Remote Coaching Research Articles

Nutritional and physical improvements in older adults through the DOREMI remote coaching approach: a real-world study

BackgroundMalnutrition (excess or defect) and sedentariness act as an accelerator in the older people frailty process. A systemic solution has been developed to engage older people in a healthier lifestyle using serious games and food monitoring. The study aimed to evaluate protocol influence on variables related to unhealthy behaviors improving dietary habits through a remote nutritional coaching approach and stimulating the population to increase physical activity through Exergames. MethodsThirty-two subjects (25 Treatments and 7 Controls, aging 65–80 years), of which 15 (11 Treatments and 4 Controls) living in the UK (ACCORD and ExtraCare Villages placed in Shenley Wood (Milton Keynes), St. Crispin (Northampton), and Showell Court (Wolverhampton)) and 17 (14 Treatments and 3 Controls) in Italy (Genoa, Liguria), were recruited and characterized in terms of nutritional status, physical, somatometric, hemodynamic and biochemical measurements, and body composition. Participants were stimulated to adopt the Mediterranean dietary pattern, by a food diary diet-app, and perform regular physical activity, by the Exergame app, for three months. At the end of the trial, users underwent the same test battery. Data were tested for normality of distribution by the Shapiro-Wilk test. Comparisons between groups were performed at baseline by unpaired Student's t-test for continuous variables, chi-square test, or Fisher's exact test for categorical variables. Analysis of Variance (ANOVA) for repeated measures was used to analyze the significance of changes over time between groups. ResultsAt the end of the trial, significant reductions of systolic (15 mmHg, P = 0.001), diastolic (5 mmHg, P = 0.025), mean (10 mmHg, P = 0.001) blood pressure, and rate-pressure product (RPP) (1,105 mmHg*bpm, P = 0.017) values were observed in DOREMI users. A trend of improvement of physical performance by the short physical performance battery (SPPB) was observed for balance and walk subtests. A significant decrease (0.91 kg, P = 0.043) in Body Mass Index (BMI) was observed in overweight subjects (BMI >25 kg/m2) after DOREMI intervention in the entire population. The Mini Nutritional Assessment (MNA) score (1, P = 0.004) significantly increased after intervention, while waist measure (3 cm, P <0.001) significantly decreased in the DOREMI users. A reduction in glycated hemoglobin (Hb) was registered (0.20%, P = 0.018) in the DOREMI UK users. ConclusionsImprovement of healthy behavior by technological tools, providing feedback between user and remote coach and increasing user's motivation, appears potentially effective. This information and communication technologies (ICT) approach offers an innovative solution to stimulate healthy eating and lifestyle behaviors, supporting clinicians in patient management.

A Module-Based Telepractice Intervention for Parents of Children with Developmental Disabilities.

In the current study, we describe a study of the Internet-based Parent-implemented Communication Strategies-Storybook (i-PiCSS). I-PiCSS is an intervention program designed to train and coach parents to use evidence-based naturalistic communication teaching (NCT) strategies (i.e., modeling, mand-model, and time delay) and reading techniques while reading storybooks with their young children with disabilities. Three participating parents were trained via online modules and coached via telepractice technologies (videoconferences). Zoom videoconference software was used for all coaching sessions. Using a single case multiple-baseline design across NCT strategies within each family, we examined, (a) parents' fidelity use of the three NCT strategies, (b) parents' use of book reading techniques, and (c) child language and communication outcomes. After self-directed training and remote coaching, parents used modeling, mand-model, and time delay strategies with higher rates and fidelity (accuracy). Children initiated more communicative acts upon parents' use of time delay and increased their numbers of single-and multiple-word responses.

Medication Optimization Among People With Type 2 Diabetes Participating in a Continuous Glucose Monitoring-Driven Virtual Care Program: Prospective Study.

