Web-based Feedback Research Articles

210 Defining the Learning Curve for Cerebral Angiography Using a Novel Web-Based Feedback Application and Head-Mounted Video Review

INTRODUCTION: The milestones that a resident or fellow should reach to achieve competence in cerebral angiography have yet to be defined. METHODS: Two neurosurgical residents were given a written knowledge exam before and after rotating on the endovascular service. Cerebral angiography diagnostic and treatment cases were prospectively collected in a novel web-based, multi-institutional feedback application. These residents performed cerebral angiography cases under graduated supervision while wearing head-mounted cameras for subsequent review with direct feedback. Residents and reviewers independently utilized CaseCurve, a novel neurosurgical resident performance tracking application, as a platform for performance rating. Numerical scores were assigned ranging from 1 (novice) to 5 (masterful) in the following categories: access, catheter navigation, table operation, closure, efficiency, finesse, angiographic interpretation, and catheter knowledge. The number of times the supervising surgeon had to take over the case was recorded. Arch anatomy and vessel tortuosity were graded. Operative videos were analyzed for operator inefficiencies and time metrics for sheath insertion and target vessel selection. Angiographic efficiency was assessed with fluoroscopic doses/times and procedural durations. RESULTS: Both residents demonstrated improvement in cognitive performance as measured by written assessment scores. Significant improvements were observed in technical performance as measured by numerical scores assigned by self-evaluation, faculty review, objective measures of angiographic efficiency, and the number of times the supervising surgeon had to take over the procedure. Concordance between faculty and resident self-evaluations was 74.2%, with residents underestimating their performance in 21% and overestimating in 5%. CONCLUSIONS: There is significant educational value for the trainer and trainee offered by our novel web-based feedback application and head-mounted video review. This data allows for accurate assessments of skill acquisition and delineation of appropriate milestones/learning categories for trainees in endovascular neurosurgery.

The Effects of Integrated Feedback based on AWE on English Writting of Chinese EFL Learners

Through a two-semester experiment on the English writing of 64 Chinese EFL learners, this study examines the effects of three types web-based feedback (automatic feedback (AF), automatic feedback with teacher feedback (TF), automatic feedback with peer feedback (PF)) based on Pigai website. The results show that all the three modes of feedback can promote the writing of the English as Foreign Language (EFL) learners with different English proficiency ((high level: F = 2.672, P = .132; low level: F = .388, P = .766). The results also reveal that there is a significant difference in the high-level group between the automatic feedback + peer feedback group and the automatic feedback group (I - J = - 6.636, P = .000) as well as between the automatic feedback + teacher feedback group and the automatic feedback group (I - J = - 6.220, P = .001; I - J = - 5. 100, P =. 001), which indicate that automatic feedback + manual feedback (PF+TF) can promote the improvement of high-level learners’ English writing more than single AF. In the low-level group, between the AF + PF group and the AF group (I - J = -1.221, P = .925) and between the AF +TF group and the AF + PF group (I - J = 6.227, P =. 097). There is no significant difference, but there is a significant difference between the AF group and the AF + TF group (I - J = - 5.122, P =. 032), indicating that AF + TF is of great help in improving the English writing of low-level English learners.

Web-based elaborative feedback provision and the development of reading skills

The purpose of this study was to find out whether web-based feedback can improve students’ reading comprehension. Fifty first-year students participated in the study: 25 in the experimental group and 25 in the control group. The study used a quasi-experimental design. Data was collected via a web-based reading comprehension test and a paper-based test. Moodle Cloud server was used to organize the training tasks and to administer the post-test for the experimental group. Data were analysed using mean, frequency, independent samples t-test, and paired samples t-test. The pre-test score indicated that students were at elementary comprehension level with a percentage of 34%, and 37% for the treatment and the comparison group, respectively. There was also a statistically significant mean difference in the post-test scores between the experimental and the control groups (t= 6.174, df= 48, and p= 0.000) with mean scores of 17.84 and 13.16, respectively. This shows that web-based feedback has significantly improved students’ reading comprehension.

