A Hybrid Model of In-Person and Telemedicine Diabetes Education and Care for Management of Patients with Uncontrolled Type 2 Diabetes Mellitus: Findings and Implications from a Multicenter Prospective Study.

Background: Patients with uncontrolled type 2 diabetes mellitus (T2DM) require close follow-up, support, and education to achieve glycemic control, especially during the initiation or intensification of insulin therapy and self-care management. This study aimed to describe and evaluate the impact of implementing a hybrid model of in-person and telemedicine care and education on glycemic control for patients with uncontrolled T2DM (hemoglobin A1c [HbA1c] ≥9%) during the coronavirus disease pandemic. Methods: This prospective multicenter-cohort pre-/post-intervention study was conducted on patients with uncontrolled T2DM. This study included three chronic illness centers affiliated with the Family and Community Medicine Department at Prince Sultan Military Medical City in Riyadh, Saudi Arabia. A hybrid model of in-person (onsite) and telemedicine care and education was developed. This involved implementing initial in-person care at the physicians' clinic and initial in-person education at the diabetes education clinic, followed by telemedicine services of tele-follow-ups, support, and education for an average 4-month follow-up period. Results: Of the enrolled 181 patients, more than half of the participants were women (n = 103, 56.9%). The mean age of participants (standard deviation) was 58.64 ± 11.23 years and the mean duration of diabetes mellitus was 13.80 ± 8.55 years. The majority of the patients (n = 144; 79.6%) were on insulin therapy. Overall, in all three centers, the hybrid model had significantly reduced HbA1c from 10.47 ± 1.23% to 7.87 ± 1.59% (mean difference of reduction 2.59% [95% confidence interval (CI) = 2.34-2.85%], p < 0.001). At the level of each center, HbA1c was reduced significantly with mean differences of 3.17% (95% CI = 2.81-3.53%), 2.49% (95% CI = 1.92-3.06%), and 2.16% (95% CI = 1.76-2.57%) at centers A, B, and C, respectively (all p < 0.001). Conclusion: The findings showed that the hybrid model of in-person and telemedicine care and education effectively managed uncontrolled T2DM. Consequently, the role of telemedicine in diabetes management could be further expanded as part of routine diabetes care in primary settings to achieve better glycemic control and minimize nonessential in-person visits when appropriate.

Assessing the Impact of a Service Excellence Program on Improving Patient Experience at Primary Health Care Centers.

BACKGROUND: Frontline clinical staff play a crucial role in shaping patient experience and, therefore, require adequate training and education to deliver exceptional service. This study aimed to assess the impact of a service excellence and quality training program on frontline clinical staff's knowledge, perception, and attitude toward patient experience and service excellence. We also examined the effect of this intervention on patient experience scores. METHODS: This study utilized a pre-post intervention design, where frontline clinical staff completed a questionnaire to establish baseline "knowledge and perception scores" and "attitude scores" related to patient experience. The same questionnaire was administered after the training program to measure any changes in scores. Patient experience scores were collected from existing data, comparing results from different quarters before and after the intervention. The training and education program covered various components, including effective communication, empathy, service standards, and service recovery. RESULTS: A total of 256 staff members, including nurses, physicians, and allied healthcare professionals, participated in the training program. The study found statistically significant improvements in all components of staff knowledge, perception, and attitude. Specifically, there was a median improvement in knowledge and perception scores, which increased from 77.2% to 96.5%. Additionally, attitude scores showed a median improvement from 73.8% to 92.5%. Moreover, the overall patient experience score increased from 62% to 72.4%. CONCLUSION: The study revealed significant improvements in staff knowledge, perception, and attitude, along with enhanced patient experience scores. These findings suggest a potential role for targeted interventions in enhancing patient experience and supporting ongoing quality improvement in primary healthcare settings.

The impact of telemedicine on patients with uncontrolled type 2 diabetes mellitus during the COVID-19 pandemic in Saudi Arabia: Findings and implications.