BackgroundThe Onduo virtual care program for people with type 2 diabetes (T2D) includes a mobile app, remote lifestyle coaching, connected devices, and telemedicine consultations with endocrinologists for medication management and prescription of real-time continuous glucose monitoring (RT-CGM) devices. In a previously described 4-month prospective study of this program, adults with T2D and baseline glycated hemoglobin (HbA1c) ≥8.0% to ≤12.0% experienced a mean HbA1c decrease of 1.6% with no significant increase in hypoglycemia.ObjectiveThe objective of this analysis was to evaluate medication optimization and management in the 4-month prospective T2D study.MethodsStudy participants received at least 1 telemedicine consultation with an Onduo endocrinologist for diabetes medication management and used RT-CGM intermittently to guide therapy and dosing. Medication changes were analyzed.ResultsOf 55 participants, 48 (87%) had a medication change consisting of a dose change, addition, or discontinuation. Of these, 15 (31%) participants had a net increase in number of diabetes medication classes from baseline. Mean time to first medication change for these participants was 36 days. The percentage of participants taking a glucagon-like peptide-1 receptor agonist increased from 25% (12/48) to 56% (n=27), while the percentages of participants taking a sulfonylurea or dipeptidyl peptidase 4 inhibitor decreased from 56% (n=27) to 33% (n=16) and 17% (n=8) to 6% (n=3), respectively. Prescriptions of other antidiabetic medication classes including insulin did not change significantly.ConclusionsThe Onduo virtual care program can play an important role in providing timely access to guideline-based diabetes management medications and technologies for people with T2D.Trial RegistrationClinicalTrials.gov NCT03865381; https://clinicaltrials.gov/ct2/show/NCT03865381

Assessing the feasibility, usability and acceptability of the MySafeRx platform among individuals in outpatient buprenorphine treatment: Lessons learned from a pilot randomized controlled trial

BackgroundIncreasing buprenorphine/naloxone (B/N) access for opioid use disorder (OUD) is essential yet ensuring adherence and preventing diversion remains challenging. This study examines the feasibility, usability, and acceptability of MySafeRx, a mobile platform integrating motivational coaching, adherence monitoring, and electronic dispensing during office-based B/N treatment. MethodsIn this multi-site randomized controlled trial, MySafeRx provided coaching and supervised self-administration of B/N by mobile recovery coaches (MRCs) via videoconference. Referred adults (ages 18–65) with OUD were randomized to 1) 42-days of adjunctive MySafeRx treatment (n = 13) or 2) a standard care control group (n = 14). ResultsThe randomized sample was 63% female and 100% White. Twelve of 13 MySafeRx participants completed at least one MRC session. The mean system usability score reported by MySafeRx participants was 78.4 (n = 12). Participants indicated they would recommend MySafeRx to a friend (mean= 4.1 of 5), and that the dispenser (4.1 of 5) and videoconferencing (4.2 of 5) were easy to use. The MRC component had the highest acceptability (4.4 of 5). MRCs observed B/N self-administration for an average of 64.3% of the required study days (men: 68.9%; women: 57.9%). On average, men (n = 4) met with MRCs on 32±14 days versus 47±6 days for women (n = 8). Exploratory analyses did not show significant differences between intervention and control groups. ConclusionsDespite the small sample, this study supports usability and acceptability of MySafeRx. Increased adherence monitoring, even with remote coaching had limited appeal, which impacted feasibility due to slow recruitment, especially as community prescribing with relaxed monitoring requirements became more widespread.

How a VR Surgical Training Company Came About: Osso VR

An example of the valaue of VR Training: ““We’ve already started to see the benefits of our technology. For example, one fellowship trained orthopedic surgeon who was trying to transition from doing posterior to anterior hips did a case that took three hours and 30 minutes. He then did a 2-week Osso VR training involving 91 sessions and remote coaching. Following this, he did the same patient’s other hip, and that case only took one hour and 45 minutes!”

The Coaching for Cognition in Alzheimer's (COCOA) trial: Study design.

