On-site Training Research Articles

QLTI-01. ASSESSING THE EFFECTIVENESS OF SUPPORT FROM ST. JUDE CHILDREN’S RESEARCH HOSPITAL TO VIETNAMESE TEAM IN TREATMENT FOR CHILDREN WITH BRAIN TUMORS

Abstract BACKGROUND Treatment for children with brain tumors requires multidisciplinary team (MDT) which is lacking in Vietnam which negatively impacts outcome. This study aims to describe the implementation and promotion of MDT approach in Vietnam with the support of St. Jude Children’s Research Hospital. METHODS We conducted a prospective descriptive study of St. Jude Children’s Research Hospital’s activities with the Vietnamese team between August 2023 and March 2024 and its impact on education, patient care and disseminating of MDC approach in Vietnam. RESULTS Onsite and online training were provided for the Vietnamese team during this time. The onsite training included exchange visits for both teams and St. Jude support for Vietnamese colleagues to attend regional and international neuro-oncology conferences. Online case discussions have been held every month from January 2024 and there are 40-60 participants each meeting from 5 main oncology centers in Vietnam. There are 3- 4 complex case discussions each meeting. A zalo group (a social media platform) for Vietnamese doctors (92 doctors) with multidisciplinary team members was established. After discussion, references and summaries of each case were distributed to the zalo group. For emergency cases, email consults are requested directly for timely input. In addition, key educational textbooks covering different disciplines of neuro-oncology (pathology, radiology and medical) were provided to different Vietnamese teams. All participants (92 doctors) found the online discussion (100.0%) benefical to further their knowledge in different fields (chemotherapy, radiation, pathology and surgery) and the outcome of consultations which guided teams to manage difficult cases. For some cases, pathology samples with local reports are sent to St. Jude to review the diagnosis and classification. CONCLUSIONS Training plays an important role in bringing knowledge and building team-based experience for Vietnamese clinicians in the treatment for children with brain tumor.

Assessment of Student Satisfaction with Dual Education in Educational Programs in Kazakhstan

Dual education, a hybrid model combining classroom learning with practical on-site training, is critical to vocational and technical education (TVET). Despite its widespread implementation, there are significant gaps in understanding how dual education influences student satisfaction. The primary objective of this study is to investigate the key factors influencing student satisfaction in Kazakhstan’s dual education system, focusing on the impact of practical and theoretical training. This study adopted a quantitative approach, and data were collected from students enrolled in dual education programs across various educational institutions using a structured survey. The survey measured overall satisfaction and professional experience on a Likert scale. The analysis revealed that the practical component of dual education significantly increases student satisfaction by 42.3%, followed by theoretical training (35.1%) and professional experience (16.6%). The model explains 46.3% of the variance in overall student satisfaction. This suggests that practical and theoretical components are critical to enhancing student experiences in dual education programs. The findings highlight the need for further development in both practical and theoretical aspects of dual education to meet student and labor market needs. The study’s implications are essential for improving vocational training programs, particularly aligning education with market expectations. The implications of our study can be instrumental in refining educational programs and aligning them with the needs of students and the labor market. Further research is necessary to explore the specific challenges different specializations face in dual education.

The Role of Neonatal Nurse Practitioners in the Implementation of a Bedside Point-of-Care Ultrasound Program.

Point-of-care ultrasound (POCUS) in the neonatal intensive care unit (NICU) is becoming increasingly utilized, with the focus of training aimed at physicians. However, the role of neonatal nurse practitioners (NNPs) in the development of POCUS programs is not well described. To describe the NNP role in the implementation of a NICU POCUS program and exemplify the potential to expand the professional scope and educational advancement of NNPs. In 2018, a multidisciplinary team assembled to develop a POCUS program in the NICU at Lucile Packard Children's Hospital (LPCH). Three NNPs received formal POCUS training in order to provide onsite training, perform and supervise POCUS imaging, and participate in quality assurance sessions. NNPs also assisted with the development of a REDCap database and imaging protocols. The LPCH POCUS NNP providers contributed to the advancement of the profession by practicing to the full scope of their role, providing leadership in program development, research, and education. Incorporating NNPs into the programmatic structure of a POCUS program can be a model for others. With advancing skill set, NNPs can be positioned to be national leaders and educators. NICUs developing POCUS programs can benefit from the integration of NNPs to serve as consistent content experts to expand the number of trained providers while assuring the quality of image capture. POCUS is becoming increasingly essential to the care of newborns. NNPs can play a central role in performing POCUS, participating in quality improvement and research, and educating other NICU providers.

