Virtual Support Research Articles

Telehealth Implementation in Federally Qualified Health Centers During the COVID-19 Pandemic: Changes to Care Provision

Background During the COVID-19 pandemic, federally qualified health centers (FQHCs) experienced rapid telehealth adoption, which drastically shifted how FQHCs delivered care to underserved patients. While studies indicate clinicians and patients would like to continue to use telehealth after the pandemic, questions remain about telehealth care quality, and there are opportunities for improvement in FQHCs. Objective The aim of this paper is to explore changes to care provision that occurred in FQHCs between 2020 and 2021 and identify opportunities to address challenges and maximize benefits as virtual care evolves. Methods A total of 15 semistructured interviews were conducted with clinic personnel (leaders, physicians, and staff) at 2 FQHCs in Northern California, between December 2020 and April 2021, to examine telehealth adoption and use of 2 synchronous modalities (audio-video and audio-only or phone) during the pandemic. Results Physicians and staff reported several positive changes as a result of using telehealth, including increases in patient reach, reductions in no-show rates, and an improved ability to discuss specific medications that patients generally have nearby for reference at home. Other changes occurring during telehealth use had mixed or negative impacts on care provision. For example, the elimination of body language cues, a reduction in the amount of information exchanged, and a reported reduced ability to develop and foster interpersonal connections affected the patient-physician relationship. Respondents also described distractions that were present in some virtual appointments, such as background noise, interruptions, or when patients were multitasking (ie, cooking and cleaning). Modifications to clinic workflow and care processes were reported as well, including the need to triage appointment types (in person vs virtual), and to conduct previsit intake interviews by phone. Clinics developed work-arounds for addressing social and nonmedical needs, such as mailing or emailing resources or pamphlets to patients or providing referrals and support by phone. Respondents also described additional considerations or processes to address newfound privacy needs of telehealth, including confirming whether patients were in a private space during the visit, switching from video to phone visits to increase privacy if necessary, and requesting follow-up from physicians if the patient was unable to share pertinent information due to a lack of privacy during a virtual appointment. Conclusions Telehealth implementation in FQHCs required modifications to care processes and impacted the patient-physician relationship. These findings highlight unique challenges and opportunities for disseminating and sustaining telehealth in settings that deliver care to safety net populations. Guidelines and evidence-based practices are needed to improve telehealth use in FQHCs, including strategies to increase information exchange during virtual appointments and support interpersonal connections between patients and physicians. The following are also needed: best practices for how clinics can most effectively triage virtual appointments; protocols to further mitigate privacy issues and decrease distractions during telehealth appointments; and identifying when telehealth can best supplement in-person care to improve patient outcomes and clinic efficiency. Conflicts of Interest None declared.

Developing a sustainability readiness strategy for health systems: Toolkit, interactive tools, and virtual support system

While the literature strongly supports the need for sustainability of evidence-based interventions (EBIs), we present a review of the literature that indicates only three articles discuss a health-focused sustainability strategy. The aims of our sustainability readiness strategy (SRS) are to increase infrastructure capacity and EBI advocacy to impact the level of sustainability readiness. In this article, we describe the development of an evidence-informed promising practice sustainability readiness strategy (SRS) with three evidence-based components. This strategy: 1) is based on an adaptation of the Getting To Outcomes® (GTO) evidence-based implementation process, 2) includes a logic model with documented evidence of the connection between targeted readiness factors and sustainability outcomes, and 3) describes resources considered necessary to support implementation of the readiness strategy, namely a step-by-step Toolkit, Excel™ Tools, webinar coaching and evaluation guides, and a coaching and evaluation training guide. The national SRS survey results are presented. Lessons learned and future dissemination and implementation plans are described.