INTRODUCTION: Routine diabetes care changed during the COVID-19 pandemic due to precautionary measures such as lockdowns, cancellation of in-person visits, and patients' fear of being infected when attending clinics. Because of the pandemic, virtual clinics were implemented to provide diabetes care. Therefore, we conducted this study to assess the impact of these virtual clinics on glycaemic control among high-risk patients with type 2 diabetes mellitus (DM). METHODS: A prospective single-cohort pre-/post telemedicine care intervention study was conducted on 130 patients with type 2 DM attending a virtual integrated care clinic at a chronic Illness center in a family and community medicine department in Riyadh, Saudi Arabia during the COVID-19 pandemic. RESULTS: The mean age of the participants was 57 years (standard deviation (SD) = 12) and the mean (SD) duration of diabetes was 14 (7) years. Over a period of 4 months, the HbA1c decreased significantly from 9.98 ± 1.33 pre-intervention to 8.32 ± 1.31 post-intervention (mean difference 1.66 ± 1.29; CI = 1.43-1.88; P <0.001). In addition, most in-person care visits were successfully replaced, as most patients (64%) needed only one or two in-person visits during the 4-month period, compared with typically one visit every 1-2 weeks in the integrated care programme before the pandemic for this group of high-risk patients. DISCUSSION: The current study found a significant positive impact of telemedicine care on glycaemic control among high-risk patients with DM during the COVID-19 pandemic. Moreover, it showed that telemedicine could be integrated into diabetic care to successfully replace many of the usual in-person care visits. Consequently, health policy makers need to consider developing comprehensive guidelines in Saudi Arabia for telemedicine care to, ensure the quality of care and address issues such as financial reimbursement and patient information privacy.

The effectiveness of visual triaging and testing of suspected COVID-19 cases in primary care setting in Saudi Arabia.

INTRODUCTION: Asymptomatic individuals could be a source of spreading the infection, especially in their households. Triaging and testing an individual for coronavirus disease (COVID-19) infection rely on the criteria included in the adopted triaging instrument, and adopted case definition of a suspected case. They both may need to be reviewed and modified to make them more effective in making the right decision. METHODS: A cross-sectional study was used to find out the effectiveness of triaging instrument and the case definition used in the fever clinic (FC) in one of our primary care centers. The data of 630 randomly selected participants who were tested in our center between April 12 and August 12 2020 were analyzed. RESULTS: About 36.8% of the 630 tested participants were positive for COVID-19. Symptomatic patients were 3.93 (95% CI; 2.58, 5.98; P < 0.001) times more likely to test positive than asymptomatic ones. The participants with a history of contact with a COVID-19 confirmed case were 1.47 (95% CI; 1.03, 2.10; P = 0.032) times more likely to test positive compared to those without such history. Symptomatic with and without history of contact were 8.40 (95% CI; 3.23, 21.86; P < 0.001) and 4.91 (95% CI; 1.84, 13.09; P < 0.001) times more likely to test positive compared to asymptomatic contact, respectively. Moreover, patients with comorbidity were also 1.85 (95% CI; 1.31, 2.60; P < 0.001) times more likely to test positive than healthy ones. The mean of the number of the households, and the mean of the number of households tested positive significantly exceeded the means of those tested negative by 1.03 (95% CI; 0.48, 1.57; P < 0.001), and 0.98 (95% CI; 0.68, 1.28; P < 0.001), respectively. From the studied triaging items only symptoms, comorbidities, and the number of households tested positive were independently associated with testing positive. Moreover, from studied symptoms, only fever, cough, myalgia, and loss of taste and smell were independently associated with testing positive. Finally, from the studied comorbidities, only diabetes mellitus was independently associated with testing positive. CONCLUSION: At the time of outbreak and pandemic, people get worried and need to be reassured, and contacts would then seek testing. However, resources including manpower, material, and money need to be protected and used wisely. Thus, the adoption of an evidence-based updated testing policy is crucially needed. Furthermore, early identification of the potential sources of the infection is also crucially needed to control the spreading of the infection.

