Leadership factors for cardiopulmonary resuscitation for clinicians in-hospital; behaviours, skills and strategies: A systematic review and synthesis without meta-analysis

AIM

To identify leadership factors for clinicians during in-hospital cardiopulmonary resuscitation.

DESIGN

Systematic review with synthesis without meta-analysis.

METHODS

The review was guided by SWiM, assessed for quality using CASP and reported with PRISMA.

DATA SOURCES

Cochrane, EMBASE, PubMed, Medline, Scopus and CINAHL (years of 2013-2023) and a manual reference list search of all included studies.

RESULTS

A total of 60 papers were identified with three major themes of useful resuscitation leadership; 'social skills', 'cognitive skills and behaviour' and 'leadership development skills' were identified. Main factors included delegating effectively, while being situationally aware of team members' ability and progress during resuscitation, and being empathetic and supportive, yet 'controlling the room' using a hands-off style. Shared decision-making to reduce cognitive load for one leader was shown to improve effective teamwork. Findings were limited by heterogeneity of studies and inconsistently applied tools to measure leadership.

CONCLUSION

Traditional authoritarian leadership styles are not wanted by team members with preference for shared leadership and collaboration. Balancing this with the need for team members to see leaders in 'control of the room' brings new challenges for leaders and trainers of resuscitation.

IMPLICATIONS FOR NURSING PROFESSION

All clinicians need effective leadership skills for cardiopulmonary resuscitation in-hospital. Nurses provide first response and ongoing leadership for cardiopulmonary resuscitation. Nurses typically display suitable skills that align with useful resuscitation leader factors.

IMPACT

What were the main findings? Collaboration rather than an authoritarian approach to leadership is preferred by team members. Nurses are suitable to 'control the room'. Restricting resuscitation team size will manage disruptive behaviour of team members.

TRIAL REGISTRATION

PROSPERO Registration: CRD42022385630.

PATIENT OF PUBLIC CONTRIBUTION

No patient of public contribution.

Representation Matters: Trust in Digital Health Information Among Black Patients With Prostate Cancer

PURPOSE

Although the majority of US adults obtain health information on the internet, the quality of information about prostate cancer is highly variable. Black adults are underrepresented in online content about prostate cancer despite a higher incidence of and mortality from the disease. The goal of this study was to explore the perspectives of Black patients with prostate cancer on the importance of racial representation in online content and other factors influencing trust.

MATERIALS AND METHODS

We conducted 7 virtual focus groups with Black patients with prostate cancer in 2022 and 2023. Participants completed an intake questionnaire with demographics followed by a group discussion, including feedback on purposefully selected online content. Transcripts were independently analyzed by 2 investigators experienced in qualitative research using a constant comparative method.

RESULTS

Most participants use online sources to look for prostate cancer information. Racial representation is an important factor affecting trust in the content. A lack of Black representation has consequences, including misperceptions about a lower risk of prostate cancer and discouraging further information-seeking. Other key themes affecting trust in online content included the importance of a reputable source of information, professional website structure, and soliciting money.

CONCLUSIONS

Underrepresentation of Black adults in prostate cancer content has the potential to worsen health disparities. Optimal online communications should include racially diverse representation and evidence-based information in a professional format from reputable sources without financial conflict.

Awareness and knowledge of the Canadian 24-Hour Movement Guidelines for Adults among adults living in Canada

Awareness and knowledge of national movement behaviour guidelines are needed to influence individual behaviour and public health policies. This study assessed the awareness and knowledge of the Canadian 24-Hour Movement Guidelines for Adults Aged 18-64 Years and Adults Aged 65 Years or Older (24HMG) recommendations among adults living in Canada across three timepoints. Online surveys were distributed to representative samples of adults living in Canada over a 6-month period. Findings suggest that short-term dissemination efforts were successful in increasing awareness of the 24HMG following guideline release. However, other strategies, such as education, may be needed to influence knowledge of guideline recommendations.

A social science research agenda to accelerate public engagement in climate change adaptation

Recent studies find that people in high-income countries now think of climate change impacts, such as flooding or periods of high temperature, as being of immediate relevance and concern. Individuals and households can take adaptation actions to help limit the severity of harm caused when climate impacts occur, for example, they could make adjustments to their homes such as installing flood gates or sun shades, or they could adapt their behavior such as staying indoors during the hottest part of the day. However, so far adaptation is not yet happening at the speed or scale needed to adequately prepare for the climate impacts already being experienced or those projected for the coming decades. Here, we propose an agenda for future social science research that would further our understanding of how best to increase engagement and action in climate change adaptation.

Written Communication From Pharmacy Benefit Managers: Is It Helpful?

INTRODUCTION

Physicians are experiencing greater burnout due to excessive time spent on paperwork. Pharmacy benefit managers (PBMs) are adding to this problem by sending excessive mail to physicians. This study examined these mailed communications to determine their frequency and if the physician acted upon them. We hypothesized that few of these mailings would be helpful to the physician.

METHODS

From July 2021 to May 2023, we collected all written communications from PBMs to a single geriatrics outpatient physician. We sorted this information by specific PBM, by communication category, if it resulted in an intervention, and if communications were repeated.

RESULTS

We found that out of 263 communications, 17 (6%) resulted in interventions made by the physician. Notices of nonformulary prescriptions (35%, N=6/17) and drug-drug interactions (35%, N=6/17) (p=0.001) resulted in interventions most frequently. The Beers list notifications did not result in intervention. Forty-one percent (108/263) of communications were repeated, and almost half of these were for recommendations (N=52/108, 48%), a category that did not result in frequent interventions.

CONCLUSION

Our hypothesis that only a small number of communications were helpful to physicians was supported. A physician will more likely make interventions if the suggestion is regarding a nonformulary prescription or a drug-drug interaction. Interestingly, notification of a medication on the Beers list did not result in a geriatrician's action. Feedback to PBMs on which communications are most helpful may decrease the amount of paperwork received by physicians and aid in combating burnout.

Use of Social Media for Health Advocacy for Digital Communities: Descriptive Study

BACKGROUND

There has been a growth surge in the use of social media among individuals today. The widespread adoption of these platforms, coupled with their engaging features, presents a unique opportunity for the dissemination of health advocacy information. Social media is known as a powerful tool used to share health policy and advocacy efforts and disseminate health information to digital community members and networks. Yet, there is still a gap in the full exploitation of this powerful instrument, among health care professionals, for health advocacy campaigns.

OBJECTIVE

This paper aims to describe the process of mobilizing social media platforms such as Twitter (rebranded to X Corp in 2023) for health advocacy of the digital community. Additionally, it aims to share the lessons and insights gained during this digital health advocacy engagement process.

METHODS

We performed a comprehensive review of Twitter analytical data to examine the impact of our social media posts. We then consolidated these analytic reports with our meeting logs to describe our systematic, iterative, and collaborative design process to implement social media efforts and generate key lessons learned.