Comprehensive treatment of Alzheimer's disease (AD) requires not only pharmacologic treatment but also management of existing medical conditions and lifestyle modifications including diet, cognitive training, and exercise. We present the design and methodology for the Coaching for Cognition in Alzheimer's (COCOA) trial. AD and other dementias result from the interplay of multiple interacting dysfunctional biological systems. Monotherapies have had limited success. More interventional studies are needed to test the effectiveness of multimodal multi‐domain therapies for dementia prevention and treatment. Multimodal therapies use multiple interventions to address multiple systemic causes and potentiators of cognitive decline and functional loss; they can be personalized, as different sets of etiologies and systems responsive to therapy may be present in different individuals. COCOA is designed to test the hypothesis that coached multimodal interventions beneficially alter the trajectory of cognitive decline for individuals on the spectrum of AD and related dementias (ADRD). COCOA is a two‐arm prospective randomized controlled trial (RCT). COCOA collects psychometric, clinical, lifestyle, genomic, proteomic, metabolomic, and microbiome data at multiple timepoints across 2 years for each participant. These data enable systems biology analyses. One arm receives standard of care and generic healthy aging recommendations. The other arm receives standard of care and personalized data‐driven remote coaching. The primary outcome measure is the Memory Performance Index (MPI), a measure of cognition. The MPI is a summary statistic of the MCI Screen (MCIS). Secondary outcome measures include the Functional Assessment Staging Test (FAST), a measure of function. COCOA began enrollment in January 2018. We hypothesize that multimodal interventions will ameliorate cognitive decline and that data‐driven health coaching will increase compliance, assist in personalizing multimodal interventions, and improve outcomes for patients, particularly for those in the early stages of the AD spectrum.Highlights The Coaching for Cognition in Alzheimer's (COCOA) trial tests personalized multimodal lifestyle interventions for Alzheimer's disease and related dementias.Dense longitudinal molecular data will be useful for future studies.Increased use of Hill's criteria in analyses may advance knowledge generation.Remote coaching may be an effective intervention.Because lifestyle interventions are inexpensive, they may be particularly valuable in reducing global socioeconomic disparities in dementia care.

A comparative analysis of instructional coaching approaches: Face-to-face versus remote coaching in preschool classrooms.

A comparative analysis of instructional coaching approaches: Face-to-face versus remote coaching in preschool classrooms.

Augmented Reality and Plastic Surgery Training: A Qualitative Study.

Background and objectiveThe coronavirus disease 2019 (COVID-19) pandemic has led to many challenges in face-to-face teaching and training in plastic surgery. However, it has also proved to be an incubator for many technological solutions. Augmented reality (AR) platforms may offer a safe, equitable, and efficient means to provide training in plastic surgery. This study aimed to explore the user's experience of AR as an educational intervention during the COVID-19 pandemic in the United Kingdom (UK).Materials and methodsThe Proximie® AR platform (Proximie Limited, London, UK) has been in use in a UK plastic surgical department for facilitating webinars, visual libraries, and streamed procedures. The experience of a range of trainers and trainees was qualitatively explored through 10 individual interviews. Data-emergent theme analysis was also performed.ResultsAR was well-received in the context of COVID-19 and training in general as a means to enable theatre access, and visual revision, remotely. The potential for its use in remote coaching and telementoring was also discussed. Recommendations were made by the users to optimise the experience both from the trainer and learner perspectives. Data were presented pertaining to the following themes: surgical AR as a substitute for hands-on learning; surgical AR and theoretical learning; considerations specific to streamed procedures using Proximie®; considerations in the use of technology in general.ConclusionHarnessing novel technologies in surgical education offers an exciting opportunity, fast-tracked by COVID-19, but applicable beyond it. Though this study includes a small sample size, its findings suggest that AR platforms may offer a uniquely interactive remote educational experience in surgical training. Strategies and suggestions for its use are discussed, as well as broader considerations in using technology in surgical education.

Training During the COVID-19 Lockdown: Knowledge, Beliefs, and Practices of 12,526 Athletes from 142 Countries and Six Continents