Web-based feedback system and the development of reading skills

Web-based feedback system and the development of reading skills

A Smartphone Intervention to Promote a Sustainable Healthy Diet: Protocol for a Pilot Study.

Changing current dietary patterns into sustainable healthy diets (ie, healthy diets with low environmental impact and socioeconomic fairness) is urgent. So far, few eating behavior change interventions have addressed all the dimensions of sustainable healthy diets at once and used cutting-edge methods from the field of digital health behavior change. The primary objectives of this pilot study were to assess the feasibility and effectiveness of an individual behavior change intervention toward the adoption of a more environmentally sustainable healthy diet as a whole and changes in specific relevant food groups, food waste, and obtaining food from fair sources. The secondary objectives included the identification of mechanisms of action that potentially mediate the effect of the intervention on behaviors, identification of potential spillover effects and covariations among different food outcomes, and identification of the role of socioeconomic status in behavior changes. We will run a series of ABA n-of-1 trials over a year, with the first A phase corresponding to a 2-week baseline evaluation, the B phase to a 22-week intervention, and the second A phase to a 24-week postintervention follow-up. We plan to enroll 21 participants from low, middle, and high socioeconomic statuses, with 7 from each socioeconomic group. The intervention will involve sending text messages and providing brief individualized web-based feedback sessions based on regular app-based assessments of eating behavior. The text messages will contain brief educational messages on human health and the environmental and socioeconomic effects of dietary choices; motivational messages to encourage the adoption of sustainable healthy diets by participants, providing tips to achieve their own behavioral goals; or links to recipes. Both quantitative and qualitative data will be collected. Quantitative data (eg, on eating behaviors and motivation) will be collected through self-reported questionnaires on several weekly bursts spread through the study. Qualitative data will be collected through 3 individual semistructured interviews before the intervention period, at the end of the intervention period, and at the end of the study. Analyses will be performed at both the individual and group levels depending on the outcome and objective. The first participants were recruited in October 2022. The final results are expected by October 2023. The results of this pilot study will be useful for designing future larger interventions on individual behavior change for sustainable healthy diets. PRR1-10.2196/41443.

A hybrid Fifth Generation based approaches on extracting and analyzing customer requirement through online mode in healthcare industry

The proposed hybrid fifth Generation-based approaches are employed to analyze and investigate the feedback of 37,855 patients from 65 hospitals worldwide and gathered through various online modes. The collected data was analyzed with various cloud-computing technologies such as Artificial Intelligence (AI) based algorithms like natural language pre-processing (NLP), text mining (TM), and sentiment analysis (SA).This work discusses the new opportunities in the healthcare sector and the capabilities that 5G influences can bring to the healthcare industry. According to a recent investigation, the overall assessment ranking agrees with the personal view (sentiment) rating analysis for the title and full element of the web-based feedback obtained from the patients of different hospitals worldwide through an online survey. There are five main categories in the healthcare sector for which patients give priority and expect good services. They are treatment, physical facilities, dependability, timely committed service, and responsiveness.This research makes theoretical and practical contributions to the interdisciplinary areas comprising computer science, data management, and healthcare services by utilizing recent analytic techniques to attain optimized results.

A Web-Based Positive Psychology App for Patients With Bipolar Disorder: Development Study.