RESULTS

Our review of monthly Twitter analytical reports and regular team meeting logs revealed several themes for successful and less successful practices in relation to our social media-based health advocacy efforts. The successful practices noted by the team included using personable, picture-based tweets; using a series of posts on a particular topic rather than an isolated post; leveraging team members' and partners' collaborations in shared posts; incorporating hashtags in tweets; using a balanced mix of texts and graphics in posts; using inclusive (nondestigmatizing) languages in tweeted posts; and use of polls to share tweets. Among the many lessons learned, we also experienced limitations including a lack of comprehensive statistics on Twitter usage for health care-related purposes such as health advocacy and limits in collating the estimates of the actual impact made on the intended digital community members by our posts.

CONCLUSIONS

Twitter has been successfully used in promoting health advocacy content, and the social media team aims to explore other social media platforms that have a wider reach than Twitter. We will continue making necessary adjustments in strategies, techniques, and styles to engage the audience as we expand onto new platforms like Instagram and TikTok for health advocacy promotions.

Lessons Learned from Developing Tailored Community Communication Campaigns in the HEALing Communities Study

This paper outlines lessons learned from tailoring communication campaigns to increase demand for, and reduce stigma toward, evidence-based practices to reduce opioid overdose deaths in 66 communities participating in the HEALing (Helping to End Addiction Long-termSM) Communities Study (HCS). We present nine lessons gathered about how to engage local communities in both virtual and in-person opioid messaging and distribution between February 2019 and June 2022. The research team created four communication campaigns and did extensive, tailored marketing and promotion to assist communities in implementing evidence-based clinical activities to reduce opioid overdose mortality. Various strategies and venues were used to amplify HCS messages, using free and paid outlets for message distribution, focusing primarily on social media due to the COVID-19 pandemic. Increasing the availability of medications for opioid use disorder and naloxone, as HCS attempted, is not enough; getting people to accept and use them depends on communication efforts. This paper focuses on the process of preparing communities for communication campaign activities, which we hope can help guide other communities preparing for opioid or substance-related campaigns in the future.

The Use of Telehealth to Improve Handoffs Between Neonatologists and Primary Care Providers for Medically Complex Infants

As part of the Supporting Pediatric Research Outcomes Utilizing Telehealth (SPROUT) collaboration, three institutions (University of California, Davis, Children's Hospital Colorado, and Children's Hospital of Philadelphia) sought to improve communication with primary care providers (PCPs) using telehealth. This project connected families of neonatal intensive care unit (NICU) patients, their PCPs, and their NICU team through telehealth to provide an enhanced hospital handoff. This case series reports four cases that exemplify the benefits of these enhanced hospital handoffs: Case 1: assisting with changing care plans after NICU discharge, Case 2: demonstrating physical findings, Case 3: incorporation of additional subspecialties through telehealth, Case 4: arranging care for remote patients. Although these cases demonstrate some of the potential benefits of these handoffs, further study is needed to determine acceptability of these handoffs and to see whether they impact patient outcomes.

Parental Perspectives on Communication from Health Care Providers following a Newborn Diagnosis of Congenital Cytomegalovirus Infection: A Secondary Analysis of a Qualitative Study

The study objective was to identify communication messages that parents of children diagnosed with congenital cytomegalovirus (cCMV) infection reported as essential and helpful. We performed a secondary analysis of focus groups and interviews conducted with 41 parents of children with cCMV who had enrolled in a long-term follow-up cCMV study at an academic medical center. Three groups of parents who had children with cCMV participated in the study: parents with children symptomatic at birth, parents with children asymptomatic at birth who later developed sensorineural hearing loss, and parents with children asymptomatic at birth who remained asymptomatic into adulthood. Using a health marketing approach, we identified six general themes from the focus group sessions: initial diagnosis, likely health outcome(s), comfort and coping, symptom watch, resources, and prevention. Receiving the initial diagnosis was shocking for many parents, and they wanted to know how their child would or could be affected. They valued access to the information, follow-up visits for early detection of hearing loss and other developmental delays, and support from other parents. Parents wished to obtain this information from their pediatrician but felt that experts offered more up-to-date knowledge about prognosis, monitoring, and treatment. With more U.S. states implementing cCMV screening strategies which would lead to more infant diagnoses, it will be necessary for providers to meet parents' expectations and communication needs.

[Social representation of persons with disabilities in marketing and advertising practice]

The article discusses the issues of including the image of persons with disabilities in marketing and advertising practice. The data reflecting the statistics of disability and consumer behavior in the market of goods and services for the disabled and persons with disabilities are presented. The purpose of the study is to analyze the current practice of marketing and advertising activities using the image of disability and persons with disabilities. It is concluded that both advertising and any other forms of marketing initiatives reflect society, and therefore most advertisers at some point create communication products that somehow reflect their target audience. Good examples of images of people with disabilities and a well-thought-out advertising campaign are designed to increase brand loyalty and at the same time make the product more popular with a wide audience.

[Social networks as a space of communication on health issues]

Social media is bringing a new dimension to healthcare as it offers an environment through which the public, patients, and healthcare professionals can report health issues with the possibility of potentially improving health outcomes. Social networks are a powerful tool that ensures cooperation between users and is a mechanism of social interaction for a wide range of people. Although the use of social networks for communication in the field of health has a number of advantages, the exchange of information must be monitored for quality and reliability, as well as to preserve the confidentiality of users.

Exploring stakeholders perspectives on TB contact investigation in Cali, Colombia: a qualitative study

Introduction

Contact investigation is a proven intervention for tuberculosis (TB) case finding and prevention. Although widely endorsed by national public health authorities and the World Health Organization, many countries struggle to implement it effectively. The objective of the study is to describe and characterize the barriers and facilitators of TB contact investigation in Cali, Colombia from the perspective and experience of the key stakeholders involved.

Methods

We collected data from group discussions during two workshop sessions with clinic and public health staff involved in TB contact investigation (June 2019 and March 2020 respectively) and semi-structured interviews with TB cases and their household contacts (July 2019 to April 2020). We undertook an inductive thematic analysis with the RADaR technique to characterize the barriers and facilitators of the TB contact investigation process.

Results

The two workshops included 21 clinics and 12 public health staff. We also conducted 26 semi-structured interviews with TB cases and their household contacts. Using thematic analysis, we identified four common themes: Healthcare Operations, Essential Knowledge, Time Limitations and Competing Responsibilities, and Interpersonal Interactions. The main barriers to conducting household visits were low data quality, stigma and mistrust, safety concerns for health workers, and limited resources. The main barriers to TB uptake by contacts were competing responsibilities, low TB risk perceptions among contacts, and difficulty accessing diagnostic tests for contacts. In contrast, good communication and social skills among health workers and accurate TB knowledge facilitated successful household visits and TB test uptake, according to key stakeholders.

Conclusion

This study provides a deeper understanding of TB contact investigation barriers and facilitators in a high-prevalence urban setting in a middle-income country from the perspective and experience of key stakeholders. The study shed light on the barriers that hinder household contacts engagement and TB test uptake such as issues of systemic capacity and TB knowledge. Also, highlighted facilitators such as the importance of interpersonal communication skills among health workers in the public and private sector. The insights from this study can serve as a valuable resource for public health organizations seeking to enhance their contact investigation efforts and improve TB control in similar settings.

