Video Teleconferencing Research Articles

Sleep telemedicine lacks immunity to Continuous Positive Airway Pressure device shortages

In this issue of SLEEP, Kosky et al. [1] take a real-world approach to explore a particular application of sleep telemedicine. Their manuscript, “Telemedicine compared to standard face-to-face care for CPAP treatment: real-world Australian experience,” shows that the former is both feasible and noninferior to the latter in terms of CPAP adherence, efficacy, and sleepiness/functional outcome improvement. While the standard care arm participants reported slightly higher satisfaction than the telemedicine arm participants, there were significant cost savings in the telemedicine arm. The study is particularly notable for several reasons, including its pragmatic design. Participants were not randomized into standard- and telemedicine-based care, a common paradigm among similar trials. Individuals living more than 100 km from the sleep center became the telemedicine arm as they likely would in usual clinical practice. As Table 1 of the article demonstrates, demographic imbalances introduced by such a recruitment model were relatively minor. Another notable feature in the study’s design was its emphasis on CPAP treatment follow-up as opposed to initial evaluation or testing. That is, initial evaluations were not constrained to video consultation if the participant chose to have that initial visit face to face in Perth. Furthermore, all participants—standard and telemedicine arm—underwent in-laboratory sleep testing and face-to-face CPAP set-up (if indicated) at the same Perth sleep center. It was at this point that the treatment models diverged most consistently; telemedicine arm participants received CPAP follow-up via telephone and remote telemonitoring via built-in CPAP device modem, while standard arm participants received CPAP follow-up via face-to-face visits and physical device downloads. The results, summarized above, revealed that the technologic blend of video teleconferencing, telephone, and remote CPAP device downloading had delivered clinically rigorous, well-accepted, and cost-effective care. Participant enrollment concluded in June 2019, just as sleep telemedicine was about to face significant disruption.

A Pilot Study to Determine if Playing Music Before Class Enhanced the "Zoom" Online Learning Environment in a Preclinical Science Course.

The COVID-19 pandemic forced students and educators to shift from the traditional physical classrooms (face to face) to online platforms such as the Zoom to host live synchronous sessions. Although this video teleconferencing software facilitated communication between students and faculty around the world, technically the blank, silenced log-in screens removed the “connectedness” of the classroom. A medical educator plays music during the pre-class Zoom synchronous session as an approach to encourage a positive learning environment in a preclinical science course.

Evaluation of a multicomponent intervention to shorten thrombolytic door-to-needle time in stroke patients in China (MISSION): A cluster-randomized controlled trial

BackgroundRapid intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) is crucial for improving outcomes. However, few randomized trials of interventions aimed at reducing in-hospital delay have been carried out in China. We aimed to evaluate the effect of a multicomponent intervention on thrombolytic door-to-needle time (DNT) of AIS patients via video teleconference based on the Behavior Change Wheel (BCW) method.Methods and findingsThis cluster-randomized trial, conducted between January 1, 2019 and December 31, 2019, randomly allocated 22 hospitals equally to PEITEM (Persuasion Environment reconstruction Incentivization Training Education Modeling) intervention or routine care plus stroke registry and subsequently enrolled 1,634 AIS patients receiving IVT within 4.5 hours upon stroke onset from participant hospitals. The PEITEM group received a 1-year PEITEM 6-component intervention based on the behavioral theory monthly via video teleconference. The primary outcome was the proportion of patients with a DNT of 60 minutes or less. A total of 987 patients participated in the PEITEM group (mean age, 69 years; female, 411 [41.6%]) and 647 patients in the control group (mean age, 70 years; female, 238 [36.8%]). Of all participants, the proportion of DNT ≤60 minutes in the PEITEM group was higher than in the control group (82.0% versus 73.3%; adjusted odds ratio, 1.77; 95% confidence interval (CI), 1.17 to 2.70; ICC, 0.04; P = 0.007). Among secondary outcomes, the average DNT was 43 minutes in the PEITEM group and 50 minutes in the control group (adjusted mean difference: −8.83; 95% CI, −14.03 to −3.64; ICC, 0.12; P = 0.001). Favorable functional outcome (score of 0 to 1 on the modified Rankin scale (mRS)) was achieved in 55.6% patients of the PEITEM group and 50.4% of the control group (adjusted odds ratio, 1.38; 95% CI, 1.00 to 1.90; ICC, 0.01; P = 0.049). Main study limitations include non-blinding of clinicians, and that specific interventions component responsible for the observed changes could not be determined.ConclusionsThe teleconference-delivered PEITEM intervention resulted in a moderate but clinically relevant shorter DNT and better functional outcome in AIS patients receiving IVT.Trial registrationClinicaltrials.gov NCT03317639.