Education about complementary and alternative medicine in cancer self-help groups by trained peers.

On average, about 50% of cancer patients use complementary and alternative medicine (CAM) in addition to conventional cancer treatment. Since there is a high need for information, patients often search for information about CAM and share experiences with peers, especially in self-help groups. In this study, we tested and evaluated an educational concept developed for group leaders of cancer self-help groups on how to approach the topic of CAM in their peer groups. The educational concept has been developed and piloted with health care professionals and representatives from different self-help organizations in Germany. It aims to inform and discuss the possibilities and limitations of CAM in terms of scientific evidence, to reflect user behavior, and to provide a guide on how to find and evaluate reliable and evidence-based information sources. First, self-help group leaders took part in an on-site training where they were educated on various CAM topics with the goal of being able to conduct the educational concept in their respective self-help groups. Then, the educated group leaders performed this concept in their groups. The educational concept was evaluated by both the group leaders and participants with respect to acceptance, usefulness, and satisfaction using paper-pencil questionnaires. The study was conducted in Germany based on an observational study design with a six-month follow-up. For the analyses, descriptive and univariate statistics for dependent samples were used. A total of n = 50 interested group leaders conducted the educational program in their groups. The most common implementation barriers were organizational or structural problems, as well as the feeling of being overwhelmed with managing the program in their groups. A total of n = 423 participants were educated with this program by their respective group leaders. The majority felt satisfied with the educational program and improved their knowledge about CAM. At the six months follow-up (T2), significantly more participants had consulted their physicians to inform themselves about CAM and felt more confident in finding reliable information about CAM. In this observational study, we have managed to successfully implement an educational concept with respect to the topic of CAM in cancer self-help groups. Based on the results, the concept approach will be modified to include both a CAM- professional and group leader to train the self-help groups. In the future, the effects of the program should be tested by a randomized trial.

Promoting Resilience in Healthcare Workers: A Preventative Mental Health Education Program.

Healthcare workers face greater risks for mental health conditions and chronic stress due to the demanding nature of their roles. The COVID-19 pandemic exacerbated these challenges and increased vulnerabilities to long-term mental health conditions. The present study adapts an existing resilience-based educational workshop program to address the time constraints and unique needs of the healthcare workforce in a post-COVID-19 world. Expanded from its initial focus on resilience, the workshop curriculum incorporates psychoeducation on common mental health issues. Between July 2022 and June 2024, a 15 min "huddle" format offered on-site training to equip HCWs in a large urban health system with coping strategies to prevent, manage, and recover from stress. Attendance and anonymous feedback were collected at each session via brief electronic surveys. Participant responses (n = 1403) obtained immediately post-huddle suggested positive impact on stress management, perceived leadership support, and resilience. Findings show the potential of brief huddles to improve mental health and resilience in healthcare workers and similar workforces. Our findings support the efficacy of brief, evidence-based educational huddles in enhancing resilience, mental health awareness, and coping skills among HCWs. This model holds significant potential for widespread implementation across healthcare and other high-stress workplaces.

‘Coaching differently’: using positive practice-based group coaching to promote personal and professional well-being

ABSTRACT Early Childhood Education and Care (ECEC) teachers face significant challenges to their personal and professional well-being that can influence the quality of their interactions with children. Despite this recognition, interventions exploring the potential of Positive Psychology and School-Wide Positive Behavior Support (SWPBS) to address the personal and professional well-being of ECEC teachers are lacking. In this paper, we present how a training program, theoretically grounded on the PERMA model and SWPBS approach, was delivered to 50 Portuguese ECEC teachers using an innovative coaching model, Positive Practice-based Group Coaching. The participants attended 10 on-site training sessions designed to explore the potential of group dynamics on self-reflection and problem-solving. Results indicate that the integration of the PERMA model and SWPBS approach was highly satisfactory and that a non-directive, flexible, and informal coaching style was crucial for the success of the implementation process. We discuss how Positive Practice-based Group Coaching can be useful for future professional development actions to promote the personal and professional well-being of professionals in ECEC.