Will the Doctor "See" You Now? The Development and Implementation of a Targeted Telemedicine System for Primary Care

Objectives

The coronavirus disease 2019 (COVID-19) pandemic led to a rapid adoption of telehealth. For underserved populations lacking internet access, telemedicine was accomplished by phone rather than an audio-video connection. The latter is presumed a more effective form and better approximation of an in-person visit. We sought to provide a telehealth platform to overcome barriers for underserved groups to hold video visits with their health care providers and evaluate differences between the two telehealth modalities as assessed by physicians and patients.

Methods

We designed a simplified tablet solution for video visits and piloted its use among patients who otherwise would have been completing audio-only visits. Patients consented to participation and were randomized in a 1:1 fashion to continue with their scheduled phone visit (control) versus being shipped a tablet to facilitate a video visit (intervention). Participants and providers completed communication and satisfaction surveys.

Results

Tablet and connectivity design features included removal of all functions but for the telemedicine program, LTE always-on wireless internet connectivity, absence of external equipment (cords chargers and keyboard), and no registration with a digital portal. In total, 18 patients were enrolled. Intervention patients with video-enabled devices compared to control patients agreed more strongly that they were satisfied with their visits (4.75/5 vs. 3.75/5, p = 0.02).

Conclusion

The delivered simplified tablet solution for video visits holds promise to improve access to video visits for underserved groups. Strategies to facilitate patient acceptance of devices are needed to expand the scope and potential impact of this effort.

Understanding COVID-19 vaccine hesitancy in health care professionals in Central and West Asia: lessons for future emergency mass vaccination campaigns

A Quick Assessment of Vaccine Hesitancy approach was developed to collect population insights on vaccination hesitancy for low resource environments. Insights into COVID-19 vaccine hesitancy were collected through online webinars with heads of healthcare departments and anonymized online surveys of healthcare managers (HCM) and primary healthcare workers (HCW) in four countries in Central and West Asia (Armenia, Georgia, Tajikistan, and Kyrgyzstan) between 28 February 2022 and 29 March 2022. From the responses to the survey some key themes identified that underpinned in vaccine hesitancy across the region were perceived understanding of vaccine efficacy, conflict with individual religious beliefs, concerns for side effects, and the relatively rapid development of the vaccine and that improving communications strategies to address these concerns would be critical in combatting vaccine hesitancy through any future public health emergencies.

Framing and Themes of the City of Boulder's Sugar-Sweetened Beverage Tax Coverage in the Local News From 2016 to 2018

The objective of this paper was to analyze the contents of opinion and news articles related to the city of Boulder's sugar-sweetened beverage excise tax campaigns in Boulder's only local newspaper. We searched for articles in The Daily Camera related to the sugar-sweetened beverage tax, published from January 2016 to December 2018. We conducted a content analysis, categorizing 152 relevant articles by type, authors, and frames (pro, anti, neutral) on the basis of the preponderance of arguments, themes, and use of evidence. The majority of articles were opinion (n=92) versus news (n=60). Most articles were pro-frame (n=78) versus anti-frame (n=37) and neutral frame (n=37). Pro-frame articles were more likely to cite evidence in support of arguments or the professional credentials/experience of the authors. The most frequent pro-frame themes were health, benefits of the revenues, equity, and unethical tactics of the industry. The most frequent anti-frame themes were economic consequences, claims that the measure was confusing, government overreach, and purported ineffectiveness of taxes. The leveraging of local issues by the beverage industry was observed. Themes identified in the news regarding Boulder's successful sugar-sweetened beverage tax may appear in future sugar-sweetened beverage policy campaigns and should be anticipated.

Improving communications in PPE: a solution for 'landline' telephone communication

BACKGROUND

Emergency care staff wearing elastomeric respiratory personal protective equipment (PPE) report difficulties in communicating by telephone. We developed and tested an affordable technological solution aimed at improving telephone call intelligibility for staff wearing PPE.

METHODS

A novel headset was created to enable a throat microphone and bone conduction headset to be used in combination with a standard hospital 'emergency alert' telephone system. Speech intelligibility of an ED staff member wearing PPE was compared between the proposed headset and current practice by simultaneously recording a version of the Modified Rhyme Test and a Key Sentences Test. Recordings were played back to a group of blinded ED staff listening to pairs of recordings under identical conditions. The proportion of correctly identified words was compared using a paired t-test.

RESULTS

Fifteen ED staff correctly identified a mean of 73% (SD 9%) words for speech communicated via the throat microphone system, compared with only 43% (SD 11%) of words for standard practice (paired t-test, p<0.001).

CONCLUSIONS

Introduction of a suitable headset could significantly improve speech intelligibility during 'emergency alert' telephone calls.

Increasing Undergraduate Student Knowledge about Journal Peer Review Using Outside Reading and In-Class Discussion

Peer review is an important part of the scientific publishing process that serves as a key quality control step. Learning that scientific publications go through peer review builds scientific literacy and may increase trust in published findings. Though the publication and peer review process is an established part of the practice of communicating science, this topic is not commonly taught at the undergraduate level, even in classes that regularly require students to read primary literature or author manuscripts. Often, undergraduate course lessons on peer review focus on the practice of performing peer review on other students' writing rather than explaining how this process works for independent scientists publishing their novel work as primary literature articles. As a result, there is a need for more resources related to teaching about publication and peer review. This work presents a plan for out-of-class reading and an in-class lesson on peer review practices in biology. In this module, students learn the order of events in scientific publishing and consider the relationship between peer review and public trust in science by analyzing survey data. Students completing this activity reported knowledge gains related to scientific publishing and peer review and demonstrated their knowledge on an in-class assessment. Though this activity was developed for a biochemistry course, it may be implemented in various life sciences classes from introductory to advanced levels to improve student scientific literacy.

Study of prehospital video telehealth for callers with mental health-related complaints

BACKGROUND

Patients with mental health-related complaints are a key driver of increasing emergency medical service (EMS) demand; however, they require minimal intervention by EMS personnel. We describe the outcomes of a video telehealth study by mental health nurses (MHNs) in an EMS call-taking centre.

METHODS

This was a prospective study of adult (≥18 years) EMS callers with non-urgent mental health concerns in Victoria, Australia who underwent secondary triage between 1 March 2020 and 31 May 2021. Multivariable logistic regression models were used to compare the influence of video telehealth with voice-only triage by an MHN or secondary triage practitioner on the need for ambulance dispatch. One-week follow-up was conducted with video telehealth patients. Interviews were conducted with MHNs and a cost analysis was performed.

RESULTS

A total of 9588 patients were included of which 738 (7.7%) completed video consultation. The median age of video telehealth patients was 34 years (Q1: 24, Q3: 47), 62% were female and the most common complaint was suicidal or self-harm ideation (50.0%). After multivariable adjustment, video telehealth was associated with reduced odds of emergency ambulance dispatch (OR=0.173, 95% CI 0.144 to 0.209) when compared with voice-only triage by a secondary triage practitioner, but not voice-only triage by an MHN (OR=1.009, 95% CI 0.827 to 1.232). Video triage was associated with increased referrals to alternative services (excluding EDs) when compared with voice-only triage by an MHN (OR=1.321, 95% CI 1.087 to 1.606). Among those responding to 1-week follow-up, 92.8% were satisfied with the telehealth service and MHNs viewed it favourably. The average cost per video telehealth case was half that of a traditional secondary triage.