Psychosocial screening in a pediatric diabetes clinic: Adolescents' and mothers' perspectives.

Adolescents with type 1 diabetes (T1D) frequently experience psychosocial concerns, and mental health screening is becoming increasingly common in routine diabetes care. However, little is known about what adolescents or their caregivers think about the role of mental health screening and intervention within the context of comprehensive diabetes care, or how their diabetes care providers should be involved in navigating mental health concerns. This study used qualitative methods to obtain the perspectives of adolescents with T1D and their caregivers regarding these issues. Participants were 13 adolescents with T1D (ages 12-19 years; M = 15.1 years; 53.8% female; 61.5% Hispanic/Latinx White) and 13 mothers, recruited from an outpatient pediatric endocrinology clinic in South Florida, who participated in semi-structured interviews via video teleconference. Thematic content analysis was used to evaluate participants' responses. Adolescents and their mothers reported positive experiences with the clinic's psychosocial screening procedures and appreciated meeting with the psychology team during visits. They wanted the clinic to offer more opportunities for peer support. Mothers highlighted barriers to seeking mental health care outside of the clinic and the importance of mental health professionals understanding diabetes. Mothers also wanted the clinic to offer more on-site therapeutic services. Study participants valued psychosocial screening and supported addressing mental health as a routine part of diabetes comprehensive care.

A randomized study to measure and enhance the health-related quality of life in patients with cancer receiving immune checkpoint modulators (ME-Q).

TPS6603 Background: Existing data demonstrate the impact of Immune checkpoint modulators (ICMs) on Health-Related Quality of Life (HRQOL), but this was from studies that used HRQOL tools developed for patients treated with chemotherapy and/or radiation. To address this gap, we developed a toxicity subscale to cover important immune-related adverse events (irAEs) to combine this subscale with the generic FACT-G to measure HRQOL in patients treated with ICMs, the FACT-ICM. This trial proposes to validate the use of the FACT-ICM as a tool for HRQOL measurement and simultaneously to assess the benefit of remote symptom monitoring and management using a new electronic platform developed specifically for patients receiving ICMs. Methods: Participants will be randomized (1:1) before starting their standard of care ICM therapy to either usual care or the monitoring arm. The ME-Q platform uses a web-based application to enable remote monitoring of patient symptoms and HRQOL, allowing all participants enrolled in both the usual care or monitoring arms to complete the FACT-ICM and other questionnaires (DART, Health Resource Utilization, Decision regret scale, post-study system usability questionnaire) at set time points. Patients on the monitoring arm will have their electronic responses sent automatically, and new or significant worsening symptoms of clinical concern will generate an alert to the advanced practicing nurse (APN) responsible for replying to the patient and acting on responses. Via phone or a video teleconference, the nurse will perform a targeted assessment and provide standardized clinical advice and interventions based on well-established clinical algorithms and international guidelines for the management of irAEs. The APN will inform the patient's clinical team about the patient's responses and obtain the treating team's input and agreement on a proposed treatment plan. Patients enrolled in the usual care arm will respond to the questionnaires; however, their responses are not transmitted to their clinical team. The primary objective will be to validate the PRO tool for HRQOL measurement, and the secondary objective is to improve HRQOL in cancer patients receiving ICMs by remote monitoring and symptom management using the ME-Q electronic platform. We estimate that a total sample size of 266 patients (divided into two arms) achieves 90% power to detect an effect size of 0.4 in mean score changes (from baseline to 4 months) between arms using a two-sample t-test with a two-sided significance level of 0.05. Enrolment is to be completed in 2 years.

The Contribution of Transference Focused Psychotherapy in Improving Psychiatry Trainees’ Attitude and Technical Confidence Towards Patients With Personality Disorders

AimsTransference-focused psychotherapy (TFP) is a manualized evidence-based treatment for severe personality disorders (PDs) based on a psychodynamic approach that focuses on object relations theory. It has been used as a teaching tool in different psychiatric settings. Psychiatry trainees are often the “first-responders” in multiple services, and they have to deal with patients with PDs in various settings. Yet there is a documented gap in psychiatry trainees’ education regarding the assessment and management of patients with PD pathology. The aim of our study was to evaluate whether a series of teaching sessions on TFP theory and techniques as applied to PD could improve the attitude and technical confidence of psychiatric trainees in the clinical encounter of a patient with a PD.MethodsTwo cohorts of psychiatry trainees in Tower Hamlet's East London Foundation Trust received four teaching sessions, each of one hour duration, on TFP theory and techniques. All the sessions were delivered online, using video teleconferencing software. 14 Trainees completed 2 questionnaires, pre- and post-teaching: the Attitude to Personality Disorder Questionnaire (APDQ) and the Clinical Confidence with Personality Disorder Questionnaire (CCPDQ). The APDQ asks the responder to score from 1–6 the frequency they experience certain feelings towards patients with PD. In the absence of a suitable instrument, we developed the CCPDQ consisting of a set of 13 questions rated on a 6-point Likert scale addressing key issues identified in TFP including establishing and maintaining the treatment frame and in implementing the 4 main techniques. We also conducted a 1-hour focus group post teaching which was videorecorded, transcribed, and analysed thematically.ResultsOn quantitative analysis, the Wilcoxon signed-rank test indicated statistically significant improvements in the total APDQ score (P = 0.003, r = 0.81) and in the CCPDQ questionnaires (P = 0.001, r = 0.88).The thematic analysis showed an overall positive effect of the TFP teaching on trainees’ attitude and confidence: they felt it improved their understanding of the nature of personality disorder, their awareness and management of countertransference, awareness of object relations and relation dyads at play in the encounter.ConclusionTraining junior doctors about TFP theory and techniques as applied to PD can significantly improve their attitude towards these patients and their technical confidence in the clinical encounter. Of note, our workshop is resource light and can easily be delivered by remote teaching. Based on these findings, teaching of TFP in the core psychiatric training curriculum should be considered.

Development of an Online Role-play-based Medical Interview Training Method for Fourth-year Pharmacy Students

With the coronavirus disease 2019 pandemic, businesses are rapidly expanding their online practices, and the online medical care system has been established and is growing. The field of pharmacy education is also looking for ways to conduct practical online training. Hence, we developed an online role-play-based medical interview training method for fourth-year pharmacy students. The purpose of this study was to describe in detail this method and to clarify the effect of online on medical interviewing practice. The training sessions were conducted using video teleconferencing software. Two settings were used for the role-play scenarios: the pharmacy and hospital. To evaluate the effectiveness of the sessions, a questionnaire was sent to the students, and the results were analyzed using text mining. The most important requirement for successfully conducting the interviews was a stable voice connection, and we reduced audio interruptions and delays by connecting the host personal computer to a wired local area network. We also solved the problem of howling when multiple terminals were installed in the same room by muting all devices in the room. Results of the analysis of the questionnaires suggested that students were more tense online. We also found that students perceived a difference between online and face-to-face interviews in terms of eye contact and the presentation of documents. In this way, we succeeded in conducting smooth online role-playing sessions while taking countermeasures against infection. In the future, it will be necessary to devise nonverbal communication methods and digital methods of presenting the training material.

COVID-19 and the emergence of inpatient tele-ward rounds

IntroductionTelemedicine has been at the heart of healthcare system’s strategic response to the COVID-19 pandemic. Within psychiatry, there has been a surge of research and guidelines into the use of video-teleconferencing to replace face to face consultations across clinical settings. Clinical ward rounds are central to inpatient psychiatric care yet little guidance is available on how best to integrate telemedicine into the multidisciplinary work of inpatient psychiatry.ObjectivesWe report on the introduction of video teleconferencing for psychiatric ward rounds on our acute inner-London psychiatric unit during the outbreak of COVID-19.MethodsIn undertaking the rapid transition to tele-ward rounds, we had to reconcile the multiple functions of psychiatric ward rounds with the technological resources available to us.ResultsTele-ward rounds helped simplify care delivery, facilitate multidisciplinary collaboration and improve accessibility for patients and relatives in a time of crisis. The transition to tele-ward rounds also brought about technical, operational and communication issues that may impact on the patient experience and quality of care including governance challenges, contextual dissonance and technological limitations.ConclusionsThe routine use of newer technology in psychiatry ward rounds is unlikely to succeed on the basis of improvisation, particularly given the stream of technical innovations in telemedicine, and the multifarious quality of social interactions in our clinical setting. Staff training and the development of an adapted etiquette and code of communication are both essential. Patient participation in future developments will also help ensure tele-ward rounds continue to meet the standards of high quality inpatient psychiatric care beyond the COVID-19 pandemic.DisclosureNo significant relationships.

Is it as good as being in person? The effectiveness of a modified clinician facilitated buried in treasures group for hoarding disorder using video teleconferencing

The COVID-19 pandemic has necessitated the use of video-teleconferencing (VTC) for psychological treatments but VTC effectiveness studies are sparse. We examined treatment outcomes for a modified Buried in Treasures (BIT) group program for hoarding disorder (HD) delivered via VTC. Participants were 10 individuals with HD. Hoarding severity was evaluated at pre, mid, post, and six-month follow-up. Results showed significant decrease in hoarding symptoms over time (with an average decrease of 32%). The dropout rate was low (9%) and 30% of participants were fully recovered at follow-up. These results support the adaptation of in-person BIT for HD into a VTC format.

Experiences of risk in Australian hotel quarantine: a qualitative study

BackgroundIn response to the threat of COVID-19 infection, Australia mandated a 14 day quarantine period in a designated facility for all travellers returning from overseas from late March 2020. These facilities were usually hotels, or hotel-like serviced apartments, and also included a repurposed former mining village in the Northern Territory. This paper aimed to investigate the experiences of risk of people quarantined in designated supervised facilities in Australia, which has not been systematically explored before.MethodsIn this qualitative study semi-structured interviews were conducted with 58 participants quarantined between March 2020 and January 2021. Participants were returned Australian citizens and residents who were required to undergo mandatory supervised quarantine for COVID-19. Interviews were conducted using video teleconferencing (via Zoom), transcribed and coded, then analysed thematically.ResultsWhile participants generally supported the concept of quarantine to protect the Australian public, they were critical of elements of it where they felt exposed to risk (COVID-related or not). They also described instances where infection control within the system seemed inadequate. For some, particularly those quarantined with small children, they reported that the facilities were inadequate or inappropriate for health and wellbeing. Using thematic analysis, three major themes were identified that related to problems in the existing system: perception of being subjected to high risk through lax standards of COVID protection in the quarantine process; risks to the community identified in quarantine; and risk in non-hotel managed quarantine facilities.ConclusionsThere are systemic issues with infection control in hotel quarantine, which can be further undermined by individual non-compliance. Risks to safety for those in quarantine can be reduced, both in terms of infection control within hotel quarantine and, in the case of the Northern Territory facility, timely in-person medical care as needed for non-COVID conditions. Systems of infection control need ongoing review to ensure that people entering quarantine are protected from known risks of infection at every stage. Medical services in quarantine facilities should be examined to ensure timely and appropriate non-COVID medical services are available.

It's Not Fair: Remote Students Report Feeling Disadvantaged in a Hybrid Clinical Physiology Course

Just as there was a transition to remote teaching because of the COVID pandemic, many universities are in the process of transitioning back to in person classrooms. Case in point, Clinical Physiology I is the first semester of a 5000 level two‐semester course that is offered as a flipped class. Even with the transition to fully online teaching in the Spring of 2020, the robust breakout room feature of the video teleconferencing software, Zoom, permitted small group work that occurs with the flipped to continue.As the fall 2021 semester approached, the University approved a return to in person classes, however several students emailed the course instructor (L.C. Anderson) expressing concern and asking if an online option would be available. Students completed a pre‐class survey in which they committed to attend class in person or remotely via zoom. The instructor continued the flipped classroom with some students in small groups in person and some students in zoom breakout rooms. The students scored lower than expected on the first exam. Traditionally, the average of the first exam is approximately 80%, however the Fall 2021 Exam 1 average was 70%. Of 40 students, 13 scored less than 70%; this statistic was concerning given that students must earn a 70% to pass the course. To address the difficulty of the exam and to make sure students had learned the material, the course instructor flagged 13 questions (of 40 test questions total) with questionable testing statistics. Student submitted reflective essays on three of the exam questions but could write about all 13 questions for extra credit. From the student writings, the instructor ascertained that 3 of the test questions were flawed and all students were given credit for those 3 questions. Post exam reflections and adjustments raised the course average to 85%.Sensing continued anxiety within class, the instructor surveyed the students. The survey results suggested that remote students were less satisfied with class and perceived that they, as a group, had done poorly on the exam. Remote students reported feeling unfairly disadvantaged by the flipped classroom model online and reported a lack of trust in their online group members. This led the instructor to ask the questions: 1) Did the remote students score worse than the in‐person students? 2) If there is a performance difference, are there other factors that could explain the difference? In‐person students answered an average of 29.9 + 4.8 questions (about 75%) correctly whereas remote students answered an average of 25.7 + 5.8 (about 64%) correctly which was significantly different (Student’s T test, p=0.015). There was no significant difference between the performance of males and females, however BIPOC students averaged 23.6 + 6.0 with white students averaging 29.7 + 4.5 (Student's T Test, p= 0.001). This difference was lessened but persisted after the exam correction. This was an alarming observation; furthermore, more BIPOC students were participating remotely. The instructor invited students to meet one on one to review exam 1, added office hours and used student feedback to adjust class activities. The class performance improved on exam 2; furthermore, there were no significant differences between 1) in person versus remote students, 2) male versus female students and 3) BIPOC versus white students.

Telemental Health

Telemental Health

Abstract NS1: Mobile Health Technology Is Feasible And Effective For Self-management Support Among Underserved Stroke Survivors

Background and Purpose: Self-management Support (SMS) helps stroke survivors control risk factors to prevent second stroke. Little is known about feasibility and effectiveness of using mobile health technology (MHT) for SMS among underserved stroke survivors. The investigators studied feasibility and effectiveness of using a video teleconference mobile application to deliver a SMS program to underserved, hard to reach stroke survivors. Methods: The Video teleconference Self-management TO Prevent stroke (V-STOP) program was evaluated using longitudinal design with measurements at baseline, immediately post intervention (6 weeks), intermediate (12 weeks), and at study end (18 weeks). Medically underserved stroke survivors with uncontrolled stroke risk factors were included. Feasibility was assessed as time in intervention, telehealth satisfaction, stroke knowledge and SMS effectiveness were measured as psychological (depression, PHQ-8; anxiety, GAD-7), social (community integration questionnaire), and stroke self-management (goal attainment) outcomes. Generalized estimating equations were used with site and time in intervention as covariates. Results: V-STOP was successfully delivered to 106 participants using MHT over 2 years. Mean age was 59.3 (±10.9), majority were white (82.1%), males (54.3%), not living alone (85.9%), married (52.8%), with low annual income (<$25,000) ( 58.5%), and health insurance (59.4%). Program feasibility indicated mean number of V-STOP sessions were 4.6 (±1.8), with 4.4 (±2.0) hours of total time for the intervention. Overall satisfaction at 6 weeks with V-STOP (4.8(±0.5)) and telehealth (4.7(±0.5)) was high. Stroke knowledge was high at 12 weeks (9.6(±0.7)). SMS effectiveness indicated improvement in psychological outcomes at 6, 12, and 18 weeks from baseline; depression (18 weeks - β = 0.64 (CI 0.49-0.84)) and anxiety (18 weeks - β = 0.66 (CI 0.51-0.85)). Community integration improved by 18 weeks - β = 1.08 (CI 1.01-1.16) and stroke self-management also improved long term at 12 and 18 weeks (β = 0.92 (CI 0.84-0.99). Conclusion: MHT is feasible to deliver SMS to underserved stroke survivors. It improves psycho-social and self-management goal setting and goal attainment outcomes.

Coproducing Knowledge of the Implementation of Complex Digital Health Interventions for Adults with Acquired Brain Injury and their Communication Partners: Protocol for a Mixed Methods Study.

BackgroundThe Social Brain Toolkit, conceived and developed in partnership with stakeholders, is a novel suite of web-based communication interventions for people with brain injury and their communication partners. To support effective implementation, the developers of the Social Brain Toolkit have collaborated with people with brain injury, communication partners, clinicians, and individuals with digital health implementation experience to coproduce new implementation knowledge. In recognition of the equal value of experiential and academic knowledge, both types of knowledge are included in this study protocol, with input from stakeholder coauthors.ObjectiveThis study aims to collaborate with stakeholders to prioritize theoretically based implementation targets for the Social Brain Toolkit, understand the nature of these priorities, and develop targeted implementation strategies to address these priorities, in order to support the Social Brain Toolkit’s implementation.MethodsTheoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation, a maximum variation sample (N=35) of stakeholders coproduced knowledge of the implementation of the Social Brain Toolkit. People with brain injury (n=10), communication partners (n=11), and clinicians (n=5) participated in an initial web-based prioritization survey based on the NASSS framework. Survey completion was facilitated by plain English explanations and accessible captioned videos developed through 3 rounds of piloting. A speech-language pathologist also assisted stakeholders with brain injury to participate in the survey via video teleconference. Participants subsequently elaborated on their identified priorities via 7 web-based focus groups, in which researchers and stakeholders exchanged stakeholder perspectives and research evidence from a concurrent systematic review. Stakeholders were supported to engage in focus groups through the use of visual supports and plain English explanations. Additionally, individuals with experience in digital health implementation (n=9) responded to the prioritization survey questions via individual interview. The results will be deductively analyzed in relation to the NASSS framework in a coauthorship process with people with brain injury, communication partners, and clinicians.ResultsEthical approval was received from the University of Technology Sydney Health and Medical Research Ethics Committee (ETH20-5466) on December 15, 2020. Data were collected from April 13 to November 18, 2021. Data analysis is currently underway, with results expected for publication in mid-2022.ConclusionsIn this study, researchers supported individuals with living experience of acquired brain injury, of communicating with or clinically supporting someone post injury, and of digital health implementation, to directly access and leverage the latest implementation research evidence and theory. With this support, stakeholders were able to prioritize implementation research targets, develop targeted implementation solutions, and coauthor and publish new implementation findings. The results will be used to optimize the implementation of 3 real-world, evidence-based interventions and thus improve the outcomes of people with brain injury and their communication partners.International Registered Report Identifier (IRRID)DERR1-10.2196/35080

Digital storytelling to facilitate consumer engagement in healthcare research.

Consumer engagement in healthcare research presents with challenges, one of which is ensuring that the consumers have comprehended the often complex concepts in scientific research. This study aimed to compare how well older adult consumers understood video-based versus written and verbal description approaches to provision of information. Twenty adults in the community aged 60years and older were recruited for this study; half were randomised to receive the information via a digital story, and the other half received the same information from a written brief. Both mediums were presented via video teleconferencing. An interviewer was present to ask questions and address queries. Participants who viewed the digital story requested for clarifications less frequently compared to those who received the written brief. Difficulty in understanding the information rose with complexity, but providing concrete examples aided comprehension of the information. Complex concepts benefit from the provision of concrete examples to facilitate understanding. Video-based approaches to provision of information are acceptable forms of participant engagement in research and require less human resources to successfully convey key information and facilitate understanding of the information. Research procedures that employ large amounts of data collection and/or asynchronous methods should consider the use of video-based approaches, such as digital stories, to increase cost-effectiveness.

Increasing buprenorphine access for veterans with opioid use disorder in rural clinics using telemedicine

Background:Having prescribers use clinical video teleconferencing (telemedicine) to prescribe buprenorphine to people with opioid use disorder (OUD) has shown promise but its implementation is challenging. We describe barriers, facilitators and lessons learned while implementing a system to remotely prescribe buprenorphine to Veterans in rural settings. Methods: We conducted a quality improvement project aimed at increasing the availability of medications for OUD (MOUD) to Veterans. This project focused on tele-prescribing buprenorphine to rural sites via a hub (centralized prescribers) and spoke (rural clinics) model. After soliciting a wide-range of inputs from site visits, qualitative interviews of key stakeholders at rural sites, and review of preliminary cases, a “how-to” toolkit was developed and iteratively refined to guide tele-prescribing of buprenorphine. After internal and external facilitation strategies were employed, Veterans with OUD at three clinics were transitioned to buprenorphine treatment via telemedicine. Results: Factors impacting adoption of the tele-prescribing intervention were mapped to the Consolidated Framework for Implementation Research (CFIR) constructs. Barriers to adoption included concerns about legality of tele-prescribing a controlled substance, conflicting interests between different stakeholders, and coordination with an existing buprenorphine program requiring more attendance and abstinence from Veterans than the tele-prescribing program required. Factors facilitating adoption included a sense of mission around combating the opioid epidemic, preexisting use of and comfort with tele-prescribing, and rural sites’ control over Veterans referred to tele-prescribers. A total of 12 patients from rural areas were successfully transitioned onto buprenorphine, of whom 9 remained on buprenorphine 6 months after initiation of treatment. Conclusions: Implementing tele-prescribing was negotiated with stakeholders at the target clinics and operationalized in a toolkit to guide future efforts. Implementation issues can be addressed by activities that foster collaboration between hubs (centralized prescribers) and spokes (rural clinics) and by a toolkit that operationalizes tele-prescribing procedures.

Abstract PO-256: Knowledge and attitudes of a sample of Latinx LGBQ population regarding cancer screening, prevention, and barriers: An exploratory study

Abstract Background The lesbian, gay, bisexual, and queer/questioning (LGBQ) population, also referred to as sexual and gender minorities (SGM), is a medically underserved and understudied population in the United States. Literature has argued that, as of recent years, there are a limited number of early cancer detection and prevention guidelines catered specifically to LGBTQ+ community, which creates a gap in access to healthcare services for this population. Furthermore, there are potential barriers that exist for LGBT people, such as discrimination from healthcare providers and other societal constraints which could further contribute to the lack of screening for cancer. The purpose of this study is to explore the knowledge, attitudes, and individual experiences of LGBQ individuals regarding cancer prevention, screening, and treatment to develop educational material that would help cater the needs of this population Methods This study consisted of a series of structured qualitative interviews facilitated as focal groups. The interview guideline contained questions regarding the domains of knowledge, attitudes, and individuals experiences on cancer screening in SGM. The recruitment process was facilitated via online flyers in social media platforms and through local community organizations that provide services for the Puerto Rican SGM population. Participants that reached out were screened for eligibility based on age and self-identified gender and sexual orientation. The focal groups have been carried out via a video teleconferencing software to limit contact with participants considering COVID-19. The interviews have been recorded and transcribed ad-verbatim for analysis purposes. Thematic analysis with open ended coding is being used to analyze the data obtained. Results A total of 8 participants completed the informed consent and proceeded to participate in the focal groups. The cervical cancer focal group consisted of 4 participants who identified as lesbian, bisexual, and non-binary women. 2 self-identified gay men of prostate cancer focal group and the colorectal cancer focal group included 3 gay men. As analysis was carried out, the following recurring themes were identified: Treatment knowledge, Treatment limitations, General recommendations regarding Healthcare services, Social limitations for Healthcare services, Experiences on Healthcare settings. Discussion Preliminary analysis exposes participants exhibited a general lack of knowledge regarding cervical, prostate, and colorectal cancer symptomatology and screening procedures. In the case of the Cervical Cancer focus group, participants agreed their general experience in healthcare settings could be improved by educating healthcare providers on being more inclusive with the LGBTQ community and adjusting the healthcare setting to be less heterocentric. The participants in the focal groups for Prostate Cancer and Colorectal Cancer, on the other hand, stated that the approach should be directed towards educating the LGTTQ+ community on cancer symptomatology and cancer screening practices. Citation Format: Gabriela López Toledo, German J. Rivera Castellar, Elmer Marrero, Marta M. Sánchez Aracil, Mirza J. Rivera Lugo. Knowledge and attitudes of a sample of Latinx LGBQ population regarding cancer screening, prevention, and barriers: An exploratory study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-256.