BackgroundPatients with bipolar disorder (BD) report lower quality of life and lower levels of well-being than the general population. Despite the growing availability of psychotherapeutic and self-management interventions, important unmet needs remain. These unmet needs are closely linked to positive psychology domains. Although a growing number of studies have evaluated the impact of positive psychology interventions (PPIs) on patients with severe mental illness in general, only few have addressed the application of positive psychology for BD.ObjectiveThis study aimed to gain insight into the opinions of patients with BD and health care professionals about (web-based) PPIs for BD and to develop and pilot-test an app containing PPIs specifically designed for patients with BD.MethodsThe study was conducted in accordance with the Center for eHealth and Disease Management road map principles and incorporated cocreation and designing for implementation. Data were collected using focus group discussions, questionnaires, rapid prototyping, and web-based feedback on a prototype from the participants. In total, 3 focus groups were conducted with 62% (8/13) of patients with BD and 38% (5/13) of professionals. The collected data were used to develop a smartphone app containing short PPIs. The content was based on PPIs for which a solid base of evidence is available. Finally, a pilot test was conducted to test the app.ResultsFocus groups revealed that PPIs as part of the current BD treatment can potentially meet the following needs: offering hope, increasing self-esteem, expressing feelings, acceptance, and preventing social isolation. Some patients expressed concern that PPIs may provoke a manic or hypomanic episode by increasing positive affect. The pilot of the app showed that the PPIs are moderately to highly valued by the participants. There were no adverse effects such as increase in manic or hypomanic symptoms.ConclusionsWith the systematic use of user involvement (patients and professionals) in all steps of the development process, we were able to create an app that can potentially fulfill some of the current unmet needs in the treatment of BD. We reached consensus among consumers and professionals about the potential benefits of PPIs to address the unmet needs of patients with BD. The use of PPI for BD is intriguing and can be usefully explored in further studies. We emphasize that more evaluation studies (quantitative and qualitative) that are focused on the effect of PPIs in the treatment of BD should be conducted. In addition, to establish the working mechanisms in BD, explorative, qualitative, designed studies are required to reveal whether PPIs can address unmet needs in BD.

Beyond opioid prescribing: Evaluation of a substance use disorder curriculum for OBGYN residents.

Amidst the current opioid crisis, there is a need for better integration of substance use disorder screening and treatment across specialties. However, there is no consensus regarding how to best instruct OBGYN trainees in the clinical skills related to opioid and other substance use disorders (SUD). Study objectives were (1) to assess the effectiveness a SUD curriculum to improve self-reported competence among OBGYN residents and (2) to explore its effectiveness to improve attending evaluations of residents' clinical skills as well as its feasibility and acceptability from the resident perspective. A pilot 3-session curriculum was developed and adapted to SUD screening and treatment which included readings, didactics, and supervised outpatient clinical experiences for OBGYN post-graduate year 1 (PGY-1) residents rotating through an integrated OBGYN-SUD clinic. Eighteen residents completed pre and post clinical skills self-assessments (SUD screening, counseling, referring, Motivational Interviewing) using an adapted Zwisch Rating Scale (range 1-5). Scores were compared between time points using paired t-tests. Sub-samples also (a) were evaluated by the attending on three relevant Accreditation Council for Graduate Medical Education Milestones (ACGME) milestone sets using the web-based feedback program, myTIPreport (n = 10) and (b) completed a qualitative interview (n = 4). All PGY-1s (18/18) across three academic years completed the 3-session SUD curriculum. Clinical skill self-assessments improved significantly in all areas [SUD Screening (2.44 (0.98) vs 3.56 (0.62), p = <0.01); Counseling (1.81 (0.71) vs 3.56 (0.51), p = < .01; Referring (2.03 (0.74) vs 3.17 (0.71), p = < .01; Motivational Interviewing (1.94 (1.06) vs 3.33 (0.69), p = < .01)]. Milestone set levels assigned by attending evaluations (n = 10) also improved. Qualitative data (n = 4) revealed high acceptability; all curriculum components were viewed positively, and feedback was provided (e.g., desire for more patient exposures). A pilot SUD curriculum tailored for OBGYN PGY-1 residents that goes beyond opioid prescribing to encompass SUD management is feasible, acceptable and likely effective at improving SUD core clinical skills.

A resident robotic curriculum utilizing self-selection and a web-based feedback tool.