Abdominal wall abscess following laparoscopic cholecystectomy: an unusual late complication of lost gallstones.

Laparoscopic cholecystectomy (LC) is associated with a significant risk of gallbladder perforation with spillage of bile and stones into the peritoneal cavity. The retrieval of the spilled stones is not always possible by laparoscopic technique. Majority of these cases do not have any problem in future but sometimes the lost stones lead to serious complications. The authors present a case of lost gallstones, which resulted into an abdominal wall abscess and discharging sinus 9 years after LC. This late presentation is among the very few reports after LC. Risk factors for gallbladder perforation, various techniques to avoid spillage of stones, possible complications and their management is discussed.

Effect of verbal instructions and image size on visual search strategies in basketball free throw shooting.

We assessed the effects on basketball free throw performance of two types of verbal directions with an external attentional focus. Novices (n = 16) were pre-tested on free throw performance and assigned to two groups of similar ability (n = 8 in each). Both groups received verbal instructions with an external focus on either movement dynamics (movement form) or movement effects (e.g. ball trajectory relative to basket). The participants also observed a skilled model performing the task on either a small or large screen monitor, to ascertain the effects of visual presentation mode on task performance. After observation of six videotaped trials, all participants were given a post-test. Visual search patterns were monitored during observation and cross-referenced with performance on the pre- and post-test. Group effects were noted for verbal instructions and image size on visual search strategies and free throw performance. The 'movement effects' group saw a significant improvement in outcome scores between the pre-test and post-test. These results supported evidence that this group spent more viewing time on information outside the body than the 'movement dynamics' group. Image size affected both groups equally with more fixations of shorter duration when viewing the small screen. The results support the benefits of instructions when observing a model with an external focus on movement effects, not dynamics.

Specificity of task constraints and effects of visual demonstrations and verbal instructions in directing learners' search during skill acquisition.

In the present study, the efficacy of visual demonstrations and verbal instructions as instructional constraints on the acquisition of movement coordination was investigated. Fifteen participants performed an aiming task on 100 acquisition and 20 retention trials, under 1 of 3 conditions: a modeling group (MG), a verbally directed group (VDG), and a control group (CG). The MG observed a model intermittently throughout acquisition, whereas the VDG was verbally instructed to use the model's movement pattern. Participants in the CG received neither form of instruction. Kinematic analysis revealed that compared with verbal instructions or no instructions, visual demonstrations significantly improved participants' approximation of the model's coordination pattern. No differences were found in movement outcomes. Coordination data supported the visual perception perspective on observational learning, whereas outcome data suggested that the modeling effect is mainly a function of task constraints, that is, the novelty of a movement pattern.

Effects of manipulating relative and absolute motion information during observational learning of an aiming task.

In the visual perception perspective of observational learning, the manipulation of relative and absolute motion information in visual demonstrations optimally directs learners' search towards appropriate task solutions. We assessed the effect of emphasizing transformational information and removal of structural information using point-light kinematic displays in approximating the model's relative motion patterns. Participants viewed computer-simulated point-light demonstrations or normal video demonstrations before and intermittently throughout 100 acquisition trials with knowledge of results on an underarm modified-dart aiming task. On the next day, all participants performed 20 retention trials without demonstrations. The kinematics of spatial and temporal coordination and control variables were examined relative to the model's action, as well as performance scores. The results indicated that approximation of the model's spatial and temporal coordination and control patterns was achieved after observation of either type of demonstrations. No differences were found in movement outcomes. In a second experiment, the effects of manipulating absolute motion information by slow-motion demonstrations were examined relative to real-time demonstrations. Real-time demonstrations led to a closer approximation to the model's spatial and temporal coordination patterns and better outcome scores, contradicting predictions that slow-motion displays convey intact relative motion information. We speculate that the effect of visual demonstration speed on action perception and reproduction is a function of task constraints--that is, novelty or familiarity of relative motion of demonstrated activities.