Peningkatan Keterlibatan Peserta Didik pada Pembelajaran Jarak Jauh dengan Menggunakan Fitur Lesson Quizizz

The implementation of distance learning in Informatics Engineering has many problems, one of which is the lack of student engagement during learning. The purpose of this study is to improve student engagement by using a feature called Lesson in Quizizz. Lecture teaches on video teleconference and instructs students on Lesson in Quizizz to interact and give feedback about the lesson. The survey method is the research method used for this study. At the end of the semester, students are given a questionnaire regarding increasing interest in learning with conventional methods and the Lesson Quizizz added. The results showed that the student engagement using the Lesson Quizizz features increased by 4.5% compared to conventional learning. Indicators of student engagement have a high increase along with the improvement of student concentration. Thus, Quizizz can encourage students who usually are not active in class

111 Using Video Teleconferencing for an Effective Remote Simulation Course in Transfer Medicine

Critically ill patients require transfer within and between hospitals – a necessity amplified by ITU capacity pressures during the COVID-19 pandemic. This rising demand highlighted the need for dedicated transfer teams. Alongside establishing and expanding a cross-sector transfer team, we necessarily needed to meet growing training requirements. Transfer medicine is a core competency for intensivists, anaesthetists, ITU nurses and pre-hospital staff, with simulation recommended in the respective curricula. However, COVID-related restrictions alongside demands on staff’s time, limited opportunities for face-to-face training. We overcame these challenges by developing an online simulation-based course. Teleconferencing has previously been received favourably and rated highly for educational benefit The aim of the study was to test the efficacy of and response to remote simulation-based training in transfer medicine.Before attending the online simulation, multi-disciplinary participants completed 3 hours of interactive e-learning hosted online via the platform Rise. This incorporated case-based discussions, practical assignments and filmed presentations. Simulation utilized Zoom teleconferencing to immerse participants in clinical transfers. We used high-fidelity, pre-recorded scenarios made with a mannequin simulator and high-definition video. The participants observed the simulated transfer of critically ill patients (Example screenshot of online simulated scenario with participants observingA total of 21 multi-disciplinary participants completed training: 43% doctors and 57% nurses. 100% of respondents (18) rated the course 5/5 on the Likert scale when asked ‘how much did you enjoy the course’ and 100% would recommend the course to colleagues. All rated the course extremely relevant to their practice. Average assessment scores pre- versus post-course improved by approximately 20% (74.3% to 94.4%) (Results of pre- and post-course knowledge assessmentsWe developed an effective and well-received remote simulation transfer course to deliver training to a wide-reaching audience. Participants were enthusiastic about the innovative and interactive approach, finding the online course enjoyable and relevant to their clinical practice. Results suggest the course effectively increased learning. The flexible nature of online remote provision allows for delivery at scale, to meet a rising demand. Further evaluation will establish the extent at which this training translates to performance, such as a reduction in adverse events in transfer practice.

Telehealth barriers in maternal fetal medicine providers by patient insurance status

Telehealth has the potential to improve access to care and decrease health disparities. The use of telehealth has increased following the Covid-19 pandemic. However, little is known on the variations in telehealth utilization by Maternal Fetal Medicine (MFM) providers and its relationship to patient insurance status. We aimed to assess differences in maternal fetal medicine physician telehealth usage by percentage of Medicaid-covered patients. We conducted a web-based, anonymous survey of Society for Maternal-Fetal Medicine membership in December 2020, amid the Covid-19 pandemic. Users of telehealth were defined by reported use of live video teleconferencing before or after the start of the Covid-19 pandemic. Comparisons by percentage of Medicaid-covered patients were performed using Fisher’s exact test and a p-value of < 0.05 was considered significant. Out of the total completed surveys, 328 (88%) were users of telehealth. Respondents practiced in the South (31%), West (28%), Northeast (21%), and Midwest (20%). Of the total respondents, 52% reported practicing in a university hospital setting. There was no difference in telehealth user status by the percentage of patients covered by Medicaid. There were no differences in provider-reported barriers to telehealth usage by percentage of publicly insured patients in their practice. 40% of respondents cited reimbursement / insurance coverage as a barrier to telehealth, though this was not different in practices with majority Medicaid patient populations (p =1.00). Half of the respondents across payer mix reported patient access to internet or data plans as a barrier to telehealth implementation. A majority of MFM providers offer telehealth services, with providers facing similar barriers, independent of patient insurance status. These results suggest an opportunity to improve overall uptake of telehealth for providers across a diverse payer mix.View Large Image Figure ViewerDownload Hi-res image Download (PPT)