Synchronous Videoconferencing Research Articles

Content that Promotes Intent to Change: Asynchronous and Synchronous Professional Development for Family Doctors in Continuing Medical Education

Background In 2020, a medical school in northern Ontario launched “Overcoming Barriers to Safe Opioid Prescribing,” a continuing professional development program consisting of an asynchronous online module followed by a series of optional synchronous videoconferences, which together formed a virtual community of practice (VCoP). The videoconferences followed a structured format, where a case study was introduced by one of the participants from their practice, followed by group reflections on the case and the development of strategies for implementing the learnings in their practices. Methods Mixed methods data was collected from participants utilizing a variety of tools and at different times before, during and after their engagement in the program. Qualitative data analysis produced a list of key themes that were cross-validated by anonymized, aggregated program evaluation data to identify further, module-specific themes. Results This paper examines the learning experiences and outcomes of primary care providers that participated in the online modules and synchronous videoconferences and proposes content design strategies that led to these educational experiences. The online module created a baseline of knowledge, increased participants’ familiarity with practice guidelines, comfort and confidence in prescribing and deprescribing behaviours, and increased participants’ familiarity with tools, resources, and strategies for safe opioid prescribing in their practices. The synchronous videoconferences developed a community of learning through modeling, experiential learning and the sharing of experiences and best practices. Conclusions The combination of the online module and synchronous videoconferences led to an increase in the intent to change practice, particularly with enhanced the principles of patient-centred care through their focus on practical, real-world strategies and physician-patient communication techniques. Participants noted that the foundational knowledge and resources provided in the online course was supported and contextualized through the synchronous discussions.

From Emergency Remote Teaching to an Online Educational Ecosystem: An Ecuadorian University Case Study

This case study examines the experience of Universidad Andina Simón Bolívar (UASB-E), a traditionally face-to-face institution in Ecuador, as it transitioned to online learning during and after the COVID-19 pandemic. Drawing on data from interviews, surveys, and document analysis, the study explores the challenges and opportunities associated with this rapid shift, offering insights for rethinking and redesigning higher education in the post-pandemic world. Prior to the pandemic, UASB-E primarily relied on face-to-face teaching with limited use of its virtual learning environment. In response to the crisis, the university quickly mobilized to migrate its entire educational offering online, initially adopting an emergency remote teaching approach focused on synchronous videoconferencing. However, student preferences and the need for a sustainable solution prompted UASB-E to rethink its online learning model. The study identifies six key dimensions of UASB-E's improvement in its capacity to deliver online education: (1) Technological Infrastructure and Digital Processes: Enhanced technological infrastructure and streamlined digital processes in management, administration, and academics, laying the foundation for a robust online learning environment. (2) Pedagogical Innovation: Recognizing the limitations of replicating face-to-face teaching online, UASB-E embraced activity-based instructional design, asynchronous online education, and collaborative learning strategies, promoting deeper engagement and personalized learning experiences. (3) Accessibility and Inclusivity: By leveraging the flexibility of online learning, UASB-E expanded its reach beyond its physical campus, reaching students across Ecuador who might not have otherwise accessed higher education, demonstrating the potential of online learning to democratize access to quality education. (4) Programme Diversification: Beyond emergency measures, UASB-E is strategically diversifying its academic offerings, developing new face-to-face, blended, and fully online programmes, allowing for flexibility and catering to diverse student needs and learning preferences. (5) Faculty Training and Development: Implemented a comprehensive training programme focusing on both the instrumental skills of managing online platforms and the pedagogical aspects of designing engaging and effective online learning experiences. (6) Assessment and Feedback: The study highlights the need for a more reflective and analytical approach to assessment and feedback in online environments, with efforts to improve feedback timeliness, individual support, and communication providing valuable lessons for other institutions. Beyond UASB-E's specific experience, the study emphasizes the importance of collaboration and cross-sectoral strategies in building resilient and comprehensive education systems for the future. It also underscores the need for new approaches to learning ecologies that leverage technology effectively while ensuring equitable, inclusive, and high-quality education for all. This case study offers valuable insights for higher education institutions navigating the rapidly evolving landscape of online learning. By understanding the challenges and opportunities that emerged from UASB-E's experience, other institutions can make informed decisions about their own online learning strategies and contribute to shaping a more resilient and flexible future for higher education.