Digital competency among the aged entrepreneurs under the silver economy with soft power in Thailand

The rise of the elderly in Thailand experiencing a significant demographic transformation resulted in a growing senior population to become a super-aged society by 2030. This affacted the demand for “silver economy in Thailand. The objectives are to study (1) the overview of digital competency among the aged entrepreneurs under the silver economy with soft power; and (2) the mechanism for digital competency empowerment among the aged entrepreneurs under the silver economy with soft power in Thailand. Mixed-research method was employed by quantitative (survey questionnaire) and qualitative (Focus group discussion and interview) with a total of 100 samples and 15 key informants involved: the government workers, the aged entrepreneurs, the private & industrial workers, the digital competency expertise, the elderly expertise, and the community leaders. Two main results reflected the objectives accordingly: 1) the overview of digital competency summarized from survey questionnaire found most of the positive factors as follow; 1.1) positive attitude toward digital competency even of their quite low educational background; 1.2) their positive practical existing skilled in digital competency : digital communication, digital media production, privacy, security, analytic thinking skills that can be well applied with their silver economy’s activities. 2) the mechanism for digital competency empowerment among the aged entrepreneurs found most urgent needs in more closed collaboration among all relevant sectors, starting from the lead government sector, private sector, and the local sectors to help expanding all kinds of empowerment activities. Deepen links by driving more inter-sectoral mechanism, resources sharing, regular consultation for internship, apprenticeship, on-site training, employment, market outlet and other schemes with equity, quality and sustainable practices.

Person Centred Dementia Care Made Simple

Abstract Background This poster will outline the development and rollout of our person-centred dementia care microlearning course for all patient-facing staff based in St. James's Hospital, Dublin. Person centred care (PCC) appears to make a difference to how well people with dementia manage on hospital wards (Scerri et al., 2020). The term PCC is used widely in healthcare services and the approach is embedded in St James's nursing professional practice model, standards and policies. Yet there are health professionals who find PCC difficult to define and demonstrate in their practice (Byrne et al., 2020). Through our interactions with staff on wards and in nursing homes, Dementia Services Information Development Centre (DSiDC) are aware that healthcare staff can face difficulties in establishing a rapport with a patient with dementia. Therefore, we identified the need to design a course to facilitate the continued development of meaningful interactions between hospital staff and people with dementia. The course was divided into four stand-alone modules using clear, uncomplicated language and demonstrates how staff can use key elements of Kitwood’s PCC approach in their daily practice. Methods It is becoming harder for hospital staff to be released for onsite training courses due to increasing demands on their time. With this in mind, the DSiDC team sought innovative time-efficient ways to provide dementia education to hospital staff and so a microlearning educational tool was adopted. Microlearning delivers short pieces of content in easily understandable ways utilising a variety of methods such as: video, short written text and quizzes. Accessed by a QR code, staff can complete the course on their mobile phone at a time and place that suits the individual. A pilot study of the course was conducted among staff in a nursing home and on a key ward in St. James’s Hospital. Results 73% of participants found the content ‘extremely helpful’. At start of course, 21% of participants rated their knowledge about person centred dementia care as ‘excellent’. On completion of course, this increased to 50%. One outcome of the pilot study identified an improvement of course design to three modules as opposed to four. Conclusion As a result of the positive outcomes from pilot study, it was decided as part of the wider dissemination of the course across St. James’s Hospital, to conduct a focus group to further measure the impact of the training.

Innovating Built Environment Education to Achieve SDG 4: Key Drivers for Integrating Augmented Reality Technologies

Augmented Reality Technologies (ARTs) are increasingly pivotal in transforming various industries, with notable implications for the built environment sector. This article delves into the drivers of ART adoption for education and training within the built environment, focusing on its role in enhancing educational delivery and operational efficiency. Utilising a structured survey distributed among professionals in South Africa’s built environment, this study employs descriptive and inferential statistics to analyse the data, identifying key trends and correlations. Our results demonstrated that ART significantly enhances task accuracy, fosters better collaboration and mitigates misinformation, thereby improving training and education outcomes. Professionals particularly highlight ART’s capacity to bridge the gap between theoretical knowledge and practical site experience, underscoring its value in preparatory education and on-site training. Furthermore, the analysis revealed that the integration of ART into educational curricula and professional practices not only augments learning experiences but also propels safety and quality in construction projects. Given these findings, this study strongly recommends that stakeholders in the construction and educational sectors in South Africa prioritise the adoption of ART to fully leverage its benefits for innovation and competitive advantage in the built environment.

