Face-to-face and telephone appointments in the seizure clinic: A comparative analysis based on recorded interactions

OBJECTIVE

Telephone appointments are now widely used in seizure treatment, but there is little understanding of how they compare to face-to-face appointments. Studies from other fields suggest that comparisons can be done on three levels: 1) Abstract level: duration of appointment. 2) Structural level: distribution of talk. 3) Detailed level: aspects of communication. This study aims to compare seizure clinic face-to-face and telephone appointments based on their duration, distribution of talk, and the number of questions asked by patients/companions.

METHODS

Statistical comparison between recordings and transcripts of 34 telephone appointments (recorded in 2021) and 56 face-to-face appointments (recorded in 2013).

RESULTS

There was no significant difference between the duration of face-to-face (median: 16.5 min) and telephone appointments (median: 16.2 min). There was no significant difference in the ratio of neurologist to patient/companion talk (face-to-face: 55% vs. 45%, telephone: 54% vs. 46%). Patients/companions asked significantly more questions per minute in face-to-face (median: 0.17) than telephone appointments (median: 0.06, p < 0.05).

CONCLUSION

At a broad level, seizure clinic face-to-face and telephone appointments are similar. Examining the details of the interaction, however, reveals important differences in questioning.

PRACTICE IMPLICATIONS

Practitioners could take steps to facilitate patient questioning in telephone appointments.

Can touchscreens replace teachers? Chinese children's character learning from a touchscreen-based app, video, or face-to-face instruction

Given the increasing prevalence of touchscreen devices that are intended for educational purposes, this study explored children's transfer of learning from touchscreen media compared with video and offline face-to-face learning. A total of 76 5- and 6-year-old Chinese kindergarten children (M = 68.21 months, SD = 3.57, range = 62-76; 30 boys and 46 girls) were randomly assigned to learn eight Chinese characters using a touchscreen-based app, using a video, or through face-to-face interaction. Learning was measured via the recall task scores, recognition task scores, recall efficiency, and recognition efficiency. The results revealed that children's recall and recognition task scores improved when learning took place using the touchscreen or face-to-face interaction. Children's recall efficiency and recognition efficiency were strongest in the face-to-face condition, followed by the touchscreen condition and then the video condition. The effects of instructional format on children's recall and recognition scores and recall efficiency were moderated by age; younger children's recall and recognition scores in the face-to-face condition and the touchscreen condition were significantly higher than in the video condition, yet older children's recall and recognition scores did not differ between conditions. However, for recall efficiency, younger children's recall efficiency in the face-to-face condition and the touchscreen condition was significantly higher than in the video condition; older children's recall efficiency in the face-to-face condition was higher than in both the touchscreen condition and the video condition. In conclusion, both face-to-face interaction and a touchscreen-based app were helpful ways for children to learn Chinese characters compared with video, but face-to-face learning showed advantages over touchscreen learning in recall efficiency for older children.

Could Online Education Replace Face-to-Face Education in Diabetes? A Systematic Review

OBJECTIVE

Diabetes Self-Management Education and Support (DSMES) is a critical component of diabetes care. This study aims to examine the effect of online-based educational interventions on diabetes management compared to face-to-face interventions.

METHODS

A systematic review was conducted by searching three databases for studies in English or Spanish between December 2023 and March 2024. The inclusion criteria were studies that compared face-to-face DSMES with online interventions.

RESULTS

The follow-up duration of the trials ranged from 1 to 12 months. Multidisciplinary teams delivered online DSMES through various means, including Short Message Service (SMS), telephone calls, video calls, websites, and applications. Online DSMES was found to be comparable to face-to-face interventions in terms of glycated hemoglobin (HbA1c) levels in people with type 1 diabetes (T1D). In contrast, online interventions that focus on weight management in people with type 2 diabetes (T2D) have shown a significant reduction in HbA1c compared to face-to-face interventions. Online DSMES was found to be superior in terms of quality of life and cost-effectiveness in both T1D and T2D. None of the analyzed studies explored the differences between individual and group methodologies.

CONCLUSIONS

The current evidence indicates that online DSMES services provide at least comparable biomedical benefits to face-to-face interventions, suggesting that online interventions could be incorporated into clinical practice as a complement or reinforcement. However, further research is needed to explore the potential benefits and effectiveness of online group sessions in DSMES.

Online Training or Face-to-Face Training from the Perspective of Ear, Nose, and Throat and Head and Neck Surgeons?

PURPOSE

To determine the preferences of Ear, Nose, and Throat (ENT) and Head-Neck Surgery (HNS) specialists and residents undergoing training for online or face-to-face training and the factors affecting the preference.

METHODS

An 16-item questionnaire was created using Google Forms and was administered to residents undergoing training in ENT departments and to specialists working in the same field. The questionnaires were distributed online and requested to be completed between August and October 2020. The study participants were analyzed in two groups according to the preference for online training or face-to-face training.

RESULTS

Evaluation was made of a total of 173 participants, as 68 (39.3%) in online training, and 105 (60.7%) in face-to-face training. Online training comprised 47 (69.1%) females and 21 (30.9%) males with a mean age of 38.9 ± 8years and face-to-face training comprised 68 (64.8%) females and 37 (35.2%) males with a mean age of 37.9 ± 7.5years (gender: P = 0.55, age: P = 0.10). Of the total sample, 39 (22.5%) subjects were single and 134 (77.5%) were married. Face-to-face training was preferred by 61.2% of the married respondents and by 59% of those who were single. While 43.4% stated that visuals and documents were similar in both forms of training, those who stated that documentation was better in face-to-face training constituted 90.2% of the group that preferred face-to-face training (P = 0.0001). Of the total participants, 65.4% stated that concentration was easier in face-to-face training (P = 0.0001). When the groups were compared according to areas of interest, more of those involved in rhinology and head-neck surgery were in face-to-face training, and those with an interest in otology were seen to be in online training (P = 0.002). A wish to continue online training after the pandemic was expressed by 80.9% of the whole sample, and 68.6% wished to continue with face-to-face training (P = 0.0001). Hybrid meetings were determined to have been selected by 86.1% (P = 0.0001).

CONCLUSION

Online web seminars have an important role as a teaching and learning tool. There is a need for further research to evaluate how these clinically focused seminars can be presented at high quality and how they can provide benefit in training.