‘Making a connection’: a qualitative study of experiences from a cancer telerehabilitation program

PurposeSpecialised group-based exercise rehabilitation is beneficial for cancer survivors but access to these services is limited. Telerehabilitation provides an opportunity to expand reach, but we do not know about the experiences of those who participate in this way. This study explored participant experiences of an exercise-based telerehabilitation program for people with cancer.MethodA qualitative study using semi-structured interviews was completed. Twenty-two cancer survivors were purposively sampled from the experimental group of a randomised controlled trial evaluating exercise-based cancer telerehabilitation delivered in groups using synchronous videoconferencing. Interviews were audio-recorded and transcribed verbatim. Data were coded independently by two reviewers and analysed inductively by thematic analysis.Results‘A feeling of connection’ was the overarching theme. Participants perceived they connected with the health service, expert health professionals, and peers through participating in the telerehabilitation program. These connections provided a personalised rehabilitation experience and improved perceptions of physical and emotional well-being. Two subthemes suggested connection was facilitated by (1) the acceptability of telerehabilitation and (2) enhanced accountability to exercise. Participants felt disconnected when they were unable to participate in the program due to cancer treatment and side effects (e.g. fatigue), feeling unwell, and co-morbidities.ConclusionWe identified that telerehabilitation facilitated connections that enhanced the reach of exercise to cancer survivors. Our findings support using telerehabilitation to deliver specialised group-based exercise programs alongside more traditional models of care to increase participation in exercise among people with cancer.

Diabetes Telemedicine Mediterranean Diet (DiaTeleMed) Study: study protocol for a fully remote randomized clinical trial evaluating personalized dietary management in individuals with type 2 diabetes

BackgroundThe Diabetes Telemedicine Mediterranean Diet (DiaTeleMed) Study is a fully remote randomized clinical trial evaluating personalized dietary management in individuals with type 2 diabetes (T2D). The study aims to test the efficacy of a personalized behavioral approach for dietary management of moderately controlled T2D, versus a standardized behavioral intervention that uses one-size-fits-all dietary recommendations, versus a usual care control (UCC). The primary outcome will compare the impact of each intervention on the mean amplitude of glycemic excursions (MAGE).MethodsEligible participants are between 21 and 80 years of age diagnosed with moderately controlled T2D (HbA1c: 6.0 to 8.0%) and managed on lifestyle alone or lifestyle plus metformin. Participants must be willing and able to attend virtual counseling sessions and log meals into a dietary tracking smartphone application (DayTwo), and wear a continuous glucose monitor (CGM) for up to 12 days. Participants are randomized with equal allocation (n = 255, n = 85 per arm) to one of three arms: (1) Personalized, (2) Standardized, or (3) UCC. Measurements occur at 0 (baseline), 3, and 6 months. All participants receive isocaloric energy and macronutrient targets to meet Mediterranean diet guidelines, in addition to 14 intervention contacts over 6 months (4 weekly then 10 biweekly) to cover diabetes self-management education. The first 4 UCC intervention contacts are delivered via synchronous videoconferences followed by educational video links. Participants in Standardized receive the same educational content as those in the UCC arm, following the same schedule. However, all intervention contacts are conducted via synchronous videoconferences, paired with Social Cognitive Theory (SCT)-based behavioral counseling, plus dietary self-monitoring of planned meals using a mobile app that provides real-time feedback on calories and macronutrients. Participants in the Personalized arm receive all elements of the Standardized intervention, in addition to real-time feedback on predicted post-prandial glycemic response (PPGR) to meals and snacks logged into the mobile app.DiscussionThe DiaTeleMed Study aims to address an important gap in the current landscape of precision nutrition by determining the contributions of behavioral counseling and personalized nutrition recommendations on glycemic control in individuals with T2D. The fully remote methodology of the study allows for scalability and innovative delivery of personalized dietary recommendations at a population level.Trial registrationClinicalTrials.gov NCT05046886. Registered on September 16, 2021.