To describe an obstetrics and gynecology residency robotic curriculum, facilitated by a web-based feedback and case-tracking tool, allowing for self-selection into advanced training. Phase I (Basic) was required for all residents and included online training modules, online assessment, and robotic bedside assistant dry lab. Phase II (Advanced) was elective console training. Before live surgery, 10 simulation drills completed to proficiency were required. A web-based tool was used for surgical feedback and case-tracking. Online assessments, drill reports, objective GEARS assessments, subjective feedback, and case-logs were reviewed (7/2018-6/2019). A satisfaction survey was reviewed. Twenty four residents completed Phase I training and 10 completed Phase II. To reach simulation proficiency, residents spent a median of 4.1h performing required simulation drills (median of 10 (3, 26) attempts per drill) before live surgery. 128 post-surgical feedback entries were completed after performance as bedside assistant (75%, n = 96) and console surgeon (5.5%, n = 7). The most common procedure was hysterectomy 111/193 (58%). Resident console surgeons performed portions of 32 cases with a mean console time of 34.6 ± 19.5min. Mean GEARS score 20.6 ± 3.7 (n = 28). Mean non-technical feedback results: communication (4.2 ± 0.8, n = 61), workload management (3.9 ± 0.9, n = 54), team skills (4.3 ± 0.8, n = 60). Residents completing > 50% of case assessed as "apprentice" 38.5% or "competent" 23% (n = 13). After curriculum change, 100% of surveyed attendings considered residents prepared for live surgical training, vs 17% (n = 6) prior to curriculum change [survey response rate 27/44 (61%)]. Attendings and residents were satisfied with curriculum; 95% and recommended continued use 90% (n = 19).This two-phase robotic curriculum allows residents to self-select into advanced training, alleviating many challenges of graduated robotic training.

Performance of a Supervisor Observational Coding System and an Audit and Feedback Intervention.

Workplace-based clinical supervision is common in community based mental health care for youth and families and could be a leveraged to scale and improve the implementation of evidence-based treatment (EBTs). Accurate methods are needed to measure, monitor, and support supervisor performance with limited disruption to workflow. Audit and Feedback (A&F) interventions may offer some promise in this regard. The study-a randomized controlled trial with 60 clinical supervisors measured longitudinally for 7 months-had two parts: (1) psychometric evaluation of an observational coding system for measuring adherence and competence of EBT supervision and (2) evaluation of an experimental Supervisor Audit and Feedback (SAF) intervention on outcomes of supervisor adherence and competence. All supervisors recorded and uploaded weekly supervision sessions for 7months, and those in the experimental condition were provided a single, monthly web-based feedback report. Psychometric performance was evaluated using measurement models based in Item Response Theory, and the effect of the SAF intervention was evaluated using mixed-effects regression models. The observational instrument performed well across psychometric indicators of dimensionality, rating scale functionality, and item fit; however, coder reliability was lower for competence than for adherence. Statistically significant A&F effects were largely in the expected directions and consistent with hypotheses. The observational coding system performed well, and a monthly electronic feedback report showed promise in maintaining or improving community-based clinical supervisors' adherence and, to a lesser extent, competence. Limitations discussed include unknown generalizability to the supervision of other EBTs.

Dissemination of a COVID-19 Rapid Response Telehealth Group Addressing Worry and Social Isolation Among Older Adults

In response to the urgent need for virtual mental health treatments during the COVID-19 pandemic, an 8-week group intervention deliverable over video or telephone was developed and disseminated in March 2020. Manual content addressed social isolation and information related to COVID-19. In August 2020, a national web-based provider feedback survey was disseminated to evaluate feasibility of the manual. Respondents (n = 21) across a variety of geriatric mental health clinics reported this intervention to be effective and clinically useful with their patients in providing social support and in mitigating COVID-19 anxieties. The majority of respondents delivered the group in multiple cohorts and found the manual adaptable beyond the early pandemic period.