ObjectiveOur objective was to explore the training-related knowledge, beliefs, and practices of athletes and the influence of lockdowns in response to the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).MethodsAthletes (n = 12,526, comprising 13% world class, 21% international, 36% national, 24% state, and 6% recreational) completed an online survey that was available from 17 May to 5 July 2020 and explored their training behaviors (training knowledge, beliefs/attitudes, and practices), including specific questions on their training intensity, frequency, and session duration before and during lockdown (March–June 2020).ResultsOverall, 85% of athletes wanted to “maintain training,” and 79% disagreed with the statement that it is “okay to not train during lockdown,” with a greater prevalence for both in higher-level athletes. In total, 60% of athletes considered “coaching by correspondence (remote coaching)” to be sufficient (highest amongst world-class athletes). During lockdown, < 40% were able to maintain sport-specific training (e.g., long endurance [39%], interval training [35%], weightlifting [33%], plyometric exercise [30%]) at pre-lockdown levels (higher among world-class, international, and national athletes), with most (83%) training for “general fitness and health maintenance” during lockdown. Athletes trained alone (80%) and focused on bodyweight (65%) and cardiovascular (59%) exercise/training during lockdown. Compared with before lockdown, most athletes reported reduced training frequency (from between five and seven sessions per week to four or fewer), shorter training sessions (from ≥ 60 to < 60 min), and lower sport-specific intensity (~ 38% reduction), irrespective of athlete classification.ConclusionsCOVID-19-related lockdowns saw marked reductions in athletic training specificity, intensity, frequency, and duration, with notable within-sample differences (by athlete classification). Higher classification athletes had the strongest desire to “maintain” training and the greatest opposition to “not training” during lockdowns. These higher classification athletes retained training specificity to a greater degree than others, probably because of preferential access to limited training resources. More higher classification athletes considered “coaching by correspondence” as sufficient than did lower classification athletes. These lockdown-mediated changes in training were not conducive to maintenance or progression of athletes’ physical capacities and were also likely detrimental to athletes’ mental health. These data can be used by policy makers, athletes, and their multidisciplinary teams to modulate their practice, with a degree of individualization, in the current and continued pandemic-related scenario. Furthermore, the data may drive training-related educational resources for athletes and their multidisciplinary teams. Such upskilling would provide athletes with evidence to inform their training modifications in response to germane situations (e.g., COVID related, injury, and illness).

Remote Fundamentals of Laparoscopic Surgery (FLS) Training in Pre-Clinical Medical Students

<h3>Study Objective</h3> To pilot a remote learning Fundamentals of Laparoscopic Surgery (FLS) elective to pre-clinical medical students. <h3>Design</h3> Due to COVID-19 restrictions, pre-clinical medical students were required to strictly quarantine for two weeks upon arrival to their clinical rotation sites, during which they would engage in an elective of their choice. Medical students enrolled in the Remote Learning FLS Elective received a laparoscopic training box (Task It) with supplies prior to traveling around the continental United States for clinical rotations. Students also received instructions to access publicly available FLS modules and videos to introduce instruments and tasks. Each learner engaged in self-guided practice with coaching available via a live-streaming platform to assist with refining their skills during the course. <h3>Setting</h3> While quarantined in three different locations (Bethesda MD, San Antonio TX, and San Diego CA) learners utilized space in their living quarters to set up the Task II trainer and computer. <h3>Patients or Participants</h3> Three pre-clinical medical students enrolled in a 2-week distance learning FLS elective. <h3>Interventions</h3> Learners participated in a 2-week distance learning elective that utilized self-directed learning and practice, use of available FLS modules and videos, and individual coaching sessions with instructor. <h3>Measurements and Main Results</h3> All learners were true novices with no prior FLS or laparoscopic experience, and minimal to no experience with surgical skills. Learners practiced individually and timed themselves practicing each skill. Each was able to attain facility with object transfer, depth perception. <h3>Conclusion</h3> All learners improved from their baseline skills level. Remote coaching of FLS with true novices is a viable alternative to traditional face to face learning with motivated learners.

20.3 REMOTE COACHING AND TECHNOLOGY FOR TRAINING COMMUNITY HEALTH WORKERS TO TREAT DEPRESSION IN PRIMARY CARE: CASE EXAMPLE FROM INDIA AND OPPORTUNITIES TO SCALE UP MENTAL HEALTH CARE GLOBALLY