Mitigating Lecturers’ Communication Uncertainty in Using SWVC During Online Lectures

This study investigates at the communication uncertainty undergraduate lecturers face when delivering lectures through synchronous web video conferencing (SWVC) during online lectures. Uncertainty Reduction Theory (URT) is employed to understand how lecturers use communication techniques to reduce uncertainty in online lecture. Undergraduate lecturers at Universitas Muhammadiyah Surakarta who have ever conducted teaching online were interviewed in semi-structured interviews. Thematic analysis is performed, with a particular focus on the methods that lecturers use to communicate with their students in order to build relationships and reduce uncertainty. The study identifies a number of important areas of uncertainty, such as technical challenges, the development of useful learning materials, evaluation of comprehension, student involvement, and conduct during online sessions. This study shows how lecturers use active, passive, and interactive strategy to reduce uncertainty. These results underline how crucial it is to deal with technology challenges, advance interactive teaching strategies, raise student participation, and establish effective communication in order to guarantee successful online education in the face of uncertainty.

Diabetes Telemedicine Mediterranean Diet (DiaTeleMed) Study: study protocol for a fully remote randomized clinical trial evaluating personalized dietary management in individuals with type 2 diabetes.

The Diabetes Telemedicine Mediterranean Diet (DiaTeleMed) Study is a fully remote randomized clinical trial evaluating personalized dietary management in individuals with type 2 diabetes (T2D). The study aims to test the efficacy of a personalized behavioral approach for dietary management of moderately-controlled T2D, versus a standardized behavioral intervention that uses one-size-fits-all dietary recommendations, versus a usual care control (UCC). The primary outcome will compare the impact of each intervention on the mean amplitude of glycemic excursions (MAGE). Eligible participants are between 21 to 80 years of age diagnosed with moderately-controlled T2D (HbA1c: 6.0-8.0%), and managed on lifestyle alone or lifestyle plus metformin. Participants must be willing and able to attend virtual counseling sessions and log meals into a dietary tracking smartphone application (DayTwo), and wear a continuous glucose monitor (CGM) for up to 12 days. Participants are randomized with equal allocation (n = 255, n = 85 per arm) to one of three arms: 1) Personalized, 2) Standardized, or 3) UCC. Measurements occur at 0 (baseline), 3, and 6 months. All participants receive isocaloric energy and macronutrients targets to meet Mediterranean diet guidelines plus 14 intervention contacts over 6 months (4 weekly then 10 biweekly) to cover diabetes self-management education. The first 4 UCC intervention contacts are delivered via synchronous videoconferences followed by educational video links. Participants in Standardized receive the same education content as UCC on the same schedule. However, all intervention contacts are conducted via synchronous videoconferences, paired with Social Cognitive Theory (SCT)-based behavioral counseling, plus dietary self-monitoring of planned meals using a mobile app that provides real-time feedback on calories and macronutrients. Participants in the Personalized arm receive all elements of the Standardized intervention, plus real-time feedback on predicted post-prandial glycemic response (PPGR) to meals and snacks logged into the mobile app. The DiaTeleMed study will address an important gap in the current landscape of precision nutrition by determining the contributions of behavioral counseling and personalized nutrition recommendations on glycemic control in individuals with T2D. The fully remote methodology of the study allows for scalability and innovative delivery of personalized dietary recommendations at a population level. The DiaTeleMed Study is registered with ClinicalTrials.gov (Identifier: NCT05046886).