A web-based feedback platform for peer and teacher feedback on writing: An Activity Theory perspective

• The web-based platform for feedback had mediated the issue of ‘face’ in peer review. • Positive impact of negative peer feedback possible through non face-to-face platform. • Platform facilitated focus on quality of comments rather than peers’ proficiency. • Peer feedback through this platform stimulated critical thinking on writer's writing. This study investigated how the use of a web-based peer review platform influenced the act of responding to and using feedback between a teacher and peers on academic writing, of 12 Chinese learners. These case studies drew on data gathered from questionnaires, stimulated recall interviews, semi-structured interviews, focused diary entries, drafts of writing and records of teacher and peer reviews posted on the web-based peer review platform, SWoRD (now called Peerceptiv). Using the theoretical lens afforded by the key concept of mediation in third-generation Activity Theory ( Engeström, 1987 , 1999 ), the data were analysed and the mediating influence of SWoRD on the various components of the activity system was investigated. It was found that SWoRD mediated the relationships between the subjects (L2 writers) and the rules (e.g., the issue of ‘face’ among Chinese learners); the community (peer reviewers of lower proficiency); and the division of labour (peer reviewers as fellow learners, as opposed to the traditional division of labour where the teacher is the expert). The findings suggest that the potential of peer feedback in helping L2 writers improve their writing, is unleashed with the mediating influence of SWoRD.

Common data elements for predictors of pediatric sepsis: A framework to standardize data collection.

Standardized collection of predictors of pediatric sepsis has enormous potential to increase data compatibility across research studies. The Pediatric Sepsis Predictor Standardization Working Group collaborated to define common data elements for pediatric sepsis predictors at the point of triage to serve as a standardized framework for data collection in resource-limited settings. A preliminary list of pediatric sepsis predictor variables was compiled through a systematic literature review and examination of global guideline documents. A 5-round modified Delphi that involved independent voting and active group discussions was conducted to select, standardize, and prioritize predictors. Considerations included the perceived predictive value of the candidate predictor at the point of triage, intra- and inter-rater measurement reliability, and the amount of time and material resources required to reliably collect the predictor in resource-limited settings. We generated 116 common data elements for implementation in future studies. Each common data element includes a standardized prompt, suggested response values, and prioritization as tier 1 (essential), tier 2 (important), or tier 3 (exploratory). Branching logic was added to the predictors list to facilitate the design of efficient data collection methods, such as low-cost electronic case report forms on a mobile application. The set of common data elements are freely available on the Pediatric Sepsis CoLab Dataverse and a web-based feedback survey is available through the Pediatric Sepsis CoLab. Updated iterations will continuously be released based on feedback from the pediatric sepsis research community and emergence of new information. Routine use of the common data elements in future studies can allow data sharing between studies and contribute to development of powerful risk prediction algorithms. These algorithms may then be used to support clinical decision making at triage in resource-limited settings. Continued collaboration, engagement, and feedback from the pediatric sepsis research community will be important to ensure the common data elements remain applicable across a broad range of geographical and sociocultural settings.

Smartphone and web-based independent consultation and feedback for joint replacement surgeries: a randomized control trial protocol

BackgroundCost control and usage regulation of medical materials (MMs) are the practical issues that the government pays close attention to. Although it is well established that there is great potential to mobilize doctors and patients in participating MMs-related clinical decisions, few interventions adopt effective measures against specific behavioral deficiencies. This study aims at developing and validating an independent consultation and feedback system (ICFS) for optimizing clinical decisions on the use of MMs for inpatients needing joint replacement surgeries.MethodsDevelopment of the research protocol is based on a problem or deficiency list derived on a trans-theoretical framework which incorporates including mainly soft systems-thinking, information asymmetry, crisis-coping, dual delegation and planned behavior. The intervention consists of two main components targeting at patients and doctors respectively. Each of the intervention ingredients is designed to tackle the doctor and patient-side problems with MMs using in joint replacement surgeries. The intervention arm receives 18 months' ICFS intervention program on the basis of the routine medical services; while the control arm, only the routine medical services. Implementation of the intervention is supported by an online platform established and maintained by the Quality Assurance Center for Medical Care in Anhui Province, a smartphone-based application program (APP) and a web-based clinical support system.DiscussionThe implementation of this study is expected to significantly reduce the deficiencies and moral hazards in decision-making of MMs using through the output of economic, efficient, sustainable and easy-to-promote cooperative intervention programs, thus greatly reducing medical costs and standardizing medical behaviors.Trial registration numberISRCTN10152297.