CONCLUSION

The use of video telehealth by MHNs was associated with fewer emergency ambulance dispatches when compared with voice-only triage by secondary triage practitioners, and increased referrals to alternative services. This cost-effective technology was viewed favourably by patients and MHNs. Expansion of video technology in EMS call taking warrants exploration.

Imaging Service Navigators: An Approach Toward More Efficient and Effective Communications

PURPOSE

Many practices have implemented support services to assist radiologists with noninterpretive tasks; however, little research has been performed to assess the overall effect of these services. The purpose of this study was to evaluate the effect of a team of imaging service navigators (ISNs) incorporated into a practice on (1) number of communications, (2) time saved by radiologists, and (3) radiologist satisfaction with the service.

METHODS

The numbers and types of reports dictated by radiologists were captured for 6-month periods before and after ISN implementation. Communication rates before and after implementation were then calculated. The amount of perceived time savings using the ISN team and satisfaction with the service were assessed through pre- and postimplementation surveys of participating radiologists. Mean and median time savings and satisfaction rates were calculated.

RESULTS

The overall communication rate increased from 2.196% before ISNs to 3.278% after ISNs (49% increase; 95% confidence interval, 47%-52%). Communication rates increased among all communication subtypes (critical, urgent, routine, and actionable), with the highest increases in urgent (94%) and actionable (75%) findings. Before implementation, radiologists reported spending 39 min on average per day on communications tasks, with only 33% of radiologists indicating that the communication process was efficient. After implementation, radiologists reported mean time savings of 28 min (95% confidence interval, 19.9-35.1), and 82% of radiologists indicated a positive or highly positive view of the ISN service.

CONCLUSIONS

After ISN implementation, communication rates increased and radiologists reported spending less time performing communications. Most radiologists were satisfied with the service.

The role of the university in recovering from COVID-19 and preparing for future crises-perspectives and experiences from Sunway University, Malaysia

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Universities, as engines of knowledge creation and dissemination and as incubators of disciplined yet original thinking, have a key role to play in tackling the most complex challenges that societies and our planet face, from infectious diseases to the climate emergency. This commentary presents the perspectives from Sunway University, a young private university in Malaysia that made a strong commitment to the sustainable development goals (SDGs) prior to the pandemic, and its experiences in promoting research, innovation, and learning as part of COVID-19 recovery and in preparation for future crises such as the climate emergency. Some of the university's initiatives include embracing the planetary health approach, reviving essential public health functions, exploring pandemic resilience, addressing 'infodemics' and promoting science diplomacy. The example of Sunway University provides some insights on the opportunities and challenges that academic institutions face as they seek to reorient the paradigm of education, research, and service away from disciplinary siloes and towards a more integrated, preventive, accessible and translational approach.

A Qualitative Investigation of Factors Affecting Saudi Patients' Communication Experience with Non-Saudi Physicians in Saudi Arabia

(1) Background: Communication is the main issue between the patient and physician. Communication gaps lead to medical errors, mistakes, and wrong diagnoses and treatments. It would certainly be a cause of patient dissatisfaction, the physicians' job dissatisfaction, and the increase in the cost of health services. (2) Objectives: The objective of the study was to explore the perception of Saudi patients when they meet non-Saudi consultants at hospitals. (3) Material and Methods: This study is exploratory in nature. Semi-structured face to face interviews were conducted. Study participants were patients from the outpatient department of the Hospitals of Qassim province, Saudi Arabia. A total of eight respondents, four male and four female, participated in the study. (4) Results: Interviews were transcribed verbatim and analyzed using a thematic analysis approach. Two main themes emerged: the first theme is encountering difference, with three sub-themes, while the second one is the absence of partnering, with four sub-themes. (5) Conclusions: The analysis of the patients' experiences of their medical encounters revealed that the effectiveness of the physician-patient communication was jeopardized by two challenges: encountering differences and the absence of partnering. (6) Limitations: This study was conducted in one site only and hence findings must be tested in application to other sites in other parts of Saudi Arabia and in other similar countries. A further limitation of this study was the cultural barrier that was encountered by the researcher during the interview process.

[The medical mistakes as consequence of poor communication]

The article is devoted to medical errors and complaints of patients, as well as to role that communications of interested parties plays in this. The patients complaints are often caused by lack of information, unprofessional approach (lacking of respect to patient and lack of empathy, poor communication skills, abusing of one's official position). The models of response of medical workers to mistakes made are described. The algorithm of physician's actions in case of accomplishing medical error is proposed.

Reframing Adolescent Development: Identifying Communications Challenges and Opportunities

Understanding Americans' deeply held and widely shared assumptions about adolescents and their development can reveal key opportunities and challenges for developmental science communicators. Twenty-nine in-depth interviews were conducted with adolescents and adults about adolescence. We analyzed the cultural models the public use to make meaning about what adolescence is, what development involves, what adolescents need, and how adolescents can be supported. The analysis revealed several cultural models that may impede public engagement around youth issues. These dominant ways of thinking include a strong focus on the vulnerability of adolescence and a narrow understanding of how environments affect adolescent development. The findings have important implications for communicators seeking to expand and deepen public thinking about adolescence.

Use of Polar Heliostats to Improve Levels of Natural Lighting inside Buildings with Little Access to Sunlight

The growing need to increase environmental and energy sustainability in buildings (housing, offices, warehouses, etc.) requires the use of solar radiation as a renewable source of energy that can help to lower carbon footprint, making buildings more efficient and thereby contributing to a more sustainable planet, while enhancing the health and wellbeing of its occupants. One of the technologies deployed in the use of solar energy in buildings is heliostats. In this context, this paper presents an analysis of the performance of a heliostat illuminator to improve illumination in a classroom at the Campus of Rabanales of the University of Cordoba (Spain). A design of a system in charge of monitoring and measuring daylighting variables using Arduino hardware technology and free software is shown. This equipment develops the communications, programming and collection of lighting data. In parallel, installation of an artificial lighting system complementary to the natural lighting system is implemented. Finally, an analysis of the impact of the proposed solution on the improvement of energy efficiency is presented. Specifically, it is estimated that up to 64% of savings in artificial lighting can be achieved in spaces with heliostatic illuminators compared to those without them.

Audio Recording Patient-Nurse Verbal Communications in Home Health Care Settings: Pilot Feasibility and Usability Study

Background

Patients’ spontaneous speech can act as a biomarker for identifying pathological entities, such as mental illness. Despite this potential, audio recording patients’ spontaneous speech is not part of clinical workflows, and health care organizations often do not have dedicated policies regarding the audio recording of clinical encounters. No previous studies have investigated the best practical approach for integrating audio recording of patient-clinician encounters into clinical workflows, particularly in the home health care (HHC) setting.