Breastfeeding in the pandemic: A qualitative analysis of breastfeeding experiences among mothers from Canada and the United Kingdom

BackgroundPrevious research shows that the COVID-19 pandemic resulted in both barriers and facilitators to breastfeeding. However, little research has looked specifically at first-time mothers’ experiences of breastfeeding during the pandemic or compared experiences of mothers living in different countries. AimThis research explores mothers’ breastfeeding experiences to describe how the COVID-19 pandemic has affected breastfeeding journeys in Canada and the United Kingdom. MethodsTen semi-structured online interviews were undertaken with first-time mothers who breastfed their baby at least once during the COVID-19 pandemic and are living in Canada or the United Kingdom. Interview transcripts were coded inductively using thematic analysis. FindingsOne overarching theme (all on mother) and four sub-themes were identified: 1) accessing and advocating for health care, 2) social support, 3) becoming a mother in isolation, and 4) breastfeeding baby. Similar themes were constructed for both countries. DiscussionMothers reported that diminished health care and social support created challenges in their breastfeeding journey. Many mothers reported receiving virtual breastfeeding support, which was largely experienced as unhelpful. Some mothers reported fewer distractions from visitors and more one-on-one time with their infant, which helped them to establish breastfeeding and a strong mother-infant bond. ConclusionIn both Canada and the United Kingdom, new mothers need consistent, reliable health care and social support when breastfeeding. This study supports the need to protect breastfeeding support in the midst of a global emergency and beyond to ensure positive breastfeeding experiences for both mother and baby.

An adaptive two‐level hierarchical controller for universal power sharing and performance enhancement of hybrid energy storage‐supported AC/DC microgrids

SummaryThe uncertainties in generation from renewable energy sources and randomness in electric vehicle charging/discharging make the generation and load in the grid more volatile. The large‐scale integration of renewable energy sources and electric vehicles has necessitated the remodeling of conventional control schemes in the microgrid. This article presents an adaptive two‐level hierarchical controller that enriches hybrid AC/DC microgrid performance. The virtual synchronous machine‐based primary controller determines the operating mode of the interlinking converter. In addition, it maintains the system's stability by providing virtual inertia support. The communication‐based secondary controller adaptively chooses the scaling factors based on hybrid AC/DC microgrid operating conditions. The adaptive secondary control loop implemented with the primary controller and hybrid energy storage system reduces the frequency/voltage deviations under extreme load volatility and enhances the transient and steady‐state performance. The novelty of the proposed two‐level hierarchical controller is that the general purpose adaptive scheme improves the power sharing in the microgrid under normal and volatile source and load conditions. The simulations and experimental results confirm the efficacy of the proposed controller. Furthermore, the hierarchical two‐level controller performance is validated using real‐time experiments on a hardware‐in‐the‐loop simulator, OPAL‐RT, and Raspberry Pi microcontroller. The real‐time analysis ascertains that the proposed two‐level hierarchical controller effectively preserves the frequency and voltage profiles and provides accurate power sharing between the subgrids.

Perceptions of Nurses Delivering Nursing Home Virtual Care Support: A Qualitative Pilot Study.

Avoidable hospitalizations among nursing home residents result in poorer health outcomes and excess costs. Consequently, efforts to reduce avoidable hospitalizations have been a priority over the recent decade. However, many potential interventions are time-intensive and require dedicated clinical staff, although nursing homes are chronically understaffed. The OPTIMISTIC project was one of seven programs selected by CMS as "enhanced care & coordination providers" and was implemented from 2012 to 2020. This qualitative study explores the perceptions of the nurses that piloted a virtual care support project developed to expand the program's reach through telehealth, and specifically considered how nurses perceived the effectiveness of this program. Relationships, communication, and access to information were identified as common themes facilitating or impeding the perceived effectiveness of the implementation of virtual care support programs within nursing homes.

Building Unique Collaborative Global Marine CO2 Observatories

The NOAA Pacific Marine Environmental Laboratory (PMEL) carbon program has made sustained investments over the last two decades in equipment development, autonomous sampling, and virtual support that undergird the global carbon observing infrastructure. As a result, the program plays an integral role in supporting ocean carbon research with collaborating institutions worldwide (Sutton and Sabine, 2023, in this issue).

Enabling Patients as Partners on Virtual Teams: A Scoping Review.