A Novel Resident Robotic Curriculum Using Self-Selection for Advanced Training and a Single Web-Based Tool for Feedback and Case-Tracking

Study Objective Describe a novel two-phase robotic curriculum facilitated by a web-based feedback and case-tracking tool, which allows residents to self-select into advanced training. Design Descriptive. Setting Academic Hospital. Patients or Participants OBGYN residents and faculty. Interventions Phase I (Basic), required of all residents, includes online training modules, assessment, and robotic dry lab. Phase II (Advanced) console training is elective. Residents complete 10 SIM drills to proficiency before performing live surgery. A web-based tool is used for surgical feedback. Resident online assessments, SIM lab reports, feedback, and case-logs were reviewed (7/2018-6/2019). Attendings and residents completed a beta-tested satisfaction survey. Measurements and Main Results All 24 residents completed Phase I training. Phase II was initiated by 12 residents and 10/12(83.3%) completed all 10 SIM drills. A median of 10(3,26) attempts were required to complete each drill with a mean time of 5.1hrs to complete all drills. 128 web-based post-surgical feedback entries were completed. Residents performed as bedside assistants (75%,n=96), console surgeon (5.5%,n=7), or both (19.5%,n=25). Most common tracked procedure was hysterectomy 111/193(57.5%). Console surgeons performed 32 cases with a mean console time of 34.6±19.5min. Most common procedure steps included: colpotomy/cuff closure 31.1%, uterine artery 75% and utero-ovarian vessel seal/transection 84.4%(n=32). 28/32(87.5%) Global Evaluative Assessment of Robotic Skills (GEARS) assessments were completed. Mean GEARS score 20.6±3.7(n=28), communication (4.2±0.8,n=61), workload management (3.9±0.9,n=54), and team skills (4.3±0.8,n=60). Residents completing >50% of case were assessed as “apprentice” 38.5% or “competent” 23.1%(n=13). 27/44(61.4%), satisfaction survey response rate. After curriculum change, attendings considered residents prepared as bedside assistants and console surgeons (100%), whereas only 16.7% were prepared before (n=6). Respondents were satisfied with the curriculum (95.0%), found the web-based tool helpful to give/receive feedback (90.0%), and recommended continued use (90.0%) (n=19). Conclusion This novel robotic curriculum allows residents to self-select into advanced training. A web-based tool improves individualized feedback and case-tracking alleviates many challenges of graduated robotic training.

Automated detection of pulmonary embolism in CT pulmonary angiograms using an AI-powered algorithm.

To evaluate the performance of an AI-powered algorithm for the automatic detection of pulmonary embolism (PE) on chest computed tomography pulmonary angiograms (CTPAs) on a large dataset. We retrospectively identified all CTPAs conducted at our institution in 2017 (n = 1499). Exams with clinical questions other than PE were excluded from the analysis (n = 34). The remaining exams were classified into positive (n = 232) and negative (n = 1233) for PE based on the final written reports, which defined the reference standard. The fully anonymized 1-mm series in soft tissue reconstructionserved as input for the PE detection prototype algorithm that was based on a deep convolutional neural network comprising a Resnet architecture. It was trained and validated on 28,000 CTPAs acquired at other institutions. The result series were reviewed using a web-based feedback platform. Measures of diagnostic performance were calculated on a per patient and a per finding level. The algorithm correctly identified 215 of 232 exams positive for pulmonary embolism (sensitivity 92.7%; 95% confidence interval [CI] 88.3-95.5%) and 1178 of 1233 exams negative for pulmonary embolism (specificity 95.5%; 95% CI 94.2-96.6%). On a per finding level, 1174 of 1352 findings marked as embolus by the algorithm were true emboli. Most of the false positive findings were due to contrast agent-related flow artifacts, pulmonary veins, and lymph nodes. The AI prototype algorithm we tested has a high degree of diagnostic accuracy for the detection of PE on CTPAs. Sensitivity and specificity are balanced, which is a prerequisite for its clinical usefulness. • An AI-based prototype algorithm showed a high degree of diagnostic accuracy for the detection of pulmonary embolism on CTPAs. • It can therefore help clinicians to automatically prioritize exams with a high suspection of pulmonary embolism and serve as secondary reading tool. • By complementing traditional ways of worklist prioritization in radiology departments, this can speed up the diagnostic and therapeutic workup of patients with pulmonary embolism and help to avoid false negative calls.