Influence of autistic traits and communication role on eye contact behavior during face-to-face interaction

Eye contact is a central component in face-to-face interactions. It is important in structuring communicative exchanges and offers critical insights into others' interests and intentions. To better understand eye contact in face-to-face interactions, we applied a novel, non-intrusive deep-learning-based dual-camera system and investigated associations between eye contact and autistic traits as well as self-reported eye contact discomfort during a referential communication task, where participants and the experimenter had to guess, in turn, a word known by the other individual. Corroborating previous research, we found that participants' eye gaze and mutual eye contact were inversely related to autistic traits. In addition, our findings revealed different behaviors depending on the role in the dyad: listening and guessing were associated with increased eye contact compared with describing words. In the listening and guessing condition, only a subgroup who reported eye contact discomfort had a lower amount of eye gaze and eye contact. When describing words, higher autistic traits were associated with reduced eye gaze and eye contact. Our data indicate that eye contact is inversely associated with autistic traits when describing words, and that eye gaze is modulated by the communicative role in a conversation.

A comparative study on the effectiveness of online and in-class team-based learning on student performance and perceptions in virtual simulation experiments

BACKGROUND

The swift transition to online teaching in medical education has presented the challenge of replicating in-class engagement and interaction essential for active learning. Despite online team-based learning (TBL) offering potential solutions through structured cooperative activities, its efficacy in virtual simulation experiment courses remains scantily researched. This study investigates the effectiveness of online TBL for teaching virtual patient experiments in a basic medical laboratory course and contrasts it with traditional offline teaching in terms of student performance and perceptions.

METHODS

A comparative analysis involved 179 Year 3 medical students using online TBL, face-to-face TBL (FTF-TBL), and the flipped classroom (FC) approach. The learning outcomes were assessed based on experiment reports, IRAT scores, TRAT scores, and final exam performance. Students' perceptions of both online and in-class TBL methodologies were also surveyed.

RESULTS

Both online and in-class TBL groups demonstrated comparable academic outcomes and surpassed the FC group in academic performance. Students displayed a marked preference for the TBL format (whether online or in-class), valuing its enhancement of learning interest and practical knowledge application. Nevertheless, refinements in discussion efficiency, platform convenience, and student-instructor interaction were indicated as potential areas of improvement in the online setting.

CONCLUSIONS

Online TBL, along with its in-class counterpart, showed superior academic performance and a more positive learning experience compared to the FC group. These findings underscore the potential of online TBL in adapting to modern pedagogical challenges and enriching medical education through virtual simulation experiments.

The effectiveness of digital delivery versus group-based face-to-face delivery of the English National Health Service Type 2 Diabetes Prevention Programme: a non-inferiority retrospective cohort comparison study

BACKGROUND

Face-to-face group-based diabetes prevention programmes have been shown to be effective in many settings. Digital delivery may suit some patients, but research comparing the effectiveness of digital with face-to-face delivery is scarce. The aim was to assess if digital delivery of the English National Health Service Diabetes Prevention Programme (NHS DPP) is non-inferior to group-based face-to-face delivery in terms of weight change, and evaluate factors associated with differential change.

METHODS

The study included those recruited to the NHS DPP in 2017-2018. Individual-level data from a face-to-face cohort was compared to two cohorts on a digital pilot who (i) were offered no choice of delivery mode, or (ii) chose digital over face-to-face. Changes in weight at 6 and 12 months were analysed using mixed effects linear regression, having matched participants from the digital pilot to similar participants from face-to-face.

RESULTS

Weight change on the digital pilot was non-inferior to face-to-face at both time points: it was similar in the comparison of those with no choice (difference in weight change: -0.284 kg [95% CI: -0.712, 0.144] at 6 months) and greater in digital when participants were offered a choice (-1.165 kg [95% CI: -1.841, -0.489]). Interactions between delivery mode and sex, ethnicity, age and deprivation were observed.

CONCLUSIONS

Digital delivery of the NHS DPP achieved weight loss at least as good as face-to-face. Patients who were offered a choice and opted for digital experienced better weight loss, compared to patients offered face-to-face only.

What is the efficacy and effectiveness of telemedicine intervention for deaf signing populations in comparison to face-to-face interventions? A systematic review

BACKGROUND

Deaf signing populations face inequality in both access to health services and health outcomes. Telemedicine intervention might offer a potential solution to address these inequalities in mental health and health related services, therefore a systematic review was carried out. The review question was: "What is the efficacy and effectiveness of telemedicine intervention for Deaf signing populations in comparison to face-to-face interventions?".

METHODS

The PICO framework was applied to identify the components of the review question for this study. The inclusion criteria were: Deaf signing populations; any intervention that includes the delivery of telemedicine therapy and/or the delivery of assessment (e.g. psychological assessments) using telemedicine; and any evidence for the benefits, efficacy and effectiveness of telemedicine intervention with Deaf people whether in health and/or mental health services. The databases PsycINFO, PubMed, Web of Science, CINAHL, and Medline were searched up to August 2021.

RESULTS

Following the search strategy, and after the duplicates were removed, 247 records were identified. Following screening, 232 were removed as they did not meet the inclusion criteria. The remaining 15 full-text articles were assessed for eligibility. Only two met the criteria to be included in the review (both concerned telemedicine and mental health interventions). However, they did not fully answer the review's research question. Therefore, the evidence gap remains regarding the effectiveness of telemedicine intervention for Deaf people.

CONCLUSIONS

The review has identified a gap in the knowledge on the efficacy and effectiveness of telemedicine intervention for Deaf people when compared with face-to-face interventions.

Digital transformation in higher education: A qualitative evaluative study of a hybrid virtual format using a smart classroom system

This study presents the salient perceptions of students and instructors in a master's program taught in a hybrid virtual format using the pocket Bipolar Laddering tool, a written open-ended electronic data collection system. Perceptions about the hybrid virtual format were tested on the participants of a master's program taught in the 2021-2022 academic year through a hybrid virtual format based on a Smart Classroom system developed as part of the digital innovations implemented to overcome the COVID-19 pandemic restrictions. This work aims to shed light on the users' salient perceptions of the format, detect the positive elements mentioned by the surveyed participants and identify the negative items in a bid to minimize, or even revert, their effects for future editions of the master. As expected, the findings suggest that one of the main advantages of this format is that it allows students who have difficulty attending classes on campus to enroll on courses. However, the participants detected diverse elements that could be improved such as interaction, the degree of socialization, or the technical problems that arose during teaching sessions. It is hoped that these findings will be of use when adjusting new editions of the program and will help to determine the design and implementation of other hybrid virtual programs in the Institution.

Engagement over telehealth: comparing attendance between dialectical behaviour therapy delivered face-to-face and via telehealth for programs in Australia and New Zealand during the Covid-19 pandemic

BACKGROUND

While the COVID-19 crisis has had numerous global negative impacts, it has also presented an imperative for mental health care systems to make digital mental health interventions a part of routine care. Accordingly, through necessity, many Dialectical Behaviour Therapy (DBT) programs transitioned to telehealth, despite little information on clinical outcomes compared with face-to-face treatment delivery. This study examined differences in client engagement (i.e. attendance) of DBT: delivered face-to-face prior to the first COVID-19 lockdown in Australia and New Zealand; delivered via telehealth during the lockdown; and delivered post-lockdown. Our primary outcomes were to compare: [1] client attendance rates of DBT individual therapy delivered face-to-face with delivery via telehealth, and [2] client attendance rates of DBT skills training delivered face-to-face compared with delivery via telehealth.

METHODS

DBT programs across Australia and New Zealand provided de-identified data for a total of 143 individuals who received DBT treatment provided via telehealth or face-to-face over a six-month period in 2020. Data included attendance rates of DBT individual therapy sessions; attendance rates of DBT skills training sessions as well as drop-out rates and First Nations status of clients.

RESULTS

A mixed effects logistic regression model revealed no significant differences between attendance rates for clients attending face-to-face sessions or telehealth sessions for either group therapy or individual therapy. This result was found for clients who identified as First Nations persons and those who didn't identify as First Nations persons.

CONCLUSIONS

Clients were as likely to attend their DBT sessions over telehealth as they were face-to-face during the first year of the Covid-19 pandemic. These findings provide preliminary evidence that providing DBT over telehealth may be a viable option to increase access for clients, particularly in areas where face-to-face treatment is not available. Further, based on the data collected in this study, we can be less concerned that offering telehealth treatment will compromise attendance rates compared to face-to-face treatment. Further research is needed comparing clinical outcomes between treatments delivered face-to-face compared delivery via telehealth.

The Effects of an Online Positive Psychology Course on Happiness, Health, and Well-Being

This study investigated the effects of an 8-week online positive psychology course on happiness, health, and well-being. There were 65 undergraduate students in the course and a comparison group of 63 undergraduates taking other online psychology courses. The participants were assessed on positive mental health (e.g., happiness, positive emotions), negative mental health (e.g., anxiety, depression), general health, and personal characteristics (e.g., hope, resilience) during the first and last week of the courses. The anxiety and depression measures had cut-offs for clinically significant symptoms. The hypotheses were that the positive psychology students would have significant improvements on all measures and a reduction in the percent anxious and depressed relative to the comparison group. The hypotheses were supported with large effect sizes for positive and negative mental health (mean ds = 0.907 and - 0.779, respectively) and medium-to-large effects for general health and personal characteristics (d = 0.674 and mean ds = 0.590, respectively). There was a reduction from 49.2 to 23.1% percent anxious and from 18.6 to 6.2% percent depressed with no change in the comparison group. In addition, improvements in the online positive psychology course were compared with a previous study of a similar face-to-face positive psychology course (Smith et al., 2021) showing the effect sizes for improvements relative to the comparison groups were larger in the online vs. face-to-face course (mean ds = 0.878. vs. 0.593). Possible explanations for these differences are discussed along with the implications for maximizing the benefits of positive psychology courses in the future.

Financial information, physical proximity and COVID: The experience of Asian sell-side equity research analysts

The need for physical proximity and face-to-face communication in financial information flows is contested. But the movement restrictions imposed across Asia during the COVID-19 pandemic, together with the elevated information needs as financial markets became stressed, provided the unique circumstances for a natural experiment to test the extent to which physical interaction is important in the origination and distribution of financial information. Drawing upon 70 interviews undertaken across Asia during 2021, primarily with sell-side analysts who act as information intermediaries in the financial ecosystem, this article provides evidence that physical proximity and face-to-face communication remains highly valued, particularly when accessing information embedded in informal local networks and originated through reciprocal client relationships. Analysts physically restricted from contacts at corporates and within their associated operating environments, reported a degradation of knowledge, especially versus more proximate competitors. The enforced physical separation also weakened previously strong social and reciprocal relationships with clients, even those co-located in the same city. Although these trends may be gradual and incremental rather than dramatic, they are persistent and self-reinforcing, and demonstrate the continued benefits of proximity and face-to-face interaction, with longer-term implications for financial geographies.

Information technology-based versus face-to-face cognitive-behavioural therapy for anxiety and depression: A systematic review and meta-analysis

BACKGROUND

We aimed to systematically review the efficacy of information technology-based cognitive behavioural therapy (ICBT) versus face-to-face cognitive behavioural therapy (FCBT) for management of anxiety and depression in adult patients.

METHODS

Systematic literature search for clinical trials comparing ICBT to FCBT in adults diagnosed with anxiety or depression was conducted. Quantitative analyses were performed to examine the efficacy of ICBT versus FCBT. Primacy outcome was change in symptom severity.

RESULTS

A total of 11 publications (10 studies and 896 participants) were included. The pooled effect size of ICBT versus FCBT did not find significant difference for post-treatment anxiety or depressive symptoms severity (Hedges' g = -0.07; 95% CI = -0.20 to 0.06), and ICBT was non-inferior to FCBT (at Cohen's d = 0.3). Maintenance of treatment efficacy also showed no significant difference between ICBT and FCBT at 6 months (g = -0.14, 95% CI = -0.42 to 0.14) and 12 months (g = -0.05, 95% CI = -0.41 to 0.32) post-treatment. Adherence rate was lower in ICBT than FCBT but did not achieve statistically significance (61% vs 88%; RR = 0.86, 95% CI = 0.74 to1.00). Results were not affected by study quality.

LIMITATIONS

The examination of study heterogeneity was limited by the small number of studies.

CONCLUSIONS

We found non-inferior performance of ICBT versus FCBT in reducing symptoms in patients diagnosed of anxiety or depressive disorders. With the social-distancing measures amid COVID-19 pandemic, service providers should give serious consideration with great caution in the decision-making process of offering ICBT to patients.

Evaluating the effectiveness of a 6-week hybrid mindfulness-based intervention in reducing the stress among caregivers of patients with dementia during COVID-19 pandemic: protocol of a randomized controlled trial

Background

Mindfulness-based intervention (MBI), an emotion-focused approach, has been shown promising and sustainable effects on enhancing the well-being of caregivers of patients with dementia (PWD). However, the conventional MBI was quite demanding, had high rates of attrition and inconsistent long-term effect. The social distancing measures introduced during the COVID-19 pandemic also restricted face-to-face psychosocial intervention. The study aims to evaluate the effectiveness of a 6-week hybrid MBI in caregivers of PWD over a 6-month follow up.

Methods

This is a single-blinded, parallel-group randomized controlled trial (RCT). Eligible participants from three local nongovernmental organizations (NGOs) will be randomly divided into intervention groups and control groups in a ratio of 1:1. The participants in the intervention group will receive 6 weekly 90-min group-based sessions delivered through a face-to-face and online approach. The participants in the control group will receive brief education on dementia care with the same group size, duration, and frequency as the sessions in the intervention group. Immediately after the intervention and at the 6-month follow-up, caring stress and other outcomes will be assessed. Besides, a focus group interview will be conducted to identify the strengths, limitations, and therapeutic components of the intervention from their perspectives. For quantitative data, intention-to-treat analysis and Generalized Estimating Equations (GEE) will be used. For qualitative data, content analysis will be used.

Discussion

This proposed hybrid model of MBI has several advantages, such as lower duration, longer follow-up period and easier access by family caregivers. Also, physiological indicators (e.g., heart rate viability and neuropsychiatric symptoms) will be measured in this study to show the body change after MBI. The quantitative and qualitative data of this research can also benefit the development of online or hybrid MBI for caregivers of PWD during the COVID-19 pandemic. Despite these strengths, it does have practical challenges and limitations. However, this proposed intervention has the potential to benefit not only the participants, but also the researcher as well as public health providers.

Trial registration: NCT05242614. Registered on 2022-02-16, https://clinicaltrials.gov/ct2/show/NCT05242614

Effects of virtual learning environments: A scoping review of literature

The purpose of this scoping review is to isolate and investigate the existing data and research that identifies if the synchronous face-to-face visual presence of a teacher in a virtual learning environment (VLE) is a significant factor in a student's ability to maintain good mental health. While the present research on this explicit interaction among VLE implementation and student mental health is limited, the material suggests a framework for strong utilization of VLEs. Overall, our research has shown that authentic, high quality VLEs are ones that have as their primary focus the communication between students and their teachers and between students and their peers. This communication is best generated through synchronous connections where there exists the ability to convey the student's immediate needs in real-time. Our research results and discussion will outline how a team approach that brings together teachers, students, administration, counsellors, mental health support staff, instructional designers, and ICT specialists is necessary to create a genuinely enriching VLE where both learning and social-emotional needs can be met. The authors present a case for further study in order to reveal the nature of the interaction among VLEs and student mental health.

Impact of the COVID-19 pandemic on teaching and learning in health professional education: a mixed methods study protocol

BACKGROUND

Due to the complex nature of healthcare professionals' roles and responsibilities, the education of this workforce is multifaceted and challenging. It relies on various sources of learning from teachers, peers, patients and may focus on Work Integrated Learning (WIL). The COVID-19 pandemic has impacted many of these learning opportunities especially those in large groups or involving in person interaction with peers and patients. Much of the curriculum has been adapted to an online format, the long-term consequence of which is yet to be recognized. The changed format is likely to impact learning pedagogy effecting both students and teachers. This requires a systematic approach to evaluation of online teaching and learning adaptation, in comparison to the previous format, where, in person education may have been the focus.

METHODS

The proposed study is a broad based evaluation of health professional education in a major Australian University. The protocol describes a mixed methods convergent design to evaluate the impact of online education on students and teachers in health professional courses including Medicine, Nursing, Allied Health and Biomedical Science. A framework, developed at the university, using Contribution Analysis (CA), will guide the evaluation. Quantitative data relating to student performance, student evaluation of units, quantity of teaching activities and resource utilization will be collected and subjected to relevant statistical analysis. Data will be collected through surveys (500 students and 100 teachers), focus groups (10 groups of students) and interviews of students and teachers (50 students beyond graduation and 25 teachers, for long term follow up to 12 months). Application of CA will be used to answer the key research questions on the short term and long-term impact of online education on teaching and learning approaches.

DISCUSSION

The protocol describes the study, which will be widely implemented over the various courses in Health Professional Education and Biomedical Science. It will evaluate how students and teachers engage with the online delivery of the curriculum, student performance, and resources used to implement these changes. It also aims to evaluate longitudinal outcome of student learning attributes and impact on graduate outcomes, which is poorly reported in educational literature.

Learning anatomy before and during COVID-19 pandemic: Students' perceptions and exam performance

The objective of our study was to explore the impact of COVID-19 pandemic on learning anatomy and to compare the students’ perceptions of “face-to-face” and “online” anatomy teaching, and to assess their impact on student's performance. We used a descriptive, cross-sectional, questionnaire-based study that focused on a single cohort of undergraduate medial students who attended anatomy demonstrations, at the College of Medicine and Medical Sciences, Arabian Gulf University (CMMS-AGU), both pre-pandemic (face-to-face) during 2019-2020 and the pandemic (online) during 2020-2021. Students who participated in this study responded in favor of face-to-face demonstrations for better understanding of the spatial orientation of body organs and systems, the visualization of the anatomical relations between structures, understanding the difficult anatomical structures, understanding the clinical correlations, and making them more confident about their practical exams. On the other hand, students were in favor of online demonstrations for retaining key information, confidence levels on discussing anatomy learning needs, effective utilization of demonstration time, and lower stress associated with the online learning. Regarding anatomy exam scores, statistically significant difference was found between mean scores of online and onsite exams in one of the two analyzed multiple choice questions tests. However, there was a statistically significant difference between the mean scores of objective structured practical examination of online and onsite exams in the two analyzed tests. Furthermore, the majority of the students who participated in the survey prefer a mixture of both face-to-face and online anatomy demonstrations during the pandemic and also in the post-COVID-19 era.

face-to-face cardiopulmonary resuscitation training on chest compression quality: A pilot randomized manikin study

OBJECTIVES

The aim of the study was to compare the effect of synchronous online and face-to-face cardiopulmonary resuscitation (CPR) training on chest compressions quality in a manikin model.

METHODS

A total of 118 fourth-year medical students participated in this study. The participants were divided into two groups: the online synchronous teaching group and the face-to-face group. Then, the participants were further randomly distributed to 1 of 2 feedback groups: online synchronous teaching and training with feedback devices (TF, n = 30) or without feedback devices (TN, n = 29) and face-to-face teaching and training with feedback devices (FF, n = 30) or without feedback devices (FN, n = 29). In the FN group and FF group, instructors delivered a 45-min CPR training program and gave feedback and guidance during training on site. In the TN group and TF group, the participants were trained with an online lecture via Tencent Meeting live broadcasting. Finally, participants performed a 2-min continuous chest compression (CC) during a simulated cardiopulmonary arrest scene without the audiovisual feedback (AVF) device. The outcome measures included CC depth, CC rate, proportions of appropriate depth (50-60 mm) and CC rate (100-120/min), percentage of correct hand location position, and percentage of complete chest recoil.

RESULTS

There was little difference in the CC quality between the synchronous online training groups and the face-to-face training groups. There was no statistically significant difference in CC quality between the TN group and FN group. There were also no statistically significant differences between the TF and FF groups in terms of correct hand position, CC depth, appropriate CC depth, complete chest recoil or CC rate. However, the FF group had a higher appropriate CC rate than the TF group (p = 0.045). In the face-to-face training groups, the AVF device group had a significantly greater CC depth, appropriate CC depth, CC rate, and appropriate CC rate. However, there was a lack of statistically significant differences in terms of correct hand position (p = 0.191) and appropriate CC depth (p = 0.123). In the synchronous online training groups, the AVF device had little effect on the CC rate (p = 0.851) and increased the appropriate CC rate, but the difference was not statistically significant (p = 0.178).

CONCLUSIONS

Synchronous online training with an AVF device would be a potential alternative approach to face-to-face chest compression training. Synchronous online training with AVF devices seems to be a suitable replacement for face-to-face training to offer adequate bystander CPR chest compression training.

The future of orthopaedic surgical education: Where do we go now?

INTRODUCTION

COVID-19 will undoubtedly change the future landscape of medical and surgical education. The economic and environmental advantages of virtual learning are clear, while access to a wider range of resources and subject specialists makes the adoption of virtual learning within surgical education an attractive prospect.

AIMS

This literature review aims to evaluate evidence on the effectiveness of virtual education in orthopaedics and how we might implement positive changes to educational practice in the future, as a result of lessons learned during the COVID-19 pandemic.

METHODOLOGY

We performed a review of the literature reporting on efficacy of learning outcomes achieved as a result of virtual education within orthopaedic surgery. Electronic searches were performed using NICE healthcare databases from the date of inception to March 2021. Relevant studies were identified, data extracted, and qualitative synthesis performed.

RESULTS

14 manuscripts with a total of 1548 participants (orthopaedic trainees or medical students) were included for analysis. Nine studies (n = 1109) selected compared e-learning to conventional learning material (control group). All nine studies reported significantly higher outcome scores for e-learning participants compared to control participants (p < 0.001 to p < 0.05). The remaining studies compared blended e-learning approaches or evaluated pre/post intervention improvements in learning outcomes. All studies demonstrated a significant improvement in learning outcomes (p < 0.0001 to p < 0.01). The majority of studies (64%) used a blended approach. No studies were identified reporting efficacy of webinars or videoconferencing within orthopaedic education.

CONCLUSION

A blended approach, combining virtual teaching, face-to-face instruction and distance learning tools, based on the evidence we have provided, would improve the quality of knowledge reception and retention, and learner satisfaction. However, in order to be successful, it is vital that these educational programmes are designed with the needs of the learner in mind, and an awareness of best practice for virtual teaching and learning.

Self-management in face-to-face peer support for adults with type 2 diabetes living in low- or middle-income countries: a systematic review

Background

Peer support has been recognised as a promising strategy to improve self-management in patients living with chronic conditions, such as Type 2 diabetes (T2D). The purpose of the review was to synthesise the best available evidence on face-to-face peer support models for adults with T2D in low and middle-income countries (LMICs).

Methods

We searched Medline, Cumulative Index to Nursing and Allied Health, Literature Academic Search Ultimate, PsycINFO, CAB Abstracts, Health Source: Nursing/Academic Edition, SPORTDiscus, Africa-Wide Information, MasterFILE Premier, SocINDEX, ERIC, PsycARTICLES, Open Dissertations, Communication & Mass Media Complete, Health Source-Consumer Edition and Google Scholar for the period January 2000 to December 2017. Reference list checking and contact with authors were additional sources of data. Screening of papers, critical appraisal and data extraction were carried out independently by at least two reviewers.

Results

From 3092 abstracts retrieved from database searches, data was extracted from 12 papers. There was no consistency in design, setting, outcomes or measurement instruments amongst the papers. The papers were associated with improvements in various clinical and behavioural outcomes. Diabetic patients and community health workers (CHWs) were identified as two common face-to-face peer support models. The recruitment and selection of diabetic patients as peer supporters focused on patients from the community, with good glycaemic control and/or leadership skills, who were recommended by healthcare professionals. Recruitment of CHWs as peer supporters was done from an existing infrastructure of CHWs in the community and, thus, selection criteria were poorly described. The training of peer supporters featured as an important component, highlighting who provided training and the duration and content covered in training. Motivational interviewing was the most common theory basis of training used in the peer support interventions. Face-to-face, group and/or individual-based peer support was often supplemented by other peer support methods. The supervision of peer supporters was generally poorly described.

Conclusions

The comprehensive synthesis of the best available evidence has led to new insights regarding face-to-face peer support as a self-management strategy for patients with T2D in LMICs. Face-to-face peer support may be implemented in innovative ways to improve the quality of life of patients with T2D.

Trial registration

PROSPERO trial registry number, CRD 42018103261.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09954-1.

Comparison of online and face-to-face valuation of the EQ-5D-5L using composite time trade-off

OBJECTIVE

The aim of this study was to compare online, unsupervised and face-to-face (F2F), supervised valuation of EQ-5D-5L health states using composite time trade-off (cTTO) tasks.

METHODS

The official EuroQol experimental design and valuation protocol for the EQ-5D-5L of 86 health states were implemented in interviewer-assisted, F2F and unsupervised, online studies. Validity of preferences was assessed using prevalence of inconsistent valuations and expected patterns of TTO values. Respondent task engagement was measured using number of trade-offs and time per task. Trading patterns such as better-than-dead only was compared between modes. Value sets were generated using linear regression with a random intercept (RILR). Value set characteristics such as range of scale and dimension ranking were evaluated between modes.

RESULTS

Five hundred one online and 1,134 F2F respondents completed the surveys. Mean elicited TTO values were higher online than F2F when compared by health state severity. Compared to F2F, a larger proportion of online respondents did not assign the poorest EQ-5D-5L health state (i.e., 55555) the lowest TTO value ([Online] 41.3% [F2F] 12.2%) (p < 0.001). A higher percentage of online cTTO tasks were completed in 3 trade-offs or fewer ([Online] 15.8% [F2F] 3.7%), (p < 0.001). When modeled using the RILR, the F2F range of scale was larger than online ([Online] 0.600 [F2F] 1.307) and the respective dimension rankings differed.

CONCLUSIONS

Compared to F2F data, TTO tasks conducted online had more inconsistencies and decreased engagement, which contributed to compromised data quality. This study illustrates the challenges of conducting online valuation studies using the TTO approach.

Social Skills Training for Autism Spectrum Disorder: a Meta-analysis of In-person and Technological Interventions

Social skills training (SST) for autism spectrum disorder (ASD) has traditionally focused on face-to-face (F2F-SST) interventions. Recently, Behavioral Intervention Technologies (BITs-SST) have been utilized to target social skills deficits using computer-based programs, avatars, and therapeutic robots. The present meta-analysis reviews recent evidence and compares the efficacy of 14 F2F-SST and four identified BITs-SST intervention trials for youth with ASD. These preliminary analyses did not indicate significant differences between F2F-SST and BITs-SST, with effect sizes consistently in the medium to high range (g = 0.81 and g = 0.93, respectively). These findings provide initial support for the continued investigation of BITs for providing SST to youth with ASD.

Effectiveness of an individual acceptance and commitment therapy for smoking cessation, delivered face-to-face and by telephone to adults recruited in primary health care settings: a randomized controlled trial

Background

The aim of this study was to examine the effectiveness of delivering an individual Acceptance and Commitment Therapy (ACT) for smoking cessation among a Chinese population.

Methods

Participants were recruited from six primary health care centers. A total of 144 were eligible to take part in the study and agreed to be randomized to the intervention (ACT) group (n = 70) and control group (n = 74), respectively. Both groups received self-help materials on smoking cessation. The ACT group also underwent an initial face-to-face session and two telephone ACT sessions at 1 week and 1 month following the first session. They were re-contacted through telephone follow-ups at 3, 6, and 12 months by research assistants. The primary outcome was self-reported 7-day point-prevalence abstinence at the 12-month follow-up session. Other outcomes included biochemically validated quitting, quitting attempts, the intention to quit, the self-perception of quitting, and psychological flexibility.

Results

There was no significant difference in the self-reported 7-day point prevalence quit rate at the 12-month follow-up between the intervention group (24.3%) and the control group (21.6%) (risk ratio = 1.12; 95%CI = (0.62, 2.05); p = 0.704). Greater improvements in secondary outcomes from baseline to the 12-month follow-up were observed in the ACT group than in the control group, including a forward progression in the participants’ readiness to quit smoking (p = 0.014) and increased psychological flexibility (p = 0.022).

Conclusions

This study is the first evidence of a randomized-controlled trial on the adoption of an individual ACT for smoking cessation, delivered initially in primary health care settings and subsequently by telephone within a Chinese population. The present study found that the brief ACT intervention could not produce a significant quit rate but was promising in terms of bringing about cognitive changes, including greater psychological flexibility, and more confidence about quitting, when compared to the use of self-help materials only among the general population.

Trial registration

This trial was registered prospectively with the U.S. National Library of Medicine: (NCT01652508) on 26th July 2012.

US population norms for the EQ-5D-5L and comparison of norms from face-to-face and online samples

Purpose

Normative scores (norms) allow for comparisons between population(s) of interest and the general population, which is useful for burden of disease studies and cost-effectiveness analysis. The primary aim of this study was to estimate US visual analogue scale (EQ VAS) and utility-based norms for the EQ-5D-5L using the face-to-face sample. The secondary aim was to compare norms estimated in the face-to-face and online populations.

Methods

This study estimated population norms from two general population surveys: (a) face-to-face and (b) online. In these surveys, respondents provided their health state using the EQ-5D-5L health classifier and the EQ VAS. Descriptive statistics, including mean, standard deviation (SD), 95% confidence interval, and median for the 5L utility and EQ VAS were estimated for each sample and across relevant respondent characteristics to serve as the basis for US EQ-5D-5L norms

Results

Face-to-face sample respondents (n = 1134) were representative of the US adult general population. In this sample, mean (SD) utility decreased with increasing age until age 45 or greater (age 45–54: 0.816 (0.249) age 55–64: 0.815 (0.243) age 65–74: 0.824 (0.217) age 75 + : 0.811 (0.218)). With increasing age, more problems were reported on all dimensions except anxiety/depression; a smaller proportion of respondents age 65 and older reported problems with anxiety/depression (23.8%) as compared to the youngest respondents (42.1%). Online (n = 2018) mean utility and EQ VAS values were consistently lower than the face-to-face sample.

Conclusions

The availability of US EQ-5D-5L norms facilitates interpretation and understanding of general population and patient health.

Electronic supplementary material

The online version of this article (10.1007/s11136-020-02650-y) contains supplementary material, which is available to authorized users.

Community pharmacists' interventions and documentation during medication therapy management encounters delivered face-to-face versus via telephone: The devil is in the details

BACKGROUND

To date, no studies are available comparing in-person versus telephone-administered medication therapy management (MTM) encounters in a community pharmacy setting with respect to medication-related problems, interventions and documentation.