Developing partnerships among patients and healthcare providers improves quality of virtual care. Successful patient engagement is influenced by digital literacy. Although adults (35-64) with chronic health challenges may be motivated to use virtual services, they may not have the required skills or orientation to effectively participate on their virtual team. This scoping review aimed to identify resources available to enable adults with chronic health challenges to participate as partners on their virtual teams. Peer-reviewed and grey literature data from 2011 to 2022 were searched. A total of 432 peer-reviewed and 357 grey literature sources were retrieved and screened, and 14 and 84 sources, respectively, met the inclusion criteria. Relevant information from the sources was extracted and analyzed in duplicate and synthesized qualitatively. Key findings include (1) virtual workflow processes/frameworks, (2) 'webside manner' guidelines which emphasize "the how" as opposed to "the what" of facilitating team interactions, and (3) virtual patient support personnel. Overall, analyses suggest there are persisting gaps to be addressed in synchronous virtual care resources for adults with chronic health challenges.

Red Deer Optimization with Artificial Intelligence Enabled Image Captioning System for Visually Impaired People

The problem of producing a natural language description of an image for describing the visual content has gained more attention in natural language processing (NLP) and computer vision (CV). It can be driven by applications like image retrieval or indexing, virtual assistants, image understanding, and support of visually impaired people (VIP). Though the VIP uses other senses, touch and hearing, for recognizing objects and events, the quality of life of those persons is lower than the standard level. Automatic Image captioning generates captions that will be read loudly to the VIP, thereby realizing matters happening around them. This article introduces a Red Deer Optimization with Artificial Intelligence Enabled Image Captioning System (RDOAI-ICS) for Visually Impaired People. The presented RDOAI-ICS technique aids in generating image captions for VIPs. The presented RDOAI-ICS technique utilizes a neural architectural search network (NASNet) model to produce image representations. Besides, the RDOAI-ICS technique uses the radial basis function neural network (RBFNN) method to generate a textual description. To enhance the performance of the RDOAI-ICS method, the parameter optimization process takes place using the RDO algorithm for NasNet and the butterfly optimization algorithm (BOA) for the RBFNN model, showing the novelty of the work. The experimental evaluation of the RDOAI-ICS method can be tested using a benchmark dataset. The outcomes show the enhancements of the RDOAI-ICS method over other recent Image captioning approaches.

Methodology for the development of augmented reality applications for the elimination of errors in the interpretation of manufacturing drawings

Nowadays, precision machining processes have been widely used in the manufacture of products mainly focused on aerospace, automotive, mold manufacturing and various types of products that demand high production volumes, precision and surface quality. However, these manufacturing processes are not exempt from errors and failures during the machining process. Recent studies found that the main errors are due to the interpretation of the information in the manufacturing drawings due to lack of experience or training of the personnel. This research project aims to eliminate errors due to misinterpretation of information in Computer Numerical Control (CNC) machining processes through the implementation of a methodology to develop Augmented Reality (AR) applications for the interpretation of manufacturing drawings. Its main contribution is to provide virtual support to the operating personnel obtaining multiple benefits such as reducing downtime due to failures in the machining process, ensuring the optimal operation of the machines, avoiding collisions of the tools and ensuring the quality of the products.

Experiences, Challenges and Coping Strategies of Never Married Single Women in Pakistan – A Qualitative Analysis

Objective. Intimate relationships have their own vital position in any psychological and social wellbeing hierarchy. This study aims to understand the reasons why some women over 30 years of age remain single, and the social dynamics associated with their marital status. Method. The study collected data through semi-structured interview of 8 educated Pakistani women aged between 30-36 years, living in Karachi. The Interpretative Phenomenological Analysis approach was used to explore the causes of singlehood. Results. The transcribed interviews were analyzed, and common themes and phrases were identified. Five main themes were derived namely similarity/affinity, freedom, ambition, match making process and unpleasent life experiences. Conclusion. Study findings highlighted that principal reasons for being single are compatibility factor and safeguarding ambition/freedom. Family pressures, lack of support to travel/live alone and social commentary are the main challenges faced by single women. Self-help strategies and virtual support groups are the major coping mechanism employed.

