Evaluation of a novel augmented reality educational tool and its effects on patient experience: A randomized controlled trial.

Introduction: Patient education is an essential element of the treatment pathway. Augmented reality (AR), with disease simulations and three-dimensional visuals, offers a developing approach to patient education. We aim to determine whether this tool can increase patient understanding of their disease and post-visit satisfaction in comparison to current standard of care (SOC) educational practices in a randomized control study. Methods: Our single-site study consisted of 100 patients with initial diagnoses of kidney masses or stones randomly enrolled in the AR or SOC arm. In the AR arm, a physician used AR software on a tablet to educate the patient. SOC patients were educated through traditional discussion, imaging, and hand-drawn illustrations. Participants completed pre- and post-physician encounter surveys adapted from the Press Ganey® patient questionnaire to assess understanding and satisfaction. Their responses were evaluated in the Readability Studio® and analyzed to quantify rates of improvement in self-reported understanding and satisfaction scores. Results: There was no significant difference in participant education level (P = 0.828) or visit length (27.6 vs. 25.0 min, P = 0.065) between cohorts. Our data indicate that the rate of change in pre- to post-visit self-reported understanding was similar in each arm (P ≥ 0.106 for all responses). The AR arm, however, had significantly higher patient satisfaction scores concerning the educational effectiveness and understanding of images used during the consultation (P < 0.05). Conclusions: While AR did not significantly increase self-reported patient understanding of their disease compared to SOC, this study suggests AR as a potential avenue to increase patient satisfaction with educational tools used during consultations.

Motivations, sources of influence and barriers to being a podiatrist: a national questionnaire of student views.

BACKGROUND: Podiatry is an allied health profession which has seen a substantial decline in numbers in recent years. Every effort is required to recruit more students to reverse this diminishing supply and meet national foot health needs. To increase the number of applications to podiatry courses and encourage individuals to choose podiatry careers, the aim of this study was to understand the key motivations, sources of influence and barriers to choosing a podiatry career among current podiatry students, and consider the influence of choosing podiatry before or after a first career. METHODS: An online questionnaire, comprising mainly Likert-scale questions, was disseminated to podiatry students in England between February and March 2021. Respondents to the questionnaire were categorised as individuals who had either decided to engage in the profession 'before' or 'after' a first career. Mann-Whitney U non-parametric difference tests were performed to compare outcome questions relating to motivations, sources of influence and barriers between groups. RESULTS: One hundred and fifteen students completed the questionnaire. Overall, the study demonstrated many similarities between the groups (before and after a first career). However, there were distinct differences when considering some of the motivations (i.e., intellectually stimulating, student bursaries), sources of influence (i.e., own patient experience) and barriers (i.e., financial, job availability) associated with engaging in the podiatry profession. Overall, altruistic reasons were the key motivations for choosing podiatry. Personal sources of influence such as conducting own research, was the most important source of influence. Similar to other studies, a lack of awareness of the podiatry profession and what it entails remains problematic. CONCLUSIONS: This is the first national questionnaire investigating career choice decision-making for podiatry students in England or in any other country. The similarities suggest that marketing is applicable to both groups. However, an absolute must is a future national strategy that makes educational sources more impactful. Additionally, following the Covid-19 pandemic, the increased interest in health and care professions suggests now is the right time to market podiatry to individuals looking for a career change. Finally, the influence of personal encounters with podiatrists shows the transformational role podiatrists can have in recruiting to the profession.

Assessment of advanced clinical practitioners.

To continue growing the advanced clinical practitioner (ACP) role nationally, and similar roles internationally, there must be widely held trust in the level of practice and the roles worked in service by ACPs. This requires infrastructure to support ACPs through their training and ensure they are fit to qualify. This short report focuses on an evaluation of assessment processes in the acute sector in a county in England, to understand their feasibility and suitability. The qualitative research design was attendance at assessment panels and 17 semi-structured interviews with assessors and ACP trainees, from nursing, physiotherapy, paramedicine and operating department practice backgrounds based at two hospitals. Key themes identified through thematic analysis were the different approaches to assessment and the support required to engage effectively with assessment. One hospital had a well understood process, including ACPs with a clear identity. The other hospital had a credible assessment process that continues to be developed. The insights from this study enabled lessons to be drawn for those responsible for workforce development who are key to the future development of the ACP role and to ensure high standards of interprofessional care.

Building a Sustainable Governmental Public Health Workforce: A Look at the Millennial Generation.

CONTEXT: Millennials have had a profound impact on society, the economy, and the US workforce. This study used generational definitions published by the Pew Research Center. Millennials includes respondents who reported an age between 21 and 36 years (born in 1981-1996) at the time the 2017 Public Health Workforce Interests and Needs Survey (PH WINS) was administered. Generation X includes respondents who reported an age between 37 and 52 years (born in 1965-1980), and the baby boom generation (baby boomers) includes respondents between 53 and 71 years of age (born in 1946-1964). Public sector agencies, including governmental public health, are increasingly interested in figuring out how to attract and retain millennials. As the governmental public health workforce anticipates upcoming retirements, knowledge about the motivations and organizational characteristics that appeal to millennials is crucial to understanding the millennial workforce and workplace dynamics for decades to come. In 2017, millennials made up 22% of the governmental public health workforce, Generation X 40%, and baby boomers 37%. OBJECTIVE: This study examined opinions, expectations, and important workplace environment factors of millennials working in governmental public health compared with other generations. DESIGN: We performed bivariate analyses and fit a logistic regression model to evaluate the association of generation with responses to a set of satisfaction and engagement PH WINS survey questions. SETTING AND PARTICