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Pilot of rapid implementation of the advanced practice provider in the workflow of an existing tele-critical care program.

ABSTRACT: Incorporating the advanced practice provider (APP) in the delivery of tele critical care medicine (teleCCM) addresses the critical care provider shortage. However, the current literature lacks details of potential workflows, deployment difficulties and implementation outcomes while suggesting that expanding teleCCM service may be difficult. Here, we demonstrate the implementation of a telemedicine APP (eAPP) pilot service within an existing teleCCM program with the objective of determining the feasibility and ease of deployment. The goal is to augment an existing tele-ICU system with a balanced APP service to assess the feasibility and potential impact on the ICU performance in several hospitals affiliated within a large academic center. A REDCap survey was used to assess eAPP workflows, expediency of interventions, duration of tasks, and types of assignments within different service locations. Between 02/01/2021 and 08/31/2021, 204 interventions (across 133 12-h shift) were recorded by eAPP (n_routine = 109 (53.4%); n_urgent = 82 (40.2%); n_emergent = 13 (6.4%). The average task duration was 10.9 ± 6.22 min, but there was a significant difference based on the expediency of the task (F [2; 202] = 3.89; p < 0.022) and type of tasks (F [7; 220] = 6.69; p < 0.001). Furthermore, the eAPP task type and expediency varied depending upon the unit engaged and timeframe since implementation. The eAPP interventions were effectively communicated with bedside staff with only 0.5% of suggestions rejected. Only in 2% cases did the eAPP report distress. In summary, the eAPP can be rapidly deployed in existing teleCCM settings, providing adaptable and valuable care that addresses the specific needs of different ICUs while simultaneously enhancing the delivery of ICU care. Further studies are needed to quantify the input more robustly.

SUBMITTER: Laudanski K

PROVIDER: S-EPMC9250728 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:The ongoing changes in learning and education towards digitalisation have been rapidly accelerated by the COVID-19 pandemic. Especially in dental education where contact to the oral cavity is an integral part of training the chosen digital examination methods and training formats must undergo high requirements to full fill the goal of a real alternative to face-to-face exams. Therefore, this study compared student performance in a newly developed Tele-OSCE with a prior OSCE examinations in presence within an oral- and maxillofacial surgery curriculum. Study participants were fourth-year (in a five year curriculum) dental students and board certified maxillofacial surgeons (examiners) that took part in a newly developed Tele-OSCE that comprised three five-minute stations (structured facial examination, management mandibular fracture and squamous cell carcinoma) using the zoom® software. Student performance was measured using validated OSCE-Checklists and compared to a previous OSCE examination from the winter term 2019 with the same OSCE stations that was conducted in presence. Significant differences were tested using the Mann-Whitney U test. Furthermore, the new Tele-OSCE was evaluated by students and examiners using previously developed questionnaires. Sixty-six dental students (study group: n=34, summer term 2021, control group: n=32 winter term 2019) and nine examiners participated in the study. Compared to previous non-pandemic OSCEs, there were no significant (p=0.53) differences in overall student performance. Evaluation of the Tele-OSCE showed that the demonstration and rating of practical skills was limited due to missing standard patients or phantoms, however, students did not fear to be misjudged. The demonstration and rating of anamnestic and consultation competencies was seen as unproblematic by students and examiners. This pilot-study showed the feasibility of a Tele-OSCE as a formative examination in dental education. However, both students and examiners felt that the demonstration and assessment of practical skills was limited due the new examination format. Nevertheless, Tele-OSCEs might offer an alternative to enable students to complete their dental training.

Project description:PurposeProof-of-principle human studies suggest that transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (L-DLPFC) may improve the clinical symptoms of depression. This multicenter study (N=35) tested remotely supervised and repeated daily multichannel tDCS delivered at home designed to target the L-DLPFC in a group of patients with major depressive disorder (MDD). The main objectives of the study were to assess the feasibility and safety of home-based, remotely-supervised tDCS for patients with MDD. As an exploratory aim, we also aimed to evaluate the efficacy. The primary efficacy measure for this study was the median percent change from baseline to the end of the 4-week post-treatment follow-up period in the observer-rated Montgomery-Asberg Depression Mood Rating Scale (MADRS).MethodsFor each study participant, this open-label feasibility telemedicine pilot study involved 37 at-home stimulation sessions (30 minutes each) of multichannel tDCS targeting L-DLPFC administered over eight weeks, with a follow-up period of 4 weeks following the final stimulation session. The stimulation montage (electrode positions and currents) was optimized by employing computational models using available structural data from a similar population (group optimization). Conducted entirely remotely, the study employed the MADRS for assessment at baseline, at weeks 4 and 8 during treatment, and at 4-week follow-up visits.ResultsThe population who completed all study visits consisted of 34 patients (85.3% women and 14.7% men) with a mean age of 59 years, a diagnosis of MDD according to DSM-V criteria, and a MADRS score ≥20 at the time of study enrolment. At baseline, the mean time since MDD diagnosis was 24.0 (SD 19.1) months. Nearly 90% of the participants (n=29) completed the full course of 37 stimulation sessions at home, covering both the acute and taper phases. No detrimental effects were observed, and no participants had suicidal ideation and/or behavior, whether at baseline during treatment or during the four weeks post-treatment. The study observed a Median percentage MADRS score reduction of 64.5% (48.6, 72.4). Over 70% of participants (n=24) showed a ≥ 50% improvement in MADRS scores from baseline to the last visit (4 weeks post-treatment), with a response rate (RR) of 72.7%. Secondary measures, including the Quick Inventory of Depressive Symptomatology-Self Report (QUIDS-SR) and the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF), reflected similar improvements. The mean (SD) and the median difference between the final visit and baseline for the Q-LES-Q-SF score were 27.9 (13.8) and 26.8 (17.9, 35.7), respectively.ConclusionsThese results suggest that remotely supervised and supported home-based tDCS is safe and feasible, and antidepressant efficacy motivates further appropriately controlled clinical studies.

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Pilot of rapid implementation of the advanced practice provider in the workflow of an existing tele-critical care program.

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