The seductive details in online mathematics learning

The new technologies and multimedia formats have given rise to highly attractive synchronous virtual environments for learning mathematics. However, the cognitive theory of multimedia learning suggests that it is preferable to eliminate seductive information from a multimedia presentation. Nevertheless, it is still unclear whether this effect manifests in ecological situations such as synchronous video conferences. In order to address this gap, two experiments were conducted to examine the effect of instructional, decorative, and seductive images on mathematics learning through synchronous video conferences, for both beginner and advanced students. The first experiment (n = 156) revealed that both materials with instructional graphics and materials without graphics are more efficient (i.e., they generate higher performance with equal mental effort) than materials with seductive graphics. In the second experiment, the moderating role of prior knowledge was analyzed (n = 163), including advanced students in the study. The results suggested that novice students performed better with materials containing instructional and decorative graphics compared to those presenting seductive graphics. However, this disadvantage of learning with seductive graphics disappeared in advanced students. It is concluded that the effectiveness of online mathematics learning depends on the type of graphics used and the level of prior knowledge. These results are discussed from the perspective of cognitive load and multimedia learning, and practical guidelines are provided for teaching and researching online mathematics learning.

Students’ perceived social presence and media richness of a synchronous videoconferencing learning environment

This correlational cross-sectional study was conducted with sixty graduate students to explore their perceived social experiences with the use of synchronous videoconferencing in the online learning environment. By applying the theories of social presence and media richness, this study investigated the perceived relationship between social presence, social space, sociability, and media richness. The communication theories of social presence and media richness were applied to better understand the relationship between the communication medium (videoconferencing) and the interactions within the mediated environments (e.g., Zoom). Looking through the lens of social constructivism, this correlational cross-sectional study explored graduate students perceived social presence and media richness of a synchronous videoconferencing learning environment by investigating how strongly and in what direction social presence, social space, sociability, and media richness were related. To answer the research question, a Pearson correlation analysis was conducted to investigate how strongly and in what direction social presence, social space, sociability, and media richness were related in a synchronous videoconferencing learning environment. The results indicated a strong, positive correlation between Social Presence and Social Space (Positive Group Behavior); Social Presence and Sociability; Social Presence and Media Richness; Social Space (Positive Group Behavior) and Sociability; Social Space (Positive Group Behavior) and Media Richness; and Sociability and Media Richness. A moderate, negative correlation was indicated between Social Space (Negative Group Behavior) and Social Presence; Social Space (Negative Group Behavior) and Sociability; and Social Space (Negative Group Behavior) and Media Richness.

Development of a mindfulness-based pediatric weight management intervention for adolescents: findings from a pilot trial adapted for telehealth delivery

ABSTRACT This study describes the development, feasibility, and acceptability of a novel group Mindfulness-Based Pediatric Weight Management (MBPWM) intervention for adolescents with overweight/obesity (OW/OB), tailored for telehealth delivery (via videoconferencing). A pilot trial of MBPWM was conducted across two cohorts of socioeconomically diverse adolescents (N = 14) with OW/OB. Cohort one received the intervention in-person, and cohort two received the intervention virtually (synchronous videoconferencing). Feasibility and acceptability were supported by session attendance, completion of daily food and mindfulness logs, and post-intervention feedback. Adolescent percent over the 95th percentile BMI based on age-and-sex (%BMIp95) decreased pre- to post-treatment, trending toward significance. No differences between cohorts one and two were observed on outcomes. While the number of participants was small, the overall pattern of findings provides initial support for feasibility and acceptability.

Analysis of Demographic and Socioeconomic Factors Influencing Adherence to a Web-Based Intervention Among Patients After Acute Coronary Syndrome: Prospective Observational Cohort Study.