THE ROLE OF VIRTUAL PEER HEALTH SUPPORT IN ALTERNATIVE ILLNESS APPRAISALS AND PATIENT SELF-REAPPRAISAL AFTER CANCER

Abstract Technology is transforming how older adults find health-related support and get connected with others who cope with similar healthproblems. This study examined the relationship between virtual peer health support and alternative appraisals of illness experience in old age among people who use the Internet for cancer related support (N=157, Age Range: 50-79, Mean = 57). Regression models with interaction terms examined whether and to what extent virtual peer health support was associated with differential illness appraisal as well as and post-diagnosis self-reappraisal. Results demonstrated that a) perceived benefits of virtual peer health support is a significant predictor of self-reported self-reappraisal (β = .24, p < .01) b) appraisals of illness experience as a traumatic event and/or as a life challenge are both significantly associated with virtual peer health support (β = .18, p < .05 and β = .23, p < .01), and c) appraisal of illness experience as a personal growth growth opportunity is not significantly associated with virtual peer health support (β = .10, p < .23). These results suggest the statistical interactions of the virtual peer health support with illness appraisals are significant predictors of self-reappraisal post-diagnosis. Specifically, those who appraised cancer to have been a traumatic experience and/or life challenge for them perceived virtual peer support to be positively influential on their self-perception after cancer diagnosis, which is in contrast to those who perceived cancer experience as an opportunity for personal growth and thus possibly not deriving further significant additional benefits from virtual peer support.

PERCEPTIONS OF NURSES DELIVERING NURSING HOME VIRTUAL CARE SUPPORT: A QUALITATIVE PILOT STUDY

Abstract Avoidable hospitalizations among nursing home residents result in poorer health outcomes and excess costs. Consequently, efforts to reduce avoidable hospitalizations have been a priority over the recent decade. However, many potential interventions are time-intensive, require dedicated clinical staff, and nursing homes are chronically understaffed. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project was one of seven sites selected by CMS as "enhanced care & coordination providers" and was implemented from 2012 to 2020. A virtual program based on the principles of OPTIMISTIC was developed in the spring of 2020 with the goal of expanding the reach of the program’s services. This qualitative study explores the perceptions and experiences of the nurses that piloted a virtual care support project in 11 nursing homes in a midwestern state, and identified the nurses’ perceived facilitators of, and barriers to, the effectiveness of delivering a novel virtual care support program. A key finding from this analysis is that relationships, communication, and access to information were identified as common themes facilitating or impeding the perceived effectiveness of implementation of virtual care support programs within nursing homes, from the perspective of the nurses delivering the services. The experiences and recommendations of the program nurses provide insights into crucial elements important to the implementation of similar virtual care support models, and the role of telehealth in bridging healthcare workforce gaps.

THIS TOO SHALL PASS: WEATHERING THE STORM AS OLDER FEMALE FAMILY CAREGIVERS FOR THOSE WITH AD/ADRD DURING COVID-19

Abstract Background Older female caregivers of persons with AD/ADRD are under-represented, under-reported, and understudied. Purpose: This qualitative study aimed to understand how COVID-19 affects older female caregivers' lived experience, ongoing capacity, and willingness to provide care for their loved one(s) with AD/ADRD. Specific Aims: Aim 1: Explicate older female caregivers' lived experience in the context of caring for family members with AD/ADRD during COVID-19. Aim 2: Elucidate how COVID-19 affected older female caregivers' relationships with their family members with AD/ADRD. Method: 172 units of meaning were extracted from 327 pages of transcripts and 972 minutes of interviews with urban (n = 10) and rural caregivers (n = 10). Thematic analysis was then conducted. Results Respondents, recruited with purposive and snowball sampling, saw hastened AD/ADRD progression in their family member(s) attributed to social isolation. For many, long-term placement was not an option for financial reasons. Respondents providing full-time caregiving depended heavily on their care recipients' financial resources for basic living expenses, reporting placement in long-term care would leave them at risk of homelessness. Black caregivers expressed an "unspoken" cultural taboo about placement. For all, caregiver disability was the only impetus for placement. Respondents in rural communities more often reported faith-based gratefulness, moments of joy, relational harmony resulting from "being stuck together", and less availability of resources allowing virtual support. Urban caregivers reported more social isolation, less awareness of resources, more intentional family member distancing, and higher pandemic-related distress. Implications: These findings have broad economic, social, policy, research, and practice implications.