Objective

This study aimed to evaluate the functionality and usability of several audio-recording devices for the audio recording of patient-nurse verbal communications in the HHC settings and elicit HHC stakeholder (patients and nurses) perspectives about the facilitators of and barriers to integrating audio recordings into clinical workflows.

Methods

This study was conducted at a large urban HHC agency located in New York, United States. We evaluated the usability and functionality of 7 audio-recording devices in a laboratory (controlled) setting. A total of 3 devices—Saramonic Blink500, Sony ICD-TX6, and Black Vox 365—were further evaluated in a clinical setting (patients’ homes) by HHC nurses who completed the System Usability Scale questionnaire and participated in a short, structured interview to elicit feedback about each device. We also evaluated the accuracy of the automatic transcription of audio-recorded encounters for the 3 devices using the Amazon Web Service Transcribe. Word error rate was used to measure the accuracy of automated speech transcription. To understand the facilitators of and barriers to integrating audio recording of encounters into clinical workflows, we conducted semistructured interviews with 3 HHC nurses and 10 HHC patients. Thematic analysis was used to analyze the transcribed interviews.

Results

Saramonic Blink500 received the best overall evaluation score. The System Usability Scale score and word error rate for Saramonic Blink500 were 65% and 26%, respectively, and nurses found it easier to approach patients using this device than with the other 2 devices. Overall, patients found the process of audio recording to be satisfactory and convenient, with minimal impact on their communication with nurses. Although, in general, nurses also found the process easy to learn and satisfactory, they suggested that the audio recording of HHC encounters can affect their communication patterns. In addition, nurses were not aware of the potential to use audio-recorded encounters to improve health care services. Nurses also indicated that they would need to involve their managers to determine how audio recordings could be integrated into their clinical workflows and for any ongoing use of audio recordings during patient care management.

Conclusions

This study established the feasibility of audio recording HHC patient-nurse encounters. Training HHC nurses about the importance of the audio-recording process and the support of clinical managers are essential factors for successful implementation.

What to do about homelessness? Journalists collaborating as claims-makers in the San Francisco Homeless Project

This content analysis considered the San Francisco Homeless Project (SFHP), a collaboration of media organizations working to generate a wave of coverage to alleviate homelessness. The effort stood out for its proposed solutions to a systemic and complex issue involving multiple ecological levels of a community, the number and variety of organizations involved, and the ongoing nature of the project. Yet, little is known about its impact and potential for replication. Researchers coded 977 articles published by 134 media organizations over an 18-month period split into three phases (Preliminary, Wave 1, and Wave 2). Article frequency, characteristics, and content (code groups) were stratified by SFHP participation and described overtime. Results revealed that in addition to creating a media blitz, SFHP participants generated significantly longer and more visual articles and were influenced by nonprofits and government agencies. However, the SFHP did not lead to a sustained change in terms of article frequency and content.

Computationally Efficient Implementation of Joint Detection and Parameters Estimation of Signals with Dispersive Distortions on a GPU

The detector is an integral part of the device for receiving and processing radio signals. Signals that have passed through the ionospheric channel acquire an unknown Doppler shift and are subject to dispersion distortions. It is necessary to carry out joint detection and parameter estimation to improve reception quality and detection accuracy. Modern hardware base developing makes it possible to implement a device for joint detection and evaluation of signals based on standard processors (CPU) and graphic processors (GPU). The article discusses the implementation of a signal detector that allows for real-time operation. A comparison of implementations of algorithms for estimating the Doppler frequency shift through multiplication by a complex exponent and the fast Fourier transform (FFT) is performed. A comparison of computational costs and execution speed on the CPU and GPU is considered.

The quest for the ring: a case study of a new submarine control room configuration

Submarine control room layouts have remained similar across decades of operation, despite the introduction of new technologies that allow for the co-location of the sound and control room. Operation of an inwards, rather than outwards, facing ring control room configuration was examined in three scenarios: Return to Periscope Depth, Inshore Operations, and Dived Tracking. A case study design employed a serving team of qualified submariners participated in all three scenarios with high and low demand. Communications and activities in the control room were recorded and analysed using the Event Analysis of Systemic Teamwork (EAST) method. EAST models collaborative teamwork through social, information, and task networks. The results from the ring configuration were compared to an outward facing baseline of the contemporary control room layout with a separate sound and control room. The ring control room configuration increased communications between operators, leading to a more information exchanged, and more tasks completed. Practitioner summary: Control room design on submarines, and other domains, has traditionally been outward facing with supervisory staff looking over the shoulders of their subordinates. In this paper, and inward looking control room design was explored, with subordinate staff facing their supervisors. This design resulted in more information exchange and productive work.

Radio Frequency over Fibre Optics Repeater for Mission-Critical Communications: Design, Execution and Test

This paper presents a technical solution that addresses mission-critical communications by extending the radio frequency coverage area using a flexible and scalable architecture. One of the main objectives is to improve both the reaction time and the coordination between mission-critical practitioners, also called public protection and disaster relief users, that operate in emergency scenarios. Mission-critical services such as voice and data should benefit from reliable communication systems that offer high availability, prioritization and flexible architecture. In this paper, we considered Terrestrial Trunked Radio (TETRA), the mobile radio standard used for mission-critical communications, as it has been designed in this respect and is widely used by first responder organizations. Even if RF coverage is designed before network deployment and continuously updated during the lifetime of the technology, some white areas may exist and should be covered by supplementary base stations or repeaters. The model presented in this paper is an optical repeater for TETRA standard that can offer up to 52.6 dB downlink, 65.6 dB uplink gain and up to 3.71 km coverage distance in a radiating cable installation scenario. The design in not limited, as it can be extended to several different mobile radio standards using the same principle. Flexibility and scalability attributes are taken into consideration, as they can build a cost-effective deployment considering both capital and operational expenditures.

Optical Fiber Time Delay Comparison Between NIST and LAMETRO

We describe the results of a bilateral measurement comparison of optical fiber time delay between the National Institute of Standards and Technology (NIST, USA) and Laboratorio de Metrología, Instituto Costarricense de Electricidad (LAMETRO-ICE, Costa Rica), which was conducted on a single-mode optical fiber reference spool at wavelengths of 1310 nm and 1550 nm. The measurement results showed the largest difference to be less than 0.93 ns, which is within the combined standard uncertainty (coverage factor k = 1) for the measurement systems at the two laboratories.

Continuous Remote Patient Monitoring: Evaluation of the Heart Failure Cascade Soft Launch

OBJECTIVE

We report on our experience of deploying a continuous remote patient monitoring (CRPM) study soft launch with structured cascading and escalation pathways on heart failure (HF) patients post-discharge. The lessons learned from the soft launch are used to modify and fine-tune the workflow process and study protocol.

METHODS

This soft launch was conducted at NorthShore University HealthSystem's Evanston Hospital from December 2020 to March 2021. Patients were provided with non-invasive wearable biosensors that continuously collect ambulatory physiological data, and a study phone that collects patient-reported outcomes. The physiological data are analyzed by machine learning algorithms, potentially identifying physiological perturbation in HF patients. Alerts from this algorithm may be cascaded with other patient status data to inform home health nurses' (HHNs') management via a structured protocol. HHNs review the monitoring platform daily. If the patient's status meets specific criteria, HHNs perform assessments and escalate patient cases to the HF team for further guidance on early intervention.

RESULTS

We enrolled five patients into the soft launch. Four participants adhered to study activities. Two out of five patients were readmitted, one due to HF, one due to infection. Observed miscommunication and protocol gaps were noted for protocol amendment. The study team adopted an organizational development method from change management theory to reconfigure the study protocol.

CONCLUSION

We sought to automate the monitoring aspects of post-discharge care by aligning a new technology that generates streaming data from a wearable device with a complex, multi-provider workflow into a novel protocol using iterative design, implementation, and evaluation methods to monitor post-discharge HF patients. CRPM with structured escalation and telemonitoring protocol shows potential to maintain patients in their home environment and reduce HF-related readmissions. Our results suggest that further education to engage and empower frontline workers using advanced technology is essential to scale up the approach.

When Does Sharing Stigmatize? Saving Money (vs. Seeking Variety) Through Access-Based Consumption

Access-based services allow financially-constrained individuals to consume a variety of goods and services without the cost of sole ownership. But might there be dangers in communicating about access-based consumption in terms of its affordability, particularly among this segment of consumers? To answer this question, we investigate the effects of framing access-based consumption in terms of two primary benefits: affordability and variety. Results from four studies suggest that although affordability might rationally be of most interest to financially-constrained individuals, framing access-based consumption's benefits in terms of affordability undermines the happiness they may extract from their consumption relative to framing in terms of variety. This difference emerges because communications focused on affordability re-affirm the negative self-identity financially-constrained individuals perceive as a result of their financial situation. Given these findings, we make clear recommendations for communications related to the access-based economy and this vulnerable set of people.

The Never-Ending Evolutionary Saga of Assessing and Demonstrating the Value of Information Services in a Biomedical Library

Demonstrating added value can be very challenging, yet it is becoming important in academic libraries. The current literature primarily discusses citation analysis and usage reports to demonstrate return on investment for collections or impact on scholarly activity. However, value is not only in our collections but also in the library staff who support the institutional mission. Vanderbilt University's Annette and Irwin Eskind Family Biomedical Library and Learning Center has been experimenting with several methods to supplement the collections data with services performed by the staff. This article discusses the project's four phases as part of the goal to strategically demonstrate the biomedical library's added value to the university and medical center.

New focuses on roles of communications between endoplasmic reticulum and mitochondria in identification of biomarkers and targets

The communication between endoplasmic reticulum (ER) and mitochondria (Mt) plays important roles in maintenance of intra- and extra-cellular microenvironment, metabolisms, signaling activities and cell-cell communication. The present review aims to overview the advanced understanding about roles of ER-Mt structural contacts, molecular interactions and chemical exchanges, signal transmissions and inter-organelle regulations in ER-Mt communication. We address how the ER-Mt communication contributes to the regulation of lipid, amino acid and glucose metabolisms by enzymes, transporters and regulators in the process of biosynthesis. We specially emphasize the importance of deep understanding about molecular mechanisms of ER-Mt communication for identification and development of biology-specific, disease-specific and metabolism-specific biomarkers and therapeutic targets for human diseases. The inhibitors and modulators of the ER-Mt communication are categorized according to therapeutic targets. Rapid development of biotechnologies will provide new insights for spatiotemporally understanding the molecular mechanisms of ER-Mt communication.

Fostering interdisciplinary collaboration: A longitudinal social network analysis of the NIH mHealth Training Institutes

BACKGROUND/OBJECTIVE

Growing recognition that collaboration among scientists from diverse disciplines fosters the emergence of solutions to complex scientific problems has spurred initiatives to train researchers to collaborate in interdisciplinary teams. Evaluations of collaboration patterns in these initiatives have tended to be cross-sectional, rather than clarifying temporal changes in collaborative dynamics. Mobile health (mHealth), the science of using mobile, wireless devices to improve health outcomes, is a field whose advancement needs interdisciplinary collaboration. The NIH-supported annual mHealth Training Institute (mHTI) was developed to meet that need and provides a unique testbed.

METHODS

In this study, we applied a longitudinal social network analysis technique to evaluate how well the program fostered communication among the disciplinarily diverse scholars participating in the 2017-2019 mHTIs. By applying separable temporal exponential random graph models, we investigated the formation and persistence of project-based and fun conversations during the mHTIs.

RESULTS

We found that conversations between scholars of different disciplines were just as likely as conversations within disciplines to form or persist in the 2018 and 2019 mHTI, suggesting that the mHTI achieved its goal of fostering interdisciplinary conversations and could be a model for other team science initiatives; this finding is also true for scholars from different career stages. The presence of team and gender homophily effects in certain years suggested that scholars tended to communicate within the same team or gender.

CONCLUSION

Our results demonstrate the usefulness of longitudinal network models in evaluating team science initiatives while clarifying the processes driving interdisciplinary communications during the mHTIs.

Leadership in a time of crisis: Lessons learned from a pandemic

The current COVID-19 pandemic is testing political leaders and healthcare systems worldwide, exposing deficits in crisis communication, leadership, preparedness and flexibility. Extraordinary situations abound, with global supply chains suddenly failing, media communicating contradictory information, and politics playing an increasingly bigger role in shaping each country's response to the crisis. The pandemic threatens not just our health but also our economy, liberty, and privacy. It challenges the speed at which we work, the quality of our research, and the effectiveness of communication within the scientific community. It can impose ethical dilemmas and emotional stress on healthcare workers. Nevertheless, the pandemic also provides an opportunity for healthcare organizations, leaders, and researchers to learn from their mistakes and to place their countries and institutions in a better position to face future challenges.

Veterans Hospital Administration Telehealth Utilization for Recreation and Creative Arts Therapies: A Brief Report

Background:

A brief query was fielded to Veterans Health Administration (VHA) facilities across the United States to provide an initial assessment of recreation therapy (RT) and creative arts therapy (CAT) telehealth utilization.

Methods:

To develop an understanding of barriers and identify potential solutions for better delivery of services, a cross-sectional survey was deployed to points of contact at 136 VHA facilities. The survey included questions across five areas: staff, infrastructure, barriers to use, training, and interventions being deployed. Descriptive statistics were calculated, and a thematic analysis of qualitative responses was conducted.

Results:

The most frequent themes from aggregated responses indicated a need for hands-on training, reliable telehealth equipment, and accessible training and tools for Veteran patients who want to use telehealth services.

Conclusion:

Telehealth delivery of RT/CAT has increased services to Veteran patient populations; however, equipment and training are needed to expand consistent delivery to enhance patient reach across a national health care system.