Although telemedicine has been proven to have significant potential for improving care for patients with cardiac problems, there remains a substantial risk of introducing disparities linked to the use of digital technology, especially for older or socially vulnerable subgroups. We investigated factors influencing adherence to a telemedicine-delivered health education intervention in patients with ischemia, emphasizing demographic and socioeconomic considerations. We conducted a descriptive, observational, prospective cohort study in consecutive patients referred to our cardiology center for acute coronary syndrome, from February 2022 to January 2023. Patients were invited to join a web-based health educational meeting (WHEM) after hospital discharge, as part of a secondary prevention program. The WHEM sessions were scheduled monthly and used a teleconference software program for remote synchronous videoconferencing, accessible through a standard computer, tablet, or smartphone based on patient preference or availability. Out of the 252 patients (median age 70, IQR 61.0-77.3 years; n=189, 75% male), 98 (38.8%) declined the invitation to participate in the WHEM. The reasons for nonacceptance were mainly challenges in handling digital technology (70/98, 71.4%), followed by a lack of confidence in telemedicine as an integrative tool for managing their medical condition (45/98, 45.9%), and a lack of internet-connected devices (43/98, 43.8%). Out of the 154 patients who agreed to participate in the WHEM, 40 (25.9%) were unable to attend. Univariable logistic regression analysis showed that the presence of a caregiver with digital proficiency and a higher education level was associated with an increased likelihood of attendance to the WHEM, while the converse was true for increasing age and female sex. After multivariable adjustment, higher education level (odds ratio [OR] 2.26, 95% CI 1.53-3.32; P<.001) and caregiver with digital proficiency (OR 12.83, 95% CI 5.93-27.75; P<.001) remained independently associated with the outcome. The model discrimination was good even when corrected for optimism (optimism-corrected C-index=0.812), as was the agreement between observed and predicted probability of participation (optimism-corrected calibration intercept=0.010 and slope=0.948). This study identifies a notable lack of suitability for a specific cohort of patients with ischemia to participate in our telemedicine intervention, emphasizing the risk of digital marginalization for a significant portion of the population. Addressing low digital literacy rates among patients or their informal caregivers and overcoming cultural bias against remote care were identified as critical issues in our study findings to facilitate the broader adoption of telemedicine as an inclusive tool in health care.

Telemedicine is here to Stay: Success and Utility of Video Consultations in Neonatology

Abstract Background and Objectives: “Synchronous videoconference telemedicine in neonatal office-practice” (SyNTOP) has been a routine practice in our center since the start of the COVID-19-related lockdown. We recently reported our experience with the “success” of this practice in terms of removing the need to visit the hospital over the next 48 h after the teleconsult. Methods: Secondary results of this retrospective descriptive study which analyzed 829 consults are presented in this manuscript. Data from electronic medical records of those who availed teleconsultation facility between March 2020 and April 2021 were retrieved. Relevant information about clinical presentation, findings from the video call, demographic information, decisions made by the clinician, and outcomes were collected. Best efforts were made to obtain follow-up information by the clinical team or guest–patient relations officers. Results: Fever (n = 118) and acute diarrheal disease (n = 58) were the common presenting complaints; most (80.5% and 95.5%, respectively) were resolved without physical examination; 265 developmental assessments were completed by video-facilitated checks. Fast-track vaccination visits where queries were resolved and bills paid online, were an innovation where well babies could avoid queues and possible exposure to crowds. One-fourths of SyNTOP were from outside the district, and 1.4% were from foreign countries. Conclusions: Teleconsults were successfully conducted in neonatal office practice for different health-care enquiries. Strategies such as fast-track vaccinations and online developmental follow-up assessments were performed by leveraging technology. We highlight the benefits of these innovations in our center with a view to enhance their uptake elsewhere. Such approaches have the potential to increase health equity and access to specialty health care.

Experiences of patients with chronic low back pain plus comorbid depressive symptoms in a videoconference group acceptance and commitment therapy or behavioral activation treatment for depression: a qualitative study

Purpose To explore the experiences of patients with chronic low back pain (CLBP) plus comorbid depressive symptoms who received a remote synchronous videoconference group form of Acceptance and Commitment Therapy (ACT) or Behavioral Activation Treatment for Depression (BATD). Methods A qualitative study (IMPACT-Q) was nested within a randomized controlled trial (RCT) designed to assess the efficacy and the cost-utility/cost-effectiveness of two therapies in the management of CLBP and depression. Fifty-five patients with CLBP plus depression were selected from the RCT. Twelve focus group sessions, each approximately 60–90 min long, were audio-recorded, transcribed verbatim, and analyzed by six coders through a thematic analysis (deductive and inductive) based on a descriptive phenomenological approach. Results Patients perceived behavioral, affective, and cognitive improvements after completing group sessions. Overall, psychotherapy was perceived as a safe and non-judgmental place to express emotions and feel understood. The main barriers reported were lack of human contact and loss of social interaction. In contrast, ease of access, flexibility in the ability to connect from anywhere, avoidance of the need to travel, and savings in time and money were key facilitators to increase attendance and adherence to therapy. Conclusion This study provided support for the acceptability of videoconference-delivered ACT or BATD in patients with CLBP plus comorbid depressive symptoms.