OBJECTIVE

The objective of this study was to evaluate types of medication-related problems, interventions, and documentation among patients receiving MTM face-to-face versus over the telephone.

METHODS

A retrospective analysis was performed on all completed comprehensive medication reviews (CMR) between 2011 and 2017 in 14 community pharmacies in Western Massachusetts, USA that belong to one district of a national chain. Medication-related problems were classified as: Beers criteria medications, untreated condition, dose too high or low, medication omission, duplicate therapy, drug-drug interaction, non-adherence, complicated dosing. Pharmacist's interventions were classified as education, medication reconciliation, and vaccination. Documentation of assessment, plan, discussion notes, and recommendations were evaluated as being present or absent.

RESULTS

In total, 297 encounters (56.5% were over the telephone) were included in the analysis. There was no significant differences between clinical and demographic characteristics and types of medication-related problems and pharmacist interventions among patients who received face-to-face versus telephone MTM service. Assessment was documented among 28% of face-to-face and 42% of telephone CMR encounters (p < 0.05). Plan was documented among 27% of face-to-face and 40% of telephone CMR encounters (p < 0.05). Discussion notes were documented among 97% of face-to-face and 98% of telephone CMR encounters (p > 0.05). Pharmacist recommendations were documented among 92% of face-to-face and 95% of telephone CMR encounters (p > 0.05).

CONCLUSIONS

Pharmacists identify medication-related problems and provide education and medication reconciliation interventions independent of the mode of delivery. The overall low frequency of assessment and plan documentation raises concerns. It is imperative for pharmacists to document both instances of provider outreach and follow-up to ascertain resolutions of patients' medication-related problems.

Effectiveness of a brief psychological mindfulness-based intervention for the treatment of depression in primary care: study protocol for a randomized controlled clinical trial

BACKGROUND

Depressive symptoms are quite prevalent in Primary Care (PC) settings. The treatment as usual (TAU) in PC is pharmacotherapy, despite the high relapse rates it produces. Many patients would prefer psychotherapy, but specialized services are overloaded. Studies that apply Mindfulness-Based Interventions (MBIs) for the treatment of depression have obtained significant improvements. Brief low-intensity approaches delivered from PC could be a promising approach. This study aims to compare a low-intensity mindfulness intervention for the treatment of depression in PC using different intervention formats - a face-to-face MBI delivered in a group and the same MBI individually applied on the Internet - to a control group that will receive PC medical treatment as usual.

METHODS

A randomized controlled clinical trial will be conducted in PC, with about 120 depressed patients allocated (1:1:1) to three groups: "face-to-face MBI + TAU", "Internet-delivered MBI + TAU", and "TAU alone". The MBI programs will be composed of four modules. The primary outcome will be depressive symptoms, measured through the Beck Depression Inventory, assessed at pre- and post-treatment and 6- and 12-month follow-ups. Other outcomes will be mindfulness, happiness, affectivity, quality of life, and the use of healthcare services. Intention-to-treat analysis using linear mixed models adjusted for baseline scores and routine sociodemographic analysis that could show baseline differences will be conducted. Per-protocol secondary outcome analyses will also be performed.

DISCUSSION

This is the first Spanish RCT to apply a low-intensity face-to-face MBI (plus TAU) to treat depression in PC settings compared to TAU (alone). Moreover, this study will also make it possible to evaluate the same MBI program (plus TAU), but Internet-delivered, considering their cost-effectiveness. Positive results from this RCT might have an important impact on mental health settings, helping to decrease the overload of the system and offering treatment alternatives beyond antidepressant medication through high-quality, flexible PC interventions.

TRIAL REGISTRATION

Clinical Trials.gov NCT03034343 . Trial Registration date 24 January 2017, retrospectively registered.

Self-directed or therapist-led parent training for children with attention deficit hyperactivity disorder? A randomized controlled non-inferiority pilot trial

BACKGROUND AND OBJECTIVES

Therapist-led behavioral parent training is a well-established treatment for behavior problems in children with attention-deficit/hyperactivity disorder (ADHD). However, parental attrition is high; self-directed forms of parent training may be a promising alternative. To date, no studies have compared these two forms of parent training in referred children with ADHD. The objectives of this pilot study were to examine the non-inferiority of a blended parent training (i.e. online program + supportive therapist contact) in comparison to its therapist-led equivalent (i.e. face-to-face parent training) regarding effects on behavioral problems, and to compare attrition rates, parental satisfaction, and therapist-time between both treatments.

METHODS

21 school-aged children with ADHD and behavioral problems, who had been referred to an outpatient mental health clinic, were randomized to blended (n = 11) or face-to-face (n = 10) parent training. Behavior problems were measured with the Child Behavior Checklist. Treatment completers and dropouts were included in the analyses.

RESULTS AND CONCLUSIONS

Blended parent training was not found to be non-inferior to face-to-face parent training in the reduction of behavior problems. Parents in the blended condition dropped out of treatment significantly earlier than parents in the face-to-face condition and were less satisfied. Therapists in the blended condition spent significantly less time on parent training than therapists in the face-to-face condition.

Comparing internet and face-to-face surveys as methods for eliciting preferences for social care-related quality of life: evidence from England using the ASCOT service user measure

Purpose

Traditionally, researchers have relied on eliciting preferences through face-to-face interviews. Recently, there has been a shift towards using internet-based methods. Different methods of data collection may be a source of variation in the results. In this study, we compare the preferences for the Adult Social Care Outcomes Toolkit (ASCOT) service user measure elicited using best–worst scaling (BWS) via a face-to-face interview and an online survey.

Methods

Data were collected from a representative sample of the general population in England. The respondents (face-to-face: n = 500; online: n = 1001) completed a survey, which included the BWS experiment involving the ASCOT measure. Each respondent received eight best–worst scenarios and made four choices (best, second best, worst, second worst) in each scenario. Multinomial logit regressions were undertaken to analyse the data taking into account differences in the characteristics of the two samples and the repeated nature of the data.

Results

We initially found a number of small significant differences in preferences between the two methods across all ASCOT domains. These differences were substantially reduced—from 15 to 5 out of 30 coefficients being different at the 5% level—and remained small in value after controlling for differences in observable and unobservable characteristics of the two samples.