Perception of the Movement Control Order during the COVID-19 Pandemic: A Qualitative Study in Malaysia

Malaysia implemented its first Movement Control Order (MCO) during the early phase of the COVID-19 pandemic to slow the transmission of the virus. This study aimed to explore the public perception of the MCO implementation and people’s experiences during this period. The study employed qualitative explorative in-depth interviews conducted with 23 Malaysian adults from various demographic backgrounds. Thematic analysis was performed using NVivo 12. Three main themes were identified: a period of information surge, heterogeneous emotional response, and attempts to adapt. During the MCO, the participants obtained information from multiple platforms. They suggested the need for clear and repeated instructions to avoid confusion and misinformation. They also acknowledged the importance of the MCO in breaking the chain of transmission and safeguarding high-risk groups; however, they also expressed that stricter enforcement from the authorities was warranted. The changes in the participants’ work–life routines, lack of physical interaction, and uncertainty about their health and the economy due to the MCO negatively impacted their psychological states. Despite these challenges, the participants attempted to adapt to life under the MCO in different ways. The findings imply that during a crisis, the public tends to seek clear and reliable information, experience emotional turmoil, and adapt to changes. The MCO implementation can be improved through an effective communication strategy and efforts to battle misinformation.

Introducing Clinical Behavioral Medicine to Veterinary Students with Real Clients and Pets: A Required Class Activity and an Optional Workshop

Addressing behavior problems in clinical practice requires diagnostic expertise as well as excellent client skills in communication, gained by experience. This issue was addressed by introducing clinical behavior to first-year veterinary students. The program was implemented over four successive terms (2017-2019) at St. George's University School of Veterinary Medicine. The clinical practice hour was introduced after a brief first-year clinical behavior course (7 lectures). Students were divided into 6-8 person teams. In a class demonstration with a student and his/her dog having behavior problems, two students served as clinicians; a third student, as a scribe, recorded case details. They discussed signalment, history, presenting problems, and possible treatment approaches for 25 minutes; then, the class divided into the assigned teams to develop their specific treatment plans and write up and submit team case reports. During each term, the student Animal Welfare and Behavior Committee organized an optional behavior workshop (enrollment was 24 veterinary students from years 1 through 3). Participation in the workshop included an introductory session and two clinical sessions. Four dog and/or cat cases were scheduled for each of the two sessions. Six students addressed each case: three students were lead clinicians. Workshop evenings concluded with a discussion of all cases. Students were presented a certificate of completion. Students gained early experience in clinical communication, behavior problems, and case write-ups. The abundance of students' pets with behavior problems made this a context that simplified recruiting real cases, but variations could be adapted as appropriate in other communities.

Readiness, Reception, and Performance of Students in a Communications Course Delivered Amid the Pandemic

Objective. To examine pharmacy student readiness, reception, and performance in a communications course amid the COVID-19 pandemic. Methods. First-year pharmacy students (2020 cohort) enrolled in a professional communications course completed a pre- and post-course questionnaire indicating their readiness and changes in reception toward online learning during the pandemic. Student learning performance (midterm and final examination grades) at the end of the course was compared with that of a class which took the same course face-to-face on campus the previous year (2019 cohort). Results. Student preference for face-to-face instruction decreased (difference in means = -1.59; p <.05), while their comfort level for online learning increased (difference in means = +0.38, p <.05) by the end of the course. No appreciable changes in rapport development with the instructor were perceived by the end of the study compared to the beginning. Student learning performance for the online cohort did not differ significantly (p >.05) compared to that of the 2019 cohort. Conclusion. The study demonstrates that students were partly prepared for online learning with the remainder of their maturation to it occurring while the quarter progressed. Remote online learning did not seem to impact student learning (grades) in this communications course during the COVID-19 crisis. Looking past the pandemic, educators and leadership at pharmacy schools and colleges may reassuringly continue to sustain online instruction, where deemed necessary, in their didactic curricula.

Communication failures contributing to patient injury in anaesthesia malpractice claims☆

BACKGROUND

Communication amongst team members is critical to providing safe, effective medical care. We investigated the role of communication failures in patient injury using the Anesthesia Closed Claims Project database.

METHODS

Claims associated with surgical/procedural and obstetric anaesthesia and postoperative pain management for adverse events from 2004 or later were included. Communication was defined as transfer of information between two or more parties. Failure was defined as communication that was incomplete, inaccurate, absent, or not timely. We classified root causes of failures as content, audience, purpose, or occasion with inter-rater reliability assessed by kappa. Claims with communication failures contributing to injury (injury-related communication failures; n=389) were compared with claims without any communication failures (n=521) using Fisher's exact test, t-test, or Mann-Whitney U-tests.

RESULTS

At least one communication failure contributing to patient injury occurred in 43% (n=389) out of 910 claims (κ=0.885). Patients in claims with injury-related communication failures were similar to patients in claims without failures, except that failures were more common in outpatient settings (34% vs 26%; P=0.004). Fifty-two claims had multiple communication failures for a total of 446 injury-related failures, and 47% of failures occurred during surgery, 28% preoperatively, and 23% postoperatively. Content failures (insufficient, inaccurate, or no information transmitted) accounted for 60% of the 446 communication failures.

CONCLUSIONS

Communication failure contributed to patient injury in 43% of anaesthesia malpractice claims. Patient/case characteristics in claims with communication failures were similar to those without failures, except that failures were more common in outpatient settings.

A Comprehensive Overview of TCP Congestion Control in 5G Networks: Research Challenges and Future Perspectives

In today’s data networks, the main protocol used to ensure reliable communications is the transmission control protocol (TCP). The TCP performance is largely determined by the used congestion control (CC) algorithm. TCP CC algorithms have evolved over the past three decades and a large number of CC algorithm variations have been developed to accommodate various network environments. The fifth-generation (5G) mobile network presents a new challenge for the implementation of the TCP CC mechanism, since networks will operate in environments with huge user device density and vast traffic flows. In contrast to the pre-5G networks that operate in the sub-6 GHz bands, the implementation of TCP CC algorithms in 5G mmWave communications will be further compromised with high variations in channel quality and susceptibility to blockages due to high penetration losses and atmospheric absorptions. These challenges will be particularly present in environments such as sensor networks and Internet of Things (IoT) applications. To alleviate these challenges, this paper provides an overview of the most popular single-flow and multy-flow TCP CC algorithms used in pre-5G networks. The related work on the previous examinations of TCP CC algorithm performance in 5G networks is further presented. A possible implementation of TCP CC algorithms is thoroughly analysed with respect to the specificities of 5G networks, such as the usage of high frequencies in the mmWave spectrum, the frequent horizontal and vertical handovers, the implementation of the 5G core network, the usage of beamforming and data buffering, the exploitation of edge computing, and the constantly transmitted always-on signals. Moreover, the capabilities of machine learning technique implementations for the improvement of TCPs CC performance have been presented last, with a discussion on future research opportunities that can contribute to the improvement of TCP CC implementation in 5G networks. This survey paper can serve as the basis for the development of novel solutions that will ensure the reliable implementation of TCP CC in different usage scenarios of 5G networks.