Objectives: Depression is a leading cause of disability that disproportionately impacts low- and middle-income countries. With greater likelihood of access to a mobile phone than mental health care in most countries, there may be opportunities to leverage these digital tools toward increasing access to depression care. We present a case example from the ESSENCE project in India using digital technology to build capacity of community health workers (CHWs), the essential workforce responsible for frontline maternal and child health services in the country, to deliver a brief evidence-based psychological treatment for depression in primary care. Methods: We discuss key considerations in the design and evaluation of the digital training program, with emphasis on strategies to overcome poor mobile connectivity in rural and underresourced settings, and ensuring participant engagement. We describe the systematic approach to tailor the program to meet the needs of the target user group of CHWs. This involved careful design of the digital program and adapting the training content to the local culture and context. We also describe the use of remote coaching and other support techniques to promote engagement and completion of the training program. Results: We present findings from a pilot study with 42 CHWs that directly informed refinements to the training program and design of a subsequent randomized controlled trial enrolling 340 CHWs. We illustrate the progression from formative research to a larger trial, and the integration of remote coaching support, text messaging, and automated reminders within the digital program to promote engagement. We describe how these efforts are informing the design of a digital platform for training frontline health workers to deliver brief psychological treatments in other settings, including the United States. Conclusions: This example of reciprocal learning in global mental health is particularly timely given the impacts of the COVID-19 pandemic, and renewed efforts to train and support frontline health workers to meet the anticipated surge in mental health challenges globally. This study could yield a blueprint for using widely available digital technology for training and supporting frontline health workers toward scaling up mental health services in India and globally. DDD, TREAT, R

FEASIBILITY, DELIVERY, AND IMPLEMENTATION OF A REMOTE CRITICAL CARE TRAINING PROGRAM IN CHINA: THE CERTAIN APPROACH

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: To describe the development, implementation, and learner engagement in a longitudinal international remote critical care continuing medical education program in China. METHODS: Based on the Mayo Clinic Checklist for Early Recognition and Treatment of Acute and Illness and iNjury (CERTAIN) program, we designed and delivered a longitudinal 40-week remote coaching program for a community-based teaching hospital in Shandong Province, China. Based on a mixed-methods needs assessment that included learner feedback using an exploratory sequential design and ICU process and outcomes data, we developed a curriculum that included asynchronous, online learning modules with multiple language captions and weekly remote education sessions using a blend of didactic presentations on common critical care syndromes, virtual simulation, journal club, and case-based discussions. Faculty included a diverse group of critical care experts and bilingual facilitators. The program also included clinical research and quality improvement workshops to facilitate implementation of key concepts identified during these activities. Participants completed a survey using a 5 point anchored Likert scale after each educational activity to provide feedback and guide course improvement. RESULTS: Twenty-two Chinese clinicians (18 physicians, 4 nurses) enrolled in this CERTAIN longitudinal program. Learners completed a total of 163 hours (mean 7.4 hr/learner) asynchronous online learning, and to date have completed 23 weekly education sessions (total 28 hours, including an extended virtual simulation experience). Survey response rate was 56%. Learners reported a high rate of overall satisfaction with the course (112, 61% Excellent; 55 (30%) Very Good) and specific topic discussions (110,60% Excellent; 57, 31% Very Good), with steady improvement over time. Perceived practice relevance was also high (110, 59% Excellent; 55,30% Very Good), and this effort has informed ongoing local performance improvement initiatives. CONCLUSIONS: Remote delivery of longitudinal critical care continuing education program in China using asynchronous learning, case-based discussion, and virtual simulation is feasible, associated with a high rate of learner satisfaction, and increases engagement in quality improvement initiatives. This innovative global education initiative offers an important potential solution to strengthen critical care services in remote, resource-limited settings at low cost, especially during the ongoing COVID-19 pandemic. CLINICAL IMPLICATIONS: The World Health Organization has identified remote education programs as a priority to strengthen international critical care services and better meet growing global clinical demand. The best method to effectively deliver continuing medical education to international healthcare providers with unique cultural, organizational, and practice backgrounds is not well defined. DISCLOSURES: no disclosure on file for Wenjuan Cui; No relevant relationships by Yue Dong, source=Web Response Patent/IP rights for a licensed product relationship with Ambient Clinical Analytics Please note: From 2016 Added 05/23/2021 by Ognjen Gajic, source=Web Response, value=Royalty No relevant relationships by Heyi Li, source=Web Response No relevant relationships by Alexander Niven, source=Web Response no disclosure on file for Lujun Qiao; No relevant relationships by Yuqiang Sun, source=Web Response no disclosure on file for Qingzhong Yuan

Building on Lessons Learned in a Mobile Intervention to Reduce Pain and Improve Health (MORPH): Protocol for the MORPH-II Trial.