Development and Piloting of Implementation Strategies to Support Delivery of a Clinical Intervention for Postpartum Hemorrhage in Four sub-Saharan Africa Countries.

Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality. A new clinical intervention (E-MOTIVE) holds the potential to improve early PPH detection and management. We aimed to develop and pilot implementation strategies to support uptake of this intervention in Kenya, Nigeria, South Africa, and Tanzania. Implementation strategy development: We triangulated findings from qualitative interviews, surveys and a qualitative evidence synthesis to identify current PPH care practices and influences on future intervention implementation. We mapped influences using implementation science frameworks to identify candidate implementation strategies before presenting these at stakeholder consultation and design workshops to discuss feasibility, acceptability, and local adaptations. Piloting: The intervention and implementation strategies were piloted in 12 health facilities (3 per country) over 3 months. Interviews (n=58), case report forms (n=1,269), and direct observations (18 vaginal births, 7 PPHs) were used to assess feasibility, acceptability, and fidelity. Implementation strategy development: Key influences included shortages of drugs, supplies, and staff, limited in-service training, and perceived benefits of the intervention (e.g., more accurate PPH detection and reduced PPH mortality). Proposed implementation strategies included a PPH trolley, on-site simulation-based training, champions, and audit and feedback. Country-specific adaptations included merging the E-MOTIVE intervention with national maternal health trainings, adapting local PPH protocols, and PPH trollies depending on staff needs. Piloting: Intervention and implementation strategy fidelity differed within and across countries. Calibrated drapes resulted in earlier and more accurate PPH detection but were not consistently used at the start. Implementation strategies were feasible to deliver; however, some instances of limited use were observed (e.g., PPH trolley and skills practice after training). Systematic intervention development, piloting, and process evaluation helped identify initial challenges related to intervention fidelity, which were addressed ahead of a larger-scale effectiveness evaluation. This has helped maximize the internal validity of the trial.

Impact of Sonographer Experience, Insonation Angle, and Bladder Filling on Uterine Artery Doppler Measurements in the First Trimester of Pregnancy.

To investigate the influence of different measurement conditions and ultrasound training level on uterine artery pulsatility index (UtA-PI) measurements as required for combined first trimester preeclampsia (PE) screening. This was a prospective study of consecutive patients with singleton pregnancies presenting for an ultrasound examination between 11 and 14 weeks' gestation. UtA-PI measurements were conducted by residents in training and repeated by experienced sonographers thereafter. UtA-PI measurements were conducted under different examination conditions. First, the trainee sonographers performed transabdominal sagittal and transverse UtA-PI measurements without bladder filling. These measurements were then repeated by the expert sonographers. Additionally, the expert sonographers also performed transvaginal UtA-PI measurements and transabdominal measurements with bladder filling. Statistical analysis was conducted with the statistical software R and included descriptive statistics as well as 2-sided paired t tests. A total of 100 women were included in the study. Mean age was 31.7 ± 4.92 years and mean gestational week was 12.5 ± 0.53 weeks. A total of 56% were nulliparous and 44% were parous. UtA-PI was significantly lower if performed by a sonographer in training versus an experienced sonographer (P = .031). No significant difference was observed in comparing transverse and sagittal techniques (P = .241). There was also no significant difference in transabominal versus transvaginal measurements (P = .806) and with an empty versus full bladder (P = .444). Experience of sonographer has a significant impact on UtA-PI. Supervised onsite training is necessary to improve reliability and consistency of UtA-PI measurements and make PE screening reliable for implementation in a universal screening setting.