Investigating the Efficacy and Cost-Effectiveness of Technology-Delivered Personalized Feedback on Dietary Patterns in Young Australian Adults in the Advice, Ideas, and Motivation for My Eating (Aim4Me) Study: Protocol for a Randomized Controlled Trial.

BackgroundWeb-based health interventions may be easier to access and time efficient relative to face-to-face interventions and therefore may be the most appropriate mode to engage young adults.ObjectiveThis study aims to investigate the impact of 3 different levels of personalized web-based dietary feedback and support on changes in diet quality.MethodsThe Advice, Ideas, and Motivation for My Eating (Aim4Me) study is a 12-month assessor-blinded, parallel-group randomized controlled trial evaluating the impact of 3 levels of web-based feedback on diet quality, measured using the Australian Recommended Food Score (ARFS). Participants (N=2570) will primarily be recruited via web-based methods and randomized to 1 of 3 groups. Group 1 (control) will receive the Healthy Eating Quiz, a web-based dietary assessment tool that generates a brief feedback report on diet quality. Individuals randomized to this group can use the brief feedback report to make positive dietary changes. Group 2 will receive the Australian Eating Survey, a web-based dietary assessment tool that generates a comprehensive feedback report on diet quality as well as macro- and micronutrient intake. Group 2 will use the comprehensive feedback report to assist in making positive dietary changes. They will also have access to the Aim4Me website with resources on healthy eating and tools to set goals and self-monitor progress. Group 3 will receive the same intervention as Group 2 (ie, the comprehensive feedback report) in addition to a tailored 30-min video consultation with an accredited practicing dietitian who will use the comprehensive feedback report to assist individuals in making positive dietary changes. The self-determination theory was used as the framework for selecting appropriate website features, including goal setting and self-monitoring. The primary outcome measure is change in diet quality. The completion of questionnaires at baseline and 3, 6, and 12 months will be incentivized with a monetary prize draw.ResultsAs of December 2019, 1277 participants have been randomized.ConclusionsThe web-based delivery of nutrition interventions has the potential to improve dietary intake of young adults. However, the level of support required to improve intake is unknown.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12618000325202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374420International Registered Report Identifier (IRRID)DERR1-10.2196/15999