BackgroundEngaging in sufficient levels of physical activity, guarding against sustained sitting, and maintaining a healthy body weight represent important lifestyle strategies for managing older adults’ chronic pain. Our first Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) randomized pilot study demonstrated that a partially remote group-mediated diet and daylong activity intervention (ie, a focus on moving often throughout the day) can lead to improved physical function, weight loss, less pain intensity, and fewer minutes of sedentary time. We also identified unique delivery challenges that limited the program’s scalability and potential efficacy.ObjectiveThe purpose of the MORPH-II randomized pilot study is to refine the MORPH intervention package based on feedback from MORPH and evaluate the feasibility, acceptability, and preliminary efficacy of this revised package prior to conducting a larger clinical trial.MethodsThe MORPH-II study is an iteration on MORPH designed to pilot a refined framework, enhance scalability through fully remote delivery, and increase uptake of the daylong movement protocol through revised education content and additional personalized remote coaching. Older, obese, and low-active adults with chronic multisite pain (n=30) will be randomly assigned to receive a 12-week remote group-mediated physical activity and dietary weight loss intervention followed by a 12-week maintenance period or a control condition. Those in the intervention condition will partake in weekly social cognitive theory–based group meetings via teleconference software plus one-on-one support calls on a tapered schedule. They will also engage with a tablet application paired with a wearable activity monitor and smart scale designed to provide ongoing social and behavioral support throughout the week. Those in the control group will receive only the self-monitoring tools.ResultsRecruitment is ongoing as of January 2021.ConclusionsFindings from MORPH-II will help guide other researchers working to intervene on sedentary behavior through frequent movement in older adults with chronic pain.Trial RegistrationClinicalTrials.gov NCT04655001; https://clinicaltrials.gov/ct2/show/NCT04655001International Registered Report Identifier (IRRID)PRR1-10.2196/29013

Feasibility and acceptability of a home-based resistance training intervention in adolescent and young adult hematopoietic cell transplant survivors.

Adolescent and young adult (AYA) hematopoietic cell transplantation (HCT) survivors are at increased risk of metabolic syndrome and lean body mass (LBM) deficits. Resistance training (RT) is a potential intervention to improve LBM, metabolic fitness, and reduce risk of cardiovascular disease. Eligible participants ages 13-39years, 80-120days post-HCT, transfusion independent, and prednisone dose ≤1mg/kg/day were approached. Baseline assessments of body composition (DXA), anthropometrics, and strength testing were completed and participants were taught a 12-week, home-based RT intervention with weekly remote coaching. Follow-up assessments were at day +200 (FU1) and +365 post-HCT (FU2). Feasibility targets were (a) 60% enrollment of approached patients, (b) 80% completion of weekly phone calls, and (c) 80% completion of the RT intervention and FU1 assessments. Acceptability was based on positive responses in qualitative interviews. Twenty of 31 (65%) eligible AYAs enrolled. Three participants failed to complete baseline measurements (2=scheduling barriers, 1=passive refusal) and four participants who completed baseline assessments did not receive the intervention (1=medical reasons, 2=no longer interested). Of those who completed baseline assessments, 13 received the intervention, completed 88.5% of coaching calls, and 11 (65%) completed FU1. LBM (kg) increased or remained unchanged in nine of nine participants with complete body composition data at FU1 (mean 1.1kg; 95%CI: 0.4, 1.9). All participants who completed FU1 reported they would recommend the intervention to an AYA HCT survivor. A home-based RT intervention in AYA HCT survivors early post HCT is both feasible and acceptable and may maintain or increase LBM.