Different interlocutors, different EFL interactional strategies: A case study of intercultural telecollaborative projects in secondary classrooms

AbstractThe purpose of this article is to investigate the interactional strategies that secondary school EFL learners use during telecollaboration with interlocutors from a different cultural and linguistic background. Its novelty lies in the educational level and cultural contexts explored as well as in the goal of examining whether frequency of strategy use may depend on the interlocutor and, if so, what the relevant factors are for such variation. The study focuses on two projects in which 10 participants from one Bulgarian school and 18 partners from two schools in Spain took part in dyadic synchronous videoconferences discussing culture-related topics. Data were collected via video recordings, field observations, semi-structured interviews, and questionnaires. The article presents both descriptive statistics and qualitative analysis of the communicative behavior of three case study students interacting with different telecollaborative partners. We found that the participants demonstrate differences in interactional behavior and utilize strategies with varying frequency depending on their interlocutor. The results also reveal crucial factors in the design of telecollaborative educational projects if learners are to successfully implement skills of discovery and interaction in real time.

Resource Document on Best Practices in Synchronous Videoconferencing-Based Telemental Health.

Background: This document represents an updated collaboration between the American Psychiatric Association (APA) and the American Telemedicine Association (ATA) to create a consolidated update of the previous APA and ATA official documents and resources in telemental health, to provide a single guide on clinical best practices for providing mental health services through synchronous videoconference. Methods: A joint writing committee drawn from the APA Committee on Telepsychiatry and the ATA TMH Special Interest Group (TMH SIG). was convened to draft and finalize the guidelines. This document draws directly from the 2018 APA/ATA guide and the ATA s previous guidelines, selecting from key statements/guidelines, consolidating them across documents, and then updating them where indicated. Guideline approval was provided following internal review by the APA, the ATA, the Board of Directors of the ATA, and the Joint Reference Committee of the APA. Results: The guidelines contain requirements, recommendations, and actions that are identified by text containing the keywords "shall," "should," or "may." Conclusions: Compliance with these recommendations will not guarantee accurate diagnoses or successful outcomes. The purpose of this guide is to assist providers in providing effective and safe medical care founded on expert consensus, research evidence, available resources, and patient needs.

Extending the UTAUT Model of Tencent Meeting for Online Courses by Including Community of Inquiry and Collaborative Learning Constructs

Synchronous videoconferencing has been chosen as a platform for conducting online courses after the outbreak of the COVID-19 pandemic. However, its acceptance has yet to be explored from interactive and cognitive aspects. This study aims to investigate factors influencing students’ acceptance of the online learning platform- Tencent Meeting/VooV Meeting, extending the UTAUT model by adding community of inquiry and collaborative learning constructs as external factors. A total of 1058 participants’ responses were collected in the autumn semester of 2022, and the survey results were analyzed using structural equation modeling. The results show that most of the influencing factors proposed in the extending UTAUT model apply to Tencent Meeting. Specifically, performance expectancy, social influence, and cognitive presence can positively and significantly predict behavioral intention in using Tencent Meeting for online courses at the 0.001 level. Facilitating conditions and behavioral intention are both determinants of usage behavior. Teaching presence and collaborative learning can positively predict cognitive presence, which is the most influential factor of behavioral intention, indicating that collaborative learning and cognitive presence should be vital considerations in promoting the usage of online learning platforms. The present study expands upon our comprehension of the determinants that impact the utilization of Tencent Meeting, thereby offering recommendations for the development of online platforms according to the cognitive and interactive necessities of students. Instructors may contemplate the creation of online exercises that necessitate higher levels of collaboration to enhance student engagement and encourage cognitive presence, addressing students’ cognitive developmental demands in a supportive manner. This study is limited to the number of selected variables used to explicate the adoption of Tencent Meeting by users with the aid of UTAUT and the community of inquiry framework. It is anticipated that subsequent research may expand upon the array of variables under consideration, such as task-technology fit, usage habits, and information technology competence. The respondents surveyed primarily comprised individuals affiliated with Chinese language universities, with an imbalanced gender distribution, and an over-representation of liberal arts majors. Thus, the generalizability of the research could be impeded. Therefore, to augment the external validity of the study, future research may collect data from various educational levels and cultural backgrounds to corroborate the research outcomes.