SUPPORTING RESIDENTS WITH DEMENTIA LIVING AND DYING IN LONG-TERM CARE AND THEIR FAMILIES DURING COVID-19

Abstract TThis presentation will share research findings about experiences during COVID-19 about implementing a virtual palliative toolkit in long-term care in Canada. The toolkit includes tools and practices to: (a) engage residents and families with dementia within a palliative approach to care, (b) develop workforce capacity through online education modules, (c) reduce stress and improve psychological health of residents, families, and staff, and (d) develop organizational structures and processes to promote a palliative approach to care. Individual interviews were conducted with residents, family members, and staff before implementing a palliative toolkit and after using it. Findings highlighted the negative impacts of COVID-19 on resident health due to isolation within home, preventing family from being at the bedside and cancelling stimulatory activities especially at end of life that were exacerbated by the lack of resources and government supports. Families appreciated the virtual supports and stated that they helped prepare them for their loved ones’ death while feeling more empowered, engaged, and supported in their journey. Although feedback from families was mostly positive, stating the virtual toolkit improved accessibility to information and supports, it was clear that some misunderstood terms, particularly what a palliative approach to care means; and others had challenges navigating the virtual platform to use the toolkit. Future work is needed to make the virtual tools more user-friendly so that they can be scaled up more widely.

TECHNICAL SUPPORTS TO BRIDGE THE DIGITAL DIVIDE FOR OLDER ADULTS PARTICIPATING IN TELEMEDICINE

Abstract Older adults’ relative lack of technological literacy is a barrier to telemedicine, including participation in virtual caregiver support programs. Details of technology assistance required before and during a virtual, seven-session group skills training program for family caregivers were recorded. A majority of participants, all older adults, had difficulty using videoconferencing technology that ranged from finding meeting links in emails to difficulty with basic device use. Personalized support was provided to each caregiver as needed. None required any support by the final session. Those with initial technology challenges felt a sense of accomplishment and increased tech comfort by the end of the sessions. While some older adults had difficulty using telemedicine technology, they were eager to learn and educable with personalized help. Infrastructure to provide this personalized help is necessary to support older adults’ desire to engage in telemedicine and to reduce the digital divide.

A Qualitative Study of the Usability and Likability of a Virtual Group-Based Social Support Program for Older Adults in Residential Care

ABSTRACT Objectives Despite social engagement being a robust predictor of wellbeing for older adults living in residential care, social programming ceased during the COVID-19 pandemic to abide by social distancing guidelines. Consequently, a tablet-based program called the Java Music Club-Digital (JMC-D) was developed. The JMC-D enables residents to engage with peers through discussion and singing from the safety of their own rooms. This study investigated the likability and usability of the JMC-D for older adults living in residential care and recreation staff. Methods Data was collected through semi-structured interviews and focus groups with seven residents and three recreation coordinators. Interviews were analyzed using thematic analysis. Results Three themes emerged: 1) Addressing a need, 2) Factors that affect virtual social connection, and 3) Usability. Interest in future participation in the JMC-D program varied depending on certain personal characteristics including comfort with computers, openness to new experiences, and existing social network. Conclusion Findings suggest that the JMC-D is likeable and usable for residents and recreation coordinators. Clinical implications Study findings can be applied by researchers and residential care staff who wish to increase the use of virtual social programs to improve the psychosocial health of residents. Constructive feedback was incorporated into the platform.

“I’m not alone”: a qualitative report of experiences among parents of children with eating disorders attending virtual parent-led peer support groups

BackgroundThe treatment for children with eating disorders (EDs) requires extensive involvement of parents. The parents of children with EDs have voiced a need for greater support, including connecting with other parents with lived experience of caring for a child with an ED. We aimed to qualitatively explore parental experiences of these groups, including their benefits and areas for improvement.MethodsThis study examined the delivery of four virtual parent-led peer support groups in Ontario, Canada for parents of children with EDs with approximately 10 parent participants per group and two parent facilitators leading each group. Parents (n = 44) were asked to attend 12 bi-weekly support group sessions over 6 months, and then complete an individual end-of-study qualitative interview. Interview data were analyzed using content analysis, following the qualitative description design.ResultsThirty-six parents completed the end-of-study qualitative interview. Participants shared their experiences and impressions related to the group’s structure and content. Notable helpful aspects of the group included being able to receive support from those with similar experiences, access to education and resources about EDs, and being able to support others. Suggestions for improvements were made, which included organizing groups according to the child’s ED diagnosis or duration of illness.ConclusionThe findings indicate that this intervention is acceptable to parents and is perceived as helpful. Future research is needed to strengthen this support group model and to study its effects for parents in different settings and for parents of children with various EDs.Trial registration: ClinicalTrials.gov NCT04686864.