467-P: Immediate and Sustained Trends in Glycemic Control during Remote Patient Monitoring in People with Type 2 Diabetes

Technologies that let patients share diabetes data with care teams can help care teams identify patients with deteriorating glycemic control and facilitate timely and remote-based interventions outside of routine clinic visits. In the current study, we investigated whether people with type 2 diabetes (PWT2D) demonstrate improved glycemia after enrolling in remote patient monitoring (RPM) pilot programs that incorporated remote data syncing and coaching. All program participants were instructed to sync their blood glucose meters with either a mobile app or a computer-based software regularly during program participation. Synced blood glucose data were available to the RPM teams via a web-based dashboard, and remote coaching was administered either regularly and/or as needed. Data from 384 PWT2D (42% female; median age: 50 years) were included in cross-sectional comparisons at baseline and at 3, 6, and 12 months of RPM program participation. Overall trends of immediate (i.e., at 3 months) and sustained (at 6 and 12 months) improvements were observed for mean blood glucose levels (baseline: 178 mg/dL to ~155 mg/dL at 3, 6, 12 months; all Ps &amp;lt;.05), and mean proportion of in-range (70-180 mg/dL; baseline: 60% to ~74% at 3, 6, 12 months; all Ps &amp;lt;.05) and high SMBG readings (&amp;gt;250 mg/dL; baseline: 14% to ~8% at 3, 6, 12 months; all Ps &amp;lt;.05), with no differences in the proportion of low (&amp;lt;70 mg/dL) readings. In summary, glycemic improvements are seen within 3 months of program participation and are sustained with continued engagement. These findings indicate that RPM programs that incorporate remote data sharing and coaching can make a substantial impact on glycemic control for people with type 2 diabetes. Disclosure T. Sheng: Employee; Self; Glooko, Inc. S. Babikian: Employee; Self; Glooko, Inc. V. Singh: Employee; Self; Glooko, Inc. M. A. Clements: Employee; Self; Glooko, Inc., Other Relationship; Self; Glooko, Inc.

Learning Fundamentals of Laparoscopic Surgery Manual Skills: An Institutional Experience With Remote Coaching and Assessment.

ABSTRACTIntroductionCOVID-19 has altered the landscape of traditional surgical education. This is a pilot study of remote coaching and assessment of Fundamentals of Laparoscopic Surgery (FLS) manual skills in obstetrics and gynecology residents.Materials and MethodsPGY-3 obstetrics and gynecology residents participated in remote assessment of FLS manual skills using a live streaming platform. Learners who showed deficiencies in proficiency participated in live-streamed coaching sessions. The coaching sessions continued until the learner and coach mutually agreed that the learner was prepared for the skills portion of the FLS certification exam. The primary outcome was learner performance on skills assessment with external validation through the FLS manual skills exam pass rate.ResultsOne learner demonstrated proficiency at baseline and the remaining nine underwent remote coaching sessions. Learners received a mean of two coaching sessions to reach mutually agreed readiness for the FLS exam as per learner and coach. All residents performed significantly better at the conclusion of the remote coaching series (11.3 ± 0.82) as compared to their baseline scores (8.8 ± 2.82) (P < .03; 95% CI, 0.31-4.69). Proficiency was externally validated through the FLS exam taken by each resident 1-2 weeks following their final assessment, with all learners passing the manual portion. The average satisfaction of learners with remote coaching was 77/100 (range 50-100). 100% of learners felt prepared for their FLS certification exam and 100% would recommend this remote training program to a colleague.ConclusionRemote coaching and assessment of FLS skills yields similar results to traditional face-to-face instruction.

Conceptualizing intubation sharing: A descriptive qualitative study of videolaryngoscopy for pediatric emergency airway management.

This study characterizes clinical and educational practices around the use of videolaryngoscopy in pediatric emergency airway management through qualitative exploration. This is a descriptive qualitative study using semi-structured interviews of emergency medicine physicians. Physicians were selected by theoretical sampling from urban, tertiary care pediatric hospitals across the United States until theoretical data saturation was achieved. The study applied a constructivist grounded theory approach to data collection and analysis. Manual line-by-line coding of interview transcripts was used initially, then grouped into categories with constant comparative analysis to generate the final coding scheme organized by themes and subthemes. Finally, memo-writing and iterative analysis meetings explored relationships between themes and identified an interpretive model. Theoretical saturation was achieved after 10 of the initial 12 interviews. Emerging from the data were six themes that describe the concept of intubation sharing: (1) Videolaryngoscopy encompasses multiple modalities that all provide a shared view and ability to record; (2) Airway experts and systems help realize the full potential of videolaryngoscopy; (3) Videolaryngoscopy can be a clinical, educational, quality assurance and research tool; (4) Some skills required for videolaryngoscopyareunique, while others overlap with direct laryngoscopy; (5) Videolaryngoscopy allows a coaching laryngoscopist to provide real-time guidance to the primary laryngoscopist from a shared view; (6) Videolaryngoscopy provides an opportunity for post-intubation coaching and feedback and shared learning from a single experience for the provider community. Through this multicenter qualitative interview study, we derived the concept of intubation sharing through videolaryngoscopy for real-time and remote coaching, for both the primary laryngoscopist and the community of emergency medicine providers who intubate.