LO33: Sharing and teaching electrocardiograms to minimize infarction

Background: Every 30-minute delay to ST-Elevation Myocardial Infarction (STEMI) reperfusion increases one-year mortality by 7.5%. A local audit found that the third of patient electrocardiograms (ECGs) not initially meeting classic STEMI criteria had an ECG-to-Activation (ETA) time of over 90 minutes, more than five times that of classic STEMIs. However, three quarters of “STEMI negative” ECGs met STEMI-equivalent patterns or rules for subtle occlusion, uncovering an opportunity for improvement. Aim Statement: We aimed to reduce ETA time, from initial emergency department (ED) ECG to activation of the cath lab, for patients whose ECGs did not meet classic STEMI criteria, by 30 minutes within one year (i.e. by Dec 2019). Measures &amp; Design: We reviewed all ED Code STEMIs over a 35-month pre-intervention period. Root Cause analyses, including Ishikawa diagram and Pareto chart, led to our Plan-Do-Study-Act cycles: 1) a survey to engage our team; 2) a Grand Rounds presentation as an educational strategy; and 3) weekly web-based feedback to all ED physicians on STEMI-equivalents and subtle occlusions, using recent local cases. Our outcome measures were ETA times, stratified by ECGs not initially meeting STEMI criteria (primary) and those that did (secondary). Our process measures were the number of website visits and page views. Our balancing measure was the proportion of Code STEMIs without culprit lesion. We used Statistical Process Control (SPC) charts with usual special cause variation rules. Evaluation/Results: ETA time for the 37.5% of 56 ECGs that did not meet classic STEMI criteria decreased from 97.5 to 53.7 minutes (min), a 43.8-min absolute decrease (p = 0.037), while those meeting STEMI criteria remained the same (16.5 to 18.2min, p = 0.75). SPC charts did not show special cause variation. There were 2,634 page views (65.9/week) and 1,092 visits (27.3/week), in a group of 80 physicians—i.e. a third of the group each week. There was no change in Code STEMIs without culprit lesions (28.0 % to 23.3%, p = 0.41). Discussion/Impact: We reduced ETA time by 43.8min for the one third of patients with culprit lesions not initially meeting classic STEMI criteria, a magnitude associated with mortality impact. To do so, we used a multi-modal educational strategy including a novel web-based feedback approach to all ED physicians. Local feedback and education on this challenging-to-diagnose subgroup, guided by ETA time as a quality metric, could be replicated in other centres.

A web-based formative feedback system using isomorphic items to support Physics learning

Formative feedback plays an important role in assisting students in their learning process. However, giving information about student weaknesses and strengths is one of the challenges teachers face when they try to implement formative assessment. This study aims to develop a web-based formative feedback system that is able to provide a specific one. This is a development research with steps including needs analysis, model design, model development, and limited model testing. The research has succeeded in developing a web-based formative feedback system through utilizing isomorphic items. The results of the initial test showed that the model can provide timely and effective formative feedback both individually and in groups of students. The use of this model also allows the teachers to discuss student’s learning difficulties in real time responses. The results of this study need to be followed up with the implementation of this model in more extensive trial.

Engaging parents using web-based feedback on child growth to reduce childhood obesity: a mixed methods study

BackgroundTo measure trends in child growth and combat rising levels of obesity, Manchester University NHS Foundation Trust and the University of Manchester have developed Children’s Health and Monitoring Programme (CHAMP). CHAMP collects an annual measurement for primary school children (aged 4 to 11) in Manchester, England, and offers feedback of Body Mass Index (BMI) results to parents via a secure website. No similar digital tool exists that both provides high resolution data on the trajectory of child growth and acts as a feedback and monitoring system. This study investigates how effectively this intervention engaged with parents and supported the reduction of childhood obesity.MethodsAnonymised CHAMP registration and BMI data (UK1990) were collected between September 2013 and March 2017 from a total of 63,337 children. BMI change over time was compared in matched cohorts of 24,551 children, whose parents had and had not registered with the CHAMP website. Qualitative focus groups and interviews were used to explore perspectives among 29 key informants (parents, school and healthcare professionals) from six schools in Manchester.ResultsOverweight children whose parents had not registered with the CHAMP website gained a median of 0.14 BMI centile between measurements, whilst children of CHAMP-registered parents reduced their BMI by a median of 0.4 centile per year (P = 0.02). Normal weight children of registered parents decreased their BMI by 0.3 centile each year, whilst those not registered increased their BMI by 0.8 centile per year (P = 0.001). There was no significant association between registration and BMI centile change in children already classified as obese (P = 0.34). A qualitative, thematic analysis revealed that the annual measurement programme was widely supported by parents and staff. A range of psychological and behavioural impacts on families were reported as a result of the monitoring and feedback processes, in some cases prompting reflection and monitoring of health and lifestyle choices.ConclusionThese early findings indicate that CHAMP, as both a monitoring system and a digital intervention, could encourage positive lifestyle change and support healthier child growth trajectories.