Rapid Conversion to a Completely Virtual Multidisciplinary ALS Clinic in Response to the COVID-19 Pandemic: Implications for Future Care Delivery.

The goals of this study were to assess the feasibility of maintaining multidisciplinary remote care, patient preferences, and outcomes of this transition because of COVID-19. From March 18, 2020 to June 3, 2020, 127 patients with amyotrophic lateral sclerosis (ALS) who were scheduled to be seen in our ALS clinic were contacted and scheduled according their preference for a telemedicine visit, telephone visit, or postponement until the next available in-person visit. Age, time from disease onset, ALS Functional Rating Scale-Revised, patient choices, and outcomes were recorded. Patient visit preferences were 69% telemedicine, 21% telephone, and 10% postpone for a later in-clinic visit. Patients with higher ALS Functional Rating Scale-Revised were more likely to choose the next in-person opening (P = 0.04). Age and time from disease onset were not related to visit type preference. There were 118 virtual encounters, of which 91 (77%) began as telemedicine and 27 (23%) as telephone visits. Most telemedicine visits were conducted successfully, but 10 were converted to a telephone visit. The clinic maintained 88.6% of patient volume compared with the prior year, during which most visits were in-person. Telemedicine care using synchronous videoconferencing is preferable and feasible for most patients on short notice, with telephone as back-up. Clinic volumes can be maintained. These findings support the conversion of a multidisciplinary ALS clinic to 1 with exclusively virtual visits when future events again disrupt in-person care.

Social presence as means to humanizing online classroom

PurposeThe previous coronavirus disease 2019 (COVID-19) pandemic has forced pre-service English teachers to conduct their teaching simulation virtually. In the context of online teaching, social presence is vital for effective learning. This skill is perceived as a way to humanize the online learning process. This article explores how social presence is represented in the pre-service teacher's synchronous online classroom and how the development of social presence enables the pre-service teachers to develop their students' well-being and thus humanize online classrooms.Design/methodology/approachThe current study draws upon case study research. The data were collected from (1) synchronous online teaching simulation recordings of pre-service English teachers from the Language Classroom Management course and (2) interview transcripts from three participants. Both data sources were transcribed, coded and analyzed. A two-step coding scheme for pre-service English teachers' social presence was adapted from the Community of Inquiry (CoI) coding template.FindingsThis study reports that all the three social presence categories (i.e. cohesive, affective and interactive) emerged from their online teaching simulation. In addition, the development of social presence to humanize online classrooms from the pre-service teachers was found in these stages: (1) having a role model for teaching, (2) showing respect and being friendly and (3) adjusting the language of instructions to the students' level.Research limitations/implicationsThis study has been limited to the pre-service teachers in one university only. Therefore, this needs to be tested in wider settings and contexts.Practical implicationsTheoretically, this study has added students' well-being as the element that connects social presence to the humanizing online classroom. Meanwhile, practically, in relation to teacher education, this paper also recommends the teaching stages leading to a more humanized online learning.Originality/valueCurrent studies tend to describe social presence in experienced teachers' asynchronous online classrooms. Rarely did the studies explore social presence as practiced by pre-service teachers in the context of synchronous videoconferencing class. Furthermore, there has also been limited research connecting social presence with humanized classrooms.