Possibilities of Simulation Training in Improving Obstetric Care Using the Perm Region as an Example

In the context of solving the problem of reducing cases of critical obstetric conditions and maternal mortality, employees of the Perm State Medical University, on behalf of the Minister of Health of the Perm Territory, developed a comprehensive training program for employees of medical organizations of the obstetric and gynecological profile and chief physicians of the Perm Territory. Over the course of the year, work was carried out to organize on-site training and training for heads of specialized departments.

Reliable and efficient integration of AI into camera traps for smart wildlife monitoring based on continual learning

In this paper, we comprehensively report on an efficient approach for the integration of artificial intelligence (AI) processing pipelines in camera traps for smart on-site wildlife monitoring. Our work covers hardware, software, and algorithmics. We have built two prototypes of smart camera trap on a maximum bill of materials of 100$. We have also built two datasets, made publicly available, comprising over 17 k images, many of them notably challenging even for humans. Leveraging our broad expertise on embedded systems, specialized software libraries and toolchains, and AI techniques such as transfer learning, explainable AI, and, most importantly, continual learning, we achieve more reliable inference on-site - specifically 10 % higher F1-score - than MegaDetector run off-site on a desktop computer. The paper includes many practical details on system realization and on-site training in addition to a vast set of lab and experimental results.

External quality assessment performance in ten countries: an IFCC global laboratory quality project.

This study aimed to assess the validity of external quality assessment (EQA) laboratory results across various cultural and environmental contexts and to identify potential improvement areas. The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Task Force on Global Laboratory Quality (TF-GLQ) conducted a 2-year study (2022 and 2023) in which EQA materials, related software and online training was provided by a commercial vendor to 100 laboratories in ten IFCC member society countries. The results were analysed on a monthly basis by the TF-GLQ, to show the number of submissions per country, tests per lab, acceptability rates, random failures and to get a measure of which analytes performed poorly. The EQA material was dispatched on a quarterly basis. Some countries had problems with customs releasing the material in a timely manner, resulting in laboratories not receiving them on time leading to no submission. We report here the results for the second year of the survey. The number of examinations varied between laboratories, ranging from seven to 84 analytes. Of the ten countries surveyed, six averaged greater than 90 % acceptable results over the whole 12-months cycle, one had unacceptable results for two of the nine months they returned results and the other four were considered to not perform to an acceptable standard. All 100 participating laboratories indicated satisfaction with the EQA survey and related services, including on-site training, and report handling. However, specimen receiving issues, suggest benefits in dispatching materials for a full 12-month cycle. Significant discrepancies in EQA performance indicate that four countries require long-term assistance, training and guidance. To ensure reliable patient results, promoting EQA in certain countries is essential to achieve the required level of quality.

Radiography students' knowledge, attitude and practice relating to infection prevention and control in the use of contrast media injectors in computed tomography.

Radiography students complete professional placements in various clinical settings and must adhere to distinct infection prevention and control (IPC) protocols. The aim of this study was to explore radiography students' training, knowledge, attitudes, and practice (KAP) relating to IPC in the use of contrast media injectors in computed tomography (CT). An online survey study was undertaken with radiography students enrolled at two Australian universities. Survey questions related to contrast media training and KAP regarding IPC in CT. Data was summarised using descriptive statistics, with comparisons between experience in public and private practice. One free-text response question focused on non-adherence to IPC best practice, analysed using content analysis. In total, 40 students completed the survey (9% response rate). Reports of IPC and contrast media equipment training was high, with disposition for further training. Regarding IPC knowledge, 65% of students responded correctly to all 'knowledge' items (individual scores range: 60-100%). Low consensus was observed regarding whether gloves replace the need for hand hygiene and if CT contrast tubing poses risk to healthcare workers (85% each). Mean scores ranged from 41% to 100% regarding identification of sterile syringe and tubing components. Responses to the open-ended question were categorised into four themes: 'High non-adherence risk working conditions', 'attitudes and practice', 'knowledge', and 'prioritise good IPC practice'. Radiography students demonstrate varied comprehension of IPC regarding contrast media equipment, and results suggest need for collaborative efforts between academic institutions and clinical training sites to integrate IPC protocols into curricula and on-site training.

Impact of respectful maternal care training of health care providers on satisfaction with birth experience in mothers undergoing normal vaginal birth: A prospective interventional study.