Pengungkapan Diri dan Manajemen Privasi Komunikasi Pasien Covid-19

This study elaborates communication privacy management (CPM) theory in describing the privacy management of Covid-19 patients. This research uses case study method. The results show that informants who are worried about isolation and social stigma consider their status as a Covid-19 patient as personal information. Meanwhile, those who has the intention to participate in stopping the spread of Covid-19 consider their status as public information, so disclosure is necessary. Social media is considered as an appropriate means of disclosure because the patients get virtual support, minimal boundary turbulence, and the presence of healthy discussions about Covid-19 within it.

1127: QUALITATIVE RESEARCH ANALYSIS OF VIRTUAL CRITICAL CARE TRAINING FOR INTERNATIONAL HEALTHCARE WORKERS

Introduction: Recently, the use of virtual platforms for training and learning has increased, and there is no doubt that it is here to stay. Virtual learning poses a significant challenge but also could provide a considerable benefit in bridging the gap in areas with limited critical care training. We analyzed data from international learners who completed virtual Fundamental Critical Care Support (FCCS) training. Methods: We conducted virtual FCCS training courses for healthcare workers in Ghana, Nigeria, the Philippines, and Pakistan. The virtual course was two days long, covering six skills stations. Participants completed a survey after the sessions. The survey questions determined the usefulness, content, delivery of various skill stations, and the most and least valuable features of the stations using a 5-point Likert scale. Results: 178 participant responses were analyzed. The participants were from various backgrounds (ex: resident physician, nurse practitioners, respiratory therapists, and attending physicians). Overall, respondents had a positive experience with the interactive virtual course. The survey showed a Likert score of approximately 4.5+ for the skills stations. One participant said, “The most valuable feature was recognizing an unstable patient and running through what to do from start to transfer.” Participants reported that the workshop would bring changes in their daily practice of medicine, especially regarding understanding critically ill patient management. As a whole, participants reported that the workshop’s least valuable features were network issues, time constraints for stations, and desire for in-person training. Most participants demonstrated a desire for a more hands-on experience in the mechanical ventilation station. Conclusions: We demonstrated that implementing virtual FCCS workshops internationally is feasible and well received by trainees. Although cost-effective, participants did crave an in-person aspect to their training. Our data demonstrates potential in virtual critical care training. By incorporating virtual and augmented reality devices, critical care training can be conducted internationally in resource-limited countries with limited health care professionals with critical care training.

An extended Step-Wise Weighted Assessment Ratio Analysis for improving criteria prioritization process Using PROMETHEE Method

The new Step Wise Weighted Assessment Ratio Analysis (SWARA) method incorporates the opinion of experts, advocates or litigants about the importance ratio. The SWARA methodology can be used in the p in a virtual environment Special decision support systems Practical implementation and Alternative Dispute Resolution. Possible polymetallic mineralization Future map of various study datasets Step wise through integration Weighted Ratio Analysis Developed by (SWARA). In the world of external methods PROMETHEE methods are very popular. One of the reasons for this popularity called PROMCALC-Promethee It is very user-friendly calculation software. Many trainers use their multiple criteria PROMCALC to handle problems. However, all users in PROMETHEE methods regarding the consequences of model assumptions made them will not know. We study the application of PROMETHEE outranking methods to portfolio selection problems. Starting from the new formulation of the PROMETHEE V method, based on the concepts of frontier portfolios and c-optimal portfolios we develop several alternative approaches. The Priority Ranking System Method for Saturation Evaluation (PROMETHEE) was used to solve the problem. Alternative is Technological (C1), Economic (C2), Political and legislative (C3), Social (personnel) (C4). Evaluation parameters are biomedical micro electromechanical systems (BioMEMS) (A1), Nano technology (A2), Biotechnology (A3), Biomedical engineering (A4). PROMETHEE methods are the best solution. The solution with the shortest distance from the negative-best solution the longest distance is determined, but comparison of these distances is not considered significant. As a result, technical factors (C1) are ranked first, while economic factors (C2) are ranked lowest.