only moderately correlated (p = 0.05 for frequency, 0.30 for duration of handwashing). Physicians washed significantly less often (p < 0.001), but more thoroughly (p < 0.001), than did nurses. Nurses washed more often after minimal or no patient contact than did physicians (p < 0.001). Individuals were very consistent in their handwashing technique. A total of 558 isolates were recovered from 158 hand cultures. The mean log count was 4.88, with no significant difference between physicians and nurses. Coagulase-negative staphylococci isolated from hands of physicians and nurses were significantly more resistant to antimicrobial agents than those of personnel with minimal patient contact (p < 0.01). Subjects had more skin damage in winter than in summer, as indicated by increased shedding of skin squames (p < 0.05). We conclude that handwashing practices vary significantly by profession and that reporting of handwashing practices by personnel is inaccurate.

Attitudes of the 1984 medical graduates of Sri Lanka to anaesthesia.

A total of 196 intern medical officers who had graduated from the four medical schools in Sri Lanka in 1984 indicated their attitudes towards anaesthesia as a medical specialty in response to a postal questionnaire. Eighty per cent of the graduates considered anaesthesia to be an established specialty in Sri Lanka, while 17% felt that the specialty had limited clinical application. A total of 62% of the graduates were not aware, prior to their entry to medical school, that anaesthesia was related to medical practice. All the graduates indicated that the intra-operative role of the anaesthetist was on a par with that of the surgeon, but 40% felt that the pre- and post-operative roles were of a secondary nature. Overall, 42% considered that an anaesthetist acts as an assistant to the surgeon. The graduates were of the opinion that only 35% of the patients undergoing surgery were appreciative of the services rendered by an anaesthetist. Fifty per cent of the graduates considered exposure to the specialty in the undergraduate curriculum as inadequate. Anaesthesia was chosen as the first career preference by 1.5%. The dominant reasons for not selecting anaesthesia as a career specialty were: minimal patient contact and patient recognition (62%), and lack of recognition of the specialty by society (54%). Anaesthetists in Sri Lanka are challenged to alter the perceptions associated with the specialty, which are probably a result of chronic staff shortages restricting practice to the confines of operating theatres.

Medical student involvement in comprehensive health care

Results have been published about student participation in comprehensive health care programs but the extent of their involvement is markedly limited. Most studies that have been reported since 1967 involve junior and senior medical students assigned to various departmental programs.^1-3Two reports are concerned directly with beginning medical students. One describes first-year students working in a Home Care Program,⁴and the other is concerned with social awareness of first- and secondyear students.⁵ In 1968, a volunteer program for first- and second-year medical students at New York Medical College was begun in Comprehensive Pediatric Health Care. The resultant attitudes or affective domain of learning after involvement in the program are described. <h3>Methods</h3> When this program was introduced, New York Medical College had a traditional curriculum which provided minimal patient contact during the first two years of education. It was noted by the faculty as well as by others

Medical Student Involvement in Comprehensive Health Care

Results have been published about student participation in comprehensive health care programs but the extent of their involvement is markedly limited. Most studies that have been reported since 1967 involve junior and senior medical students assigned to various departmental programs.^1-3Two reports are concerned directly with beginning medical students. One describes first-year students working in a Home Care Program,⁴and the other is concerned with social awareness of first- and secondyear students.⁵ In 1968, a volunteer program for first- and second-year medical students at New York Medical College was begun in Comprehensive Pediatric Health Care. The resultant attitudes or affective domain of learning after involvement in the program are described. <h3>Methods</h3> When this program was introduced, New York Medical College had a traditional curriculum which provided minimal patient contact during the first two years of education. It was noted by the faculty as well as by others