Wearables for Industrial Work Safety: A Survey

Today, ensuring work safety is considered to be one of the top priorities for various industries. Workplace injuries, illnesses, and deaths often entail substantial production and financial losses, governmental checks, series of dismissals, and loss of reputation. Wearable devices are one of the technologies that flourished with the fourth industrial revolution or Industry 4.0, allowing employers to monitor and maintain safety at workplaces. The purpose of this article is to systematize knowledge in the field of industrial wearables’ safety to assess the relevance of their use in enterprises as the technology maintaining occupational safety, to correlate the benefits and costs of their implementation, and, by identifying research gaps, to outline promising directions for future work in this area. We categorize industrial wearable functions into four classes (monitoring, supporting, training, and tracking) and provide a classification of the metrics collected by wearables to better understand the potential role of wearable technology in preserving workplace safety. Furthermore, we discuss key communication technologies and localization techniques utilized in wearable-based work safety solutions. Finally, we analyze the main challenges that need to be addressed to further enable and support the use of wearable devices for industrial work safety.

Incidence and impact of incivility in paramedicine: a qualitative study

BACKGROUND

Incivility or rudeness is a form of interpersonal aggression. Studies suggest that up to 90% of healthcare staff encounter incivility at work with it being considered 'part of the job'.

METHODS

Qualitative, in-depth, semistructured interviews (n=14) undertaken between June and December 2019. Purposive sampling was used to identify front-line paramedics working for one NHS Ambulance Trust. Interviews lasted between 16 and 45 min, were audiorecorded, verbatim transcribed and analysed using thematic analysis.

RESULTS

Four themes were identified: paramedics reported a lack of respect displayed both verbally and non-verbally from other professional groups. The general public and interdisciplinary colleagues alike have unrealistic expectations of the role of a paramedic. In order to deal with incivility paramedics often reported taking the path of least resistance which impacts on ways of working and shapes subsequent clinical decision-making, potentially threatening best practice. Finally paramedics report using coping strategies to support well-being at work. They report that a single episode of incivility is easier to deal with but subsequent episodes compound the first.

CONCLUSIONS

This study highlights the effect incivility can have on operational paramedics. Incivility from the general public and other health professionals alike can have a cumulative effect impacting on well-being and clinical decision-making.

Patient Experience and Satisfaction with Telemedicine During Coronavirus Disease 2019: A Multi-Institution Experience

Introduction: The coronavirus disease 2019 (COVID-19) heralded an unprecedented increase in telemedicine utilization. Our objective was to assess patient satisfaction with telemedicine during the COVID-19 era. Methods: Telemedicine visit data were gathered from Stanford Health Care (Stanford) and the Hospital for Special Surgery (HSS). Patient satisfaction data from HSS were captured from a Press-Ganey questionnaire between April 19, 2020, and December 12, 2020, whereas Stanford data were taken from a novel survey instrument that was distributed to all patients between June 22, 2020, and November 1, 2020. Participants: There were 60,550 telemedicine visits at Stanford, each linked with a postvisit survey. At HSS, there were 66,349 total telemedicine visits with 7,348 randomly linked with a postvisit survey. Main Outcomes and Measures: Two measures of patient satisfaction were used for this study: (1) a patient's "overall visit score" and (2) whether the patient indicated the highest possible "likelihood to recommend" (LTR) score (LTR top box score). Results: The LTR top box percentage at Stanford increased from 69.6% to 74.0% (p = 0.0002), and HSS showed no significant change (p = 0.7067). In the multivariable model, the use of a cell phone (adjusted odds ratio [aOR]: 1.18; 95% confidence interval [CI]: 1.12-1.23) and tablet (aOR: 1.15; 95% CI: 1.07-1.23) was associated with higher overall scores, whereas visits with interrupted connections (aOR: 0.49; 95% CI: 0.42-0.57) or help required to connect (aOR: 0.49; 95% CI: 0.42-0.56) predicted lower patient satisfaction. Conclusions: We present the largest published description of patient satisfaction with telemedicine, and we identify important telemedicine-specific factors that predict increased overall visit score. These include the use of cell phones or tablets, phone reminders, and connecting before the visit was scheduled to begin. Visits with poor connectivity, extended wait times, or difficulty being seen, examined, or understood by the provider were linked with reduced odds of high scores. Our results suggest that attention to connectivity and audio/visual definition will help optimize patient satisfaction with future telemedicine encounters.

Preventing Opioid-Related Harms in the Construction Industry

The construction sector has been hit hard by the opioid crisis. We describe CPWR-The Center for Construction Research and Training's recent efforts to address the challenges of opioid use in the construction industry. With support and guidance from the North America's Building Trades Unions Opioid Task Force, CPWR undertook three projects to promote prevention and best practices for struggling construction workers. The first project focused on recommendations for communications that reframe stigmatizing narratives into effective messages about prevention solutions. The second project refined and distributed a one-hour construction worker opioid hazard awareness training module. The third project assessed opportunities and barriers for the expansion and improvement of existing union peer support programs to support workers through treatment and recovery. Additional resources, such as opioid hazard tool box talks, to help reverse the impact on the sector are also described.

The Global Trust Deficit Disorder: A Communications Perspective on Trust in the Time of Global Pandemics

There has been much discussion worldwide about the crisis of trust, with evidence of declining trust in social, economic, political and media institutions. The rise of populism, and the differing impacts of the COVID-19 pandemic between nations, has been drawing attention to wider implications of pervasive distrust, including distrust of the media. In this article, I develop three propositions. First, I identify trust studies as a rich interdisciplinary field, linking communication to other branches of the social sciences and humanities. Second, I argue that we lack a comprehensive account of how trust has been understood in communication, and that doing so requires integrating macro-societal approaches with the "meso" level of institutions, and the "micro" level of interpersonal communication. Third, I propose that a focus upon trust would open up new perspectives on two important topics-the future of news media and journalism, and the global rise of populism.

Usability of electronic health record systems in UK EDs

BACKGROUND

The large volume of patients, rapid staff turnover and high work pressure mean that the usability of all systems within the ED is important. The transition to electronic health records (EHRs) has brought many benefits to emergency care but imposes a significant burden on staff to enter data. Poor usability has a direct consequence and opportunity cost in staff time and resources that could otherwise be employed in patient care. This research measures the usability of EHR systems in UK EDs using a validated assessment tool.

METHODS

This was a survey completed by members and fellows of the Royal College of Emergency Medicine conducted during summer 2019. The primary outcome was the System Usability Scale Score, which ranges from 0 (worst) to 100 (best). Scores were compared with an internationally recognised measure of acceptable usability of 68. Results were analysed by EHR system, country, healthcare organisation and physician grade. Only EHR systems with at least 20 responses were analysed.

RESULTS

There were 1663 responses from a total population of 8794 (19%) representing 192 healthcare organisations (mainly UK NHS), and 25 EHR systems. Fifteen EHR systems had at least 20 responses and were included in the analysis. No EHR system achieved a median usability score that met the industry standard of acceptable usability.The median usability score was 53 (IQR 35-68). Individual EHR systems' scores ranged from 35 (IQR 26-53) to 65 (IQR 44-80).

CONCLUSION

In this survey, no UK ED EHR system met the internationally validated standard of acceptable usability for information technology.