Conclusions

This comparison demonstrates that face-to-face and internet surveys may lead to fairly similar preferences for social care-related quality of life when differences in sample characteristics are controlled for. With or without a constant sampling frame, studies should carefully design the BWS exercise and provide similar levels of clarification to participants in each survey to minimise the amount of error variance in the choice process.

Acceptability of the method of administration of a patient-reported outcome measure (PROM) with stroke survivors, a randomised controlled trial protocol

BACKGROUND

UK-wide national clinical guidelines promote routine 6-month post-stroke follow-up assessment. However, as part of this 6-month assessment little information is gathered from the patient's perspective. The means of collecting this patient-centred information might be served best by a patient-reported outcome measure (PROM) at the 6-month assessment time point. Currently, four different methods of 6-month follow-up assessment occur; the most common being face-to-face interview followed by telephone interview, postal questionnaire and online questionnaire. Therefore, this study will investigate if the acceptability of telephone, online or postal administration of a PROM at the 6-month post-stoke time point is not inferior to face-to-face administration.

METHODS/DESIGN

A UK multicentre, blinded (analyst and researcher), pragmatic, non-inferiority study, with 80% power using a 2.5% non-inferiority margin was designed to compare the acceptability of three modes of administration (telephone interview, postal questionnaire and online questionnaire) compared with face-to-face interview administration of a PROM. We plan to approach and randomise a minimum of 808 potentially eligible participants, 202 participants per group.

DISCUSSION

The aim of this ongoing research is to understand if there is a difference between face-to-face administration and the other three methods of administering a PROM as a patient-centred supplement to the 6-month review for stroke survivors. In utilising a pragmatic design, it is believed that this study will offer UK wide generalisable results, of the acceptability of the methods under investigation, to inform clinicians and commissioners of stroke services.

TRIALS REGISTRATION

ClinicalTrials.gov: NCT03177161 . Registered on 6 June 2017.

A Meta-analytic Comparison of Face-to-Face and Online Delivery in Ethics Instruction: The Case for a Hybrid Approach

Despite the growing body of literature on training in the responsible conduct of research, few studies have examined the effectiveness of delivery formats used in ethics courses (i.e., face-to-face, online, hybrid). The present effort sought to address this gap in the literature through a meta-analytic review of 66 empirical studies, representing 106 ethics courses and 10,069 participants. The frequency and effectiveness of 67 instructional and process-based content areas were also assessed for each delivery format. Process-based contents were best delivered face-to-face, whereas contents delivered online were most effective when restricted to compliance-based instructional contents. Overall, hybrid courses were found to be most effective, suggesting that ethics courses are best delivered using a blend of formats and content areas. Implications and recommendations for future development of ethics education courses in the sciences are discussed.

Facile preparation of hexagonal tin sulfide nanoplates anchored on graphene nanosheets for highly efficient sodium storage

Tin sulfide/graphene nanocomposite with hexagonal tin sulfide (SnS₂) nanoplates anchored on reduced graphene oxide (RGO) nanosheets was easily synthesized by one-step controllable hydrothermal growth followed by mild reduction. The SnS₂ hexagonal-plates distributed tightly and uniformly on the RGO support in a more favorable face-to-face (FTF) manner. The formation of SnS₂ nanoplates with hexagonal morphology may result from the accelerating growth of six energetically equivalent high-index (1 1 0) crystal planes and prohibiting growth of the (0 0 1) crystal plane on graphene. The FTF architecture is beneficial for the optimal electric contact efficiency of SnS₂ nanoplates with RGO matrix, thus leading to the greatly enhanced electrochemical performance of SnS₂/RGO composite than bare SnS₂. The graphene-constructed two-dimensional integrated conductive networks minimize the transport paths of electrons and Na ions between electrode and electrolyte as well as accommodate the mechanical strain during long term cyclic. The SnS₂/RGO composite exhibits great application potential as an anode for sodium ion batteries with the advantages of unique structure and superior sodium storage performance.

Internet-based versus face-to-face cognitive-behavioral intervention for depression: a randomized controlled non-inferiority trial

BACKGROUND AND AIMS

In the past decade, a large body of research has demonstrated that internet-based interventions can have beneficial effects on depression. However, only a few clinical trials have compared internet-based depression therapy with an equivalent face-to-face treatment. The primary aim of this study was to compare treatment outcomes of an internet-based intervention with a face-to-face intervention for depression in a randomized non-inferiority trial.

METHOD

A total of 62 participants suffering from depression were randomly assigned to the therapist-supported internet-based intervention group (n=32) and to the face-to-face intervention (n=30). The 8 week interventions were based on cognitive-behavioral therapy principles. Patients in both groups received the same treatment modules in the same chronological order and time-frame. Primary outcome measure was the Beck Depression Inventory-II (BDI-II); secondary outcome variables were suicidal ideation, anxiety, hopelessness and automatic thoughts.

RESULTS

The intention-to-treat analysis yielded no significant between-group difference (online vs. face-to-face group) for any of the pre- to post-treatment measurements. At post-treatment both treatment conditions revealed significant symptom changes compared to before the intervention. Within group effect sizes for depression in the online group (d=1.27) and the face-to-face group (d=1.37) can be considered large. At 3-month follow-up, results in the online group remained stable. In contrast to this, participants in the face-to-face group showed significantly worsened depressive symptoms three months after termination of treatment (t=-2.05, df=19, p<.05).

LIMITATIONS

Due to the small sample size, it will be important to evaluate these outcomes in adequately-powered trials.

CONCLUSIONS

This study shows that an internet-based intervention for depression is equally beneficial to regular face-to-face therapy. However, more long term efficacy, indicated by continued symptom reduction three months after treatment, could be only be found for the online group.

Gestural cue analysis in automated semantic miscommunication annotation

The automated annotation of conversational video by semantic miscommunication labels is a challenging topic. Although miscommunications are often obvious to the speakers as well as the observers, it is difficult for machines to detect them from the low-level features. We investigate the utility of gestural cues in this paper among various non-verbal features. Compared with gesture recognition tasks in human-computer interaction, this process is difficult due to the lack of understanding on which cues contribute to miscommunications and the implicitness of gestures. Nine simple gestural features are taken from gesture data, and both simple and complex classifiers are constructed using machine learning. The experimental results suggest that there is no single gestural feature that can predict or explain the occurrence of semantic miscommunication in our setting.