To study the impact of respectful maternity care (RMC) training of health care providers on RMC and birth satisfaction in mothers undergoing normal vaginal birth. A prospective interventional study was performed comparing RMC and birth satisfaction in women undergoing vaginal births before and after RMC training of health care providers from November 2021 to March 2023 in a tertiary care center in India. Person-centered maternity care (PCMC) and birth satisfaction scale-revised (BSSR) scales were used to study women's RMC and birth satisfaction, respectively. A total of 100 women undergoing normal vaginal birth were enrolled in pre- and post-intervention phases. The intervention was done through formal and onsite training of health care providers in RMC. The mean total PCMC scale score in the post-training group demonstrated a remarkable increase to 51.95 ± 6.50, significantly higher than the pre-training mean of 32.82 ± 8.47 (P < 0.0001). The mean ± SD of the BSSR scale total score in the post-training group increased significantly to 27.17 ± 3.67, surpassing the pre-training mean of 21.19 ± 5.48 (P < 0.0001). The study showed significant improvement in RMC and birth satisfaction score in the post-training group thereby emphasizing the importance of RMC training of health care providers in the facility.

The Outcome Evaluation and Impact of Tele-mentoring Prison Medical Officers in Primary Care Psychiatry: A Model from Bihar, India

Introduction: As compared to the general population, prison inmates have a high prevalence of mental illness and substance use disorders. The authors designed and implemented a digitally driven, one-year primary care psychiatry program for medical officers in prison and correctional settings to address this need in Bihar, India. Aim: The study aimed to assess the outcome of training given to prison medical officers deputed by the Government of Bihar. Materials and Method: Five medical officers completed training out of the seven deputed. The training contained brief onsite (three-day) training in “Clinical Schedules for Primary Care Psychiatry” and three online (one-year) modules containing tele-psychiatric on-consultation training (tele-OCT), virtual classroom (VCR) sessions, and a public health module. We measured the outcome using translational quotient (TQ) and primary care psychiatry quotient (PCPQ), which were carried out 6 and 12 months after the onset of training. Results: The TQ scores in the first and second tele-OCT evaluations were 64% and 75.2% at 6 and 12 months of the course, suggesting adequate skill retention. Out of 33,565 consultations over 12 months, medical officers identified 2,947 psychiatric disorders requiring treatment, resulting in a PCPQ of 8.7%. Conclusion: Over a year, the training demonstrated efficacy in acquiring primary care psychiatry skills, and these competencies were applied in providing care for those with psychiatric disorders.

Perception on hematology/oncology pharmacy practice and education needs in Nigeria: A national survey.

Nigeria is a low-middle income country located in sub-Saharan Africa. Although cancer burden has continued to increase over time, there is a lack of pharmacists who specialize in oncology providing pharmaceutical care. The objectives of this study were to understand the perception of hematology/oncology pharmacy practice in Nigeria as well as the unmet education needs. This is a cross-sectional survey conducted in December 2023. Pharmacists who were active members of various pharmacy organizations in Nigeria were invited to complete the survey. The survey focused on the perceptions of training needs in oncology pharmacy, current challenges and opportunities, as well as resources and support needed. Descriptive statistics were utilized for the data analysis. Of the 263 responders, the largest group fell between 25 and 34 years old (35%), over half received a Bachelor of Pharmacy as their highest degree (53%), and majority did not receive any oncology pharmacy training as part of their education (73%). Many respondents strongly agreed that pharmacists in Nigeria need specialized training to better serve cancer patients (79%). Cancer therapeutics and chemotherapy pharmacology were more prioritized compared to other training needs (mean (SD): 2.63(1.95) and 2.69(1.64), respectively). The main challenge that respondents faced was a lack of relevant skills and knowledge in oncology pharmacy (mean (SD): 2.23(1.53)). More than a fourth of the respondents were aware about the board certification process (28.8%), citing overcoming the cost barrier as the main obstacle for taking the board examination (mean (SD): 1.92 (1.38)). Respondents preferred online courses and onsite specialty training (75%) as the mode of training to address unmet needs. Despite the challenges and unmet education needs in hematology/oncology clinical practice, Nigerian pharmacists are very willing to expand their knowledge and improve their skills in patient care. The findings of this study can inform policy makers, healthcare administrators, and pharmacy educators in developing global partnerships among pharmacy organizations which employ targeted strategies like sponsorships to address such unmet needs.