What constitutes a high-quality, comprehensive medico-legal asylum affidavit in the United States immigration context? A multi-sectoral consensus-building modified Delphi

In the United States, clinicians are often called upon to provide their expertise to generate expert evidence in cases of individuals seeking asylum or other forms of international protection. Due to a lack of validated guidelines specific to the U.S. immigration context, clinical evaluations produced for immigration proceedings in the United States vary in their format, structure, and content, which can be confusing for practitioners and for adjudicators assessing the weight these evaluations should be afforded in asylum proceedings. We sought to review critical components of a medico-legal asylum evaluation from an interdisciplinary perspective of key stakeholders, by collecting and synthesizing expert opinions to reach consensus on what constitutes a high-quality, comprehensive medical or psychological affidavit for U.S. immigration cases. The consensus process incorporated a three-step modified Delphi method, which took place between September and December 2021 and consisted of two rounds of online questionnaires and a synchronous video conference meeting. The areas most experts agreed on included, by order of highest agreement (combining answers of “strongly agree” and “agree”): A narrative form or checklist is preferable to a predetermined template (95%); Primary care physicians should describe their qualifications to diagnose mental health conditions (81%); Use of citation is helpful, with caveats (77%); Clinicians should include an assessment of malingering (72%); Clinicians should include an executive summary/summary of conclusions at the top of the affidavit (72%); Clinicians should reference the Istanbul Protocol and explain its relevance (66%); It may be beneficial for clinicians to describe the anticipated process of healing (57%); Clinicians may include treatment recommendations (52%). Results of this and future consensus-building efforts and resulting guidance should be used to enhance overall quality of medico-legal reports and incorporated in training programs developed for clinicians, attorneys and adjudicators.

An interprofessional school-based initiative to increase access to oral health care in underserved Florida counties.

To examine and describe the effect of an oral health education program on school-based nurses' acquisition of oral health knowledge. Three-hour synchronous videoconference sessions provided training for nurses to conduct oral health risk assessments, screen for oral diseases, deliver oral health education, apply fluoride varnish, and refer children identified in need of further assessment and treatment to a dentist. Oral health knowledge acquisition was assessed by comparing pre-training and post-training examination scores. Analyses included descriptive statistics and the Wilcoxon signed-rank test. Seventeen nurses from Suwannee, Lafayette, and Hamilton counties participated in the oral health education training program. Analyses of the school-based nurses' test results showed a significant increase in correct answers on the post-training test (93%) compared to the pre-training test (56%). Six hundred forty-one children from six elementary public schools received oral health education, oral screenings, and fluoride varnish applications. Fifty-eight percent of the children had untreated caries, 43% had treated caries, 15% had sealant on permanent molars, and 3% required urgent care. Nurses successfully referred children identified in need of further assessment and treatment to a dentist. The synchronous videoconference oral health training program was effective in improving school-based nurses' oral health knowledge. The knowledge acquired by school-based nurses via oral health training programs can be leveraged to increase access to oral health care for vulnerable and unserved school-aged populations.

Teachers' use of motivational strategies in the synchronous online environment: A self-determination theory perspective.

With the development of synchronous videoconferencing technology, research on the professional practices of synchronous online teaching has been growing at an exponential rate. However, little is known about synchronous online teachers' use of motivational strategies, despite the important role of teachers in fostering student motivation. To address this gap, this mixed-methods study examined how synchronous online teachers utilized motivational strategies and explored the influence of the synchronous online environment on the use of motivational strategies. As an analytical framework, we drew ontheneed-supportive teaching principlesof the self-determination theory, which present three types of motivational strategies: involvement, structure, and autonomy-support. The quantitative analysis of survey results collected from language teachers (N = 72) revealed the perception that autonomy-support and structure were relatively well suited to the online environment while involvement was difficult to implement. The qualitative analysis of follow-up interviews (N = 10) elucidated how the online environment influenced theteachers' use of each strategy while producing a new framework and specific strategy lists that may be applicable to synchronous online teaching. This study presents important theoretical implications regarding the application of self-determination theory in online education, while also providing practical implications for synchronous online teacher preparation and professional development.