Characteristics of Real-Time, Non-Critical Incident Debriefing Practices in the Emergency Department.

INTRODUCTION: Benefits of post-simulation debriefings as an educational and feedback tool have been widely accepted for nearly a decade. Real-time, non-critical incident debriefing is similar to post-simulation debriefing; however, data on its practice in academic emergency departments (ED), is limited. Although tools such as TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) suggest debriefing after complicated medical situations, they do not teach debriefing skills suited to this purpose. Anecdotal evidence suggests that real-time debriefings (or non-critical incident debriefings) do in fact occur in academic EDs;, however, limited research has been performed on this subject. The objective of this study was to characterize real-time, non-critical incident debriefing practices in emergency medicine (EM). METHODS: We conducted this multicenter cross-sectional study of EM attendings and residents at four large, high-volume, academic EM residency programs in New York City. Questionnaire design was based on a Delphi panel and pilot testing with expert panel. We sought a convenience sample from a potential pool of approximately 300 physicians across the four sites with the goal of obtaining \u3e100 responses. The survey was sent electronically to the four residency list-serves with a total of six monthly completion reminder emails. We collected all data electronically and anonymously using SurveyMonkey.com; the data were then entered into and analyzed with Microsoft Excel. RESULTS: The data elucidate various characteristics of current real-time debriefing trends in EM, including its definition, perceived benefits and barriers, as well as the variety of formats of debriefings currently being conducted. CONCLUSION: This survey regarding the practice of real-time, non-critical incident debriefings in four major academic EM programs within New York City sheds light on three major, pertinent points: 1) real-time, non-critical incident debriefing definitely occurs in academic emergency practice; 2) in general, real-time debriefing is perceived to be of some value with respect to education, systems and performance improvement; 3) although it is practiced by clinicians, most report no formal training in actual debriefing techniques. Further study is needed to clarify actual benefits of real-time/non-critical incident debriefing as well as details on potential pitfalls of this practice and recommendations for best practices for use

Accessibility of Pregnancy Termination: A Pilot Study of Genetic Counselors and Abortion Providers Throughout the United States

Recent literature suggests that availability and accessibility of pregnancy termination services affects patient care and decision-making. Because of this, there is a need to evaluate the impact of new legislation on accessibility. This study evaluated the accessibility of pregnancy termination throughout the United States by surveying prenatal genetic counselors and abortion providers. 116 responses from currently practicing prenatal genetic counselors and 30 responses from abortion providers within the United States were used in data analysis. Accessibility of pregnancy termination was assessed using the variables of cost, time, and distance. The degree of legislative impact was estimated using Guttmacher Institute’s Policy Trends in the States 2017, which categorizes states into four regions: supportive, middle-ground, hostile, and extremely hostile, based on the number of abortion restrictions enacted. Overall, the findings show some evidence indicating that access to abortion is more limited in states with increased legislation. Genetic counselors in hostile states were more likely to refer patients to outside providers at every evaluated gestational age range than counselors in supportive states, with 89.9% of counselors referring to providers greater than 4 hours away for referrals over 24 weeks gestation compared to 56.5% in supportive states. Counselors in hostile states were also more likely to report factors such as insurance coverage, out of pocket costs, wait times, travel, and the availability of appointments as having an impact on patients’ decisions to terminate a pregnancy than counselors in supportive states

Fundamental underpinnings of simulation education: describing a four-component instructional design approach to healthcare simulation fellowships

Although in 2020, there are more than 120 healthcare simulation fellowships established globally, there is a paucity of literature on how to design fellowship programs most effectively, to equip graduates with the knowledge, skills, and attitudes of a competent simulation educator. Offering a systematic structure to approach simulation fellowship programmatic design may aid in better achieving program goals. In this manuscript, we present the application of the 4-component instructional design model as a blueprint to the development of Simulation Education Fellowships. We offer examples used at the NYC Health + Hospitals simulation fellowship to illustrate how the 4-component model informs fellowship program design which promotes the development of a simulation educator. This manuscript will provide a roadmap to designing curricula and assessment practices including self-reflective logbooks to focus the path toward achieving desired skills and shape future conversations around programmatic development

A Scoping review of challenges, scope and assessment approaches of teledentistry: an Indian perspective

Context: In India, COVID-19 pandemic has limited the utilization and access to dental services owing to the risk of infections transmission. In this context, tele-dentistry could be useful but there is paucity of literature which provides guidance on the scope and challenges for using tele-dentistry in India. Aims: To identify challenges, scope and assessment approaches of tele-dentistry from an Indian perspective. Settings and Design: Scoping Review. Methods and Material: Scoping review was conducted using the Arksey and O’Malley framework. Databases were searched in July from April to August 2020. Studies concerning challenges and scope of tele-dentistry in India were included. Additionally, literature about assessment approaches used for tele-dentistry programs were also reviewed Results: A total of 64 studies were reviewed, out of which 26 articles were included in the final review. Scoping review reveled that tele-dentistry can act as a seamless tool for diagnosing, training and screening. Few studies suggested the relevance of smartphone technology for specialist consultations and proper diagnosis. Majority of studies revealed shortage of basic infrastructure as a major challenge for tele-dentistry in India. Assessment studies were mainly focused on economic perspective and cost-effectiveness of the programs. Conclusions: This review provide guidance for using tele-dentistry in India. It is also reflected that there is a need for further research about the assessment of tele-dentistry in terms of safety, clinical outcomes, and patient perception

Carrier Screening: Past, Present, and Future

To date, preconceptual and prenatal patients have been offered gene-by-gene, disorder-by-disorder carrier screening. Newer techniques allow screening of many disorders at one time. The goal of this review is to provide an overview of the current practice and future direction of carrier screening within the preconceptual/prenatal setting

Noninvasive prenatal screening for fetal trisomies 21, 18, 13 and the common sex chromosome aneuploidies from maternal blood using massively parallel genomic sequencing of DNA

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Strengths, weaknesses, opportunities, and threats analysis of the national program for health care of the elderly

Background: The National Program for the HealthCare of the Elderly (NPHCE) was adopted by the Ministry of Health and Family Welfare in 2010 to provide promotional, preventive, curative, and rehabilitative health-care services for the fast-growing older population in India. As literature about the assessment of NPHCE is lacking, the present study was conducted to perform a strengths, weaknesses, opportunities, and threats (SWOT) analysis of the program. Methods: The SWOT of the NPHCE program is analyzed using available literature and relevant documents. Results: Although this program embraces strategies to provide specialized training and services at primary health center, community health center, and district levels, including dedicated bedded wards, equipment, consumables, and pharmaceuticals but home-based care for the elderly, and the role of caregivers is overlooked in this program. NPHCE program can utilize the framework and take support of various ongoing healthy aging initiatives of international agencies to augment the health-care strategies for the elderly in India. Integrating schemes developed by the government for the upliftment of the elderly and the inclusion of traditional medicine systems in the program can serve as an opportunity for meeting unmet needs and improving the quality of life and well-being of the elderly. However, the growing elderly population, rise in nuclear families, and dual disease burden are significant threats to the program's implementation. Conclusion: This program can be more effective in providing comprehensive health care to the elderly if more emphasis is given to community participation, home-based care, and integrating digital health technologies and other existing welfare schemes

HIV/AIDS awareness and related health education needs among slum dwellers of Jodhpur city

Background: The people living in slums lack the basic civic amenities. Due to deprivation of socioeconomic resources and health care facilities these groups of people are more vulnerable to infectious diseases like HIV/AIDS. Aim& Objective: To assess the knowledge and awareness about HIV/AIDS and to identify related health education needs in urban slums of Jodhpur. Settings and Design: A cross sectional study was conducted during July – Nov 2018 in slums of Jodhpur city.  Methods and Material: Two stage cluster sampling strategy was used to collect data from 1200 participants regarding HIV/ AIDS knowledge and awareness to identify health education needs in urban slums. Statistical analysis used: Descriptive statistics, chi-square test and multivariate logistics analysis were used. Results: A total of 1200 participants were surveyed, out of which 48.5 % were males.   Among the study population 58% (n=697) has heard about HIV/AIDS and only 17.5% (n=211) have knowledge that the HIV and AIDS are different. Only 17.8% (n=214) have undergone HIV testing. Females were less likely aware about preventive measures of HIV than males (OR=0.09, 95%CI=0.05-0.14, P value<0.05). The younger population (15-45years) were less likely aware about preventive measures for HIV than older population (>45 years). Only 13.9% (n=110) of tobacco consumers and 11.5% (n=78) alcohol consumers have undergone HIV testing. Conclusions: The comprehensive health education program should be designed with focus on different education needs according to age and gender of urban slums