Unveiling the heterogeneous utilisation of the same digital patient management platform: case studies in primary healthcare in Sweden

BackgroundThe utilisation of digital technology in primary healthcare, particularly digital patient management platforms, has gained prominence, notably due to the global pandemic. These platforms are positioned as substitutes for face-to-face consultations and telephone triage. They are seen as a potential solution to the escalating costs associated with an aging population, increasing chronic conditions, and a shrinking healthcare workforce. However, a significant knowledge gap exists concerning the practical aspects of their implementation and their effect on the utilisation of digital patient management in primary healthcare.MethodsThis study addresses this gap by conducting a comprehensive analysis of three case studies involving the implementation of a specific digital patient management platform. Over a period of three years, we examine how the practicalities of implementation shape the adoption and utilisation of a digital patient management platform in three different clinics.ResultsOur findings revealed that differences in implementation strategies directly influenced variations in utilisation. The successful utilisation of the platform was achieved through a bottom-up decision-making process that involved the employees of the primary healthcare clinics. Onsite training, close collaboration with the eHealth provider, and a structured patient onboarding process played crucial roles in this utilisation. In contrast, a top-down approach at two of the primary healthcare clinics led to limited utilisation of the platform into daily workflows. Furthermore, making the platform a part of everyday work meant putting accessibility, by working as a team of physicians, at the forefront of continuity of care, with patients being managed by their designated physician. Additionally, it was observed that digital patient management proved most effective for addressing simple patient issues such as skin rashes, rather than complex cases, and did not reduce the demand for phone triage.ConclusionOnly one of the three clinics studied effectively integrated digital patient management into its daily operations, and did so by aligning objectives among management and all categories of healthcare professionals, employing a bottom-up decision-making process, collaborating with the eHealth service provider for regular platform adjustments to clinic needs, and implementing active patient onboarding. This sociotechnical integration resulted in high platform utilisation. In contrast, the other two clinics faced challenges due to incoherent objectives among diverse healthcare professional employees and top management, a top-down decision-making approach during implementation, limited collaboration with the eHealth service provider, and passive patient onboarding. The findings indicate that these factors negatively affected utilisation and led to low platform adoption as well as disrupted the sociotechnical balance.

Effectiveness of an ultrasound basic cancer training program through on-site training and virtual case discussions in rural Tanzania: a proof-of-concept study.

Cancer rates are rising in low- and middle-income countries. While point-of-care ultrasound is now available globally and could serve to mitigate against this rise, its use in diagnosing cancers is inconsistent in lower-resourced healthcare contexts. This proof-of-concept study investigates the feasibility of an ultrasound training concept in a low-resource setting. It evaluates whether this educational concept led to improved knowledge and application of ultrasound diagnostics, cancer screening and staging and patient care. The curriculum was developed through expert exchange and is based on the World Health Organisation's Manual of Diagnostic Ultrasound. It consisted of two didactic components: an on-site training phase across 5 days for a total of 24 hours, and a digital follow-up phase involving the meeting of a bi-weekly tumor board online. The learning objectives of the on-site training were normal imaging and recognition of common pathologies of the abdominal organs, vessels, lymph nodes, female breasts and lungs. The virtual tumour boards met to discuss cases and ultrasound findings, thus aiding continuing professional development after the training sessions had concluded. The face-to-face course component was accompanied by tests given before and after training as well as an evaluation sheet (Likert-scale with 1 = 'completely/very good' and 7 'not at all/very poor'). Of 20 participants from a rural hospital in Tanzania, a total of 16 were included in the analysis (clinical officers n = 6; medical officers n = 10). A significant increase in knowledge (p < 0.01) was measured both in the subjective self-assessment and in the theoretical competence tests. In multivariate linear regression, the status 'medical officers yes' (β = 5.4; p = 0.04) had a significant influence on theory test results at T2. During the 24 virtual tumour board meetings, 28 cases were discussed and a continuous improvement in image acquisition quality was observed. The ultrasound education concept comes with a sustainable increase in clinical competence and improved oncological ultrasound screening locally. There is potential for the transfer of the concept to other locations, which can be explored in the future.