A systematic review of adherence to physical activity interventions in individuals with type 2 diabetes.

Lifestyle interventions are pivotal for successful management of type 2 diabetes (T2D), however, the proportion of people with T2D adhering to physical activity advice has not been thoroughly studied. The purpose of this systematic review was to summarise the evidence on adherence to exercise or physical activity components in lifestyle interventions in those with T2D. We searched MEDLINE EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus on 12 November 2019. Eligible studies enrolled adults with T2D and reported the proportion of adherence to lifestyle interventions as a primary or secondary outcome. We included 11 studies (nine randomised controlled trials (RCTs) enrolling 1717 patients and two nonrandomised studies enrolling 62 patients). Only one of the studies had low risk of bias. The proportion of participants adhering to physical activity varied from 32% to 100% with a median of 58%. Adherence was higher in interventions using supervised training and lowest in interventions using remote coaching and the adherence rate in observational studies was higher compared to RCTs (92% vs. 55%; p<0.01). Study duration, risk of bias, or participants' sex, were not associated with adherence to physical activity. The proportion of those with T2D adhering to physical activity interventions for T2D varies widely and most of the included studies had a high risk of bias. These findings have important implications for planning and power analysis of future trials and when counselling patients about lifestyle interventions including physical activity or exercise components.

Supplemental Material for A Comparative Analysis of Instructional Coaching Approaches: Face-to-Face Versus Remote Coaching in Preschool Classrooms

Supplemental Material for A Comparative Analysis of Instructional Coaching Approaches: Face-to-Face Versus Remote Coaching in Preschool Classrooms

Improving stamina and mobility with preop walking in surgical patients with frailty traits \u2013OASIS IV: randomized clinical trial study protocol

BackgroundFrail older surgical patients face more than a two-fold increase in postoperative complications, including myocardial infarction, deep vein thrombosis, pulmonary embolism, pneumonia, ileus, and others. Many of these complications occur because of postoperative loss of stamina and poor mobility. Preoperative exercise may better prepare these vulnerable patients for surgery. We present the protocol for our ongoing randomized trial to assess the impact of a preoperative walking intervention with remote coaching and pedometer on outcomes of stamina (six-minute walk distance- 6MWD) and mobility (postoperative steps) in older adults with frailty traits.MethodsWe will be conducting a randomized clinical trial with a total of 120 patients permitting up to a 33% rate of attrition, to reach a final sample size of 80 (with 40 patients for each study arm). We will include patients who are age 60 or higher, score 4 or greater on the Edmonton Frailty Scale assessment, and will be undergoing a surgical operation that requires a 2 or more night hospital stay to be eligible for our trial. Using block randomization stratified on baseline 6MWD, we will assign patients to wear a pedometer. At the end of three baseline days, an athletic trainer (AT) will provide a daily step count goal reflecting a 10–20% increase from baseline. Subsequently, the AT will call weekly to further titrate the goal or calls more frequently if the patient is not meeting the prescribed goal. Controls will receive general walking advice. Our main outcome is change in 6MWD on postoperative day (POD) 2/3 vs. baseline. We will also collect 6MWD approximately 4 weeks after surgery and daily in-hospital steps.ConclusionIf changes in a 6MWD and step counts are significantly higher for the intervention group, we believe this will confirm our hypothesis that the intervention leads to decreased loss of stamina and mobility. Once confirmed, we anticipate expanding to multiple centers to assess the interventional impact on clinical endpoints.Trial registrationThe randomized clinical trial was registered on clinicaltrials.gov under the identifier NCT03892187 on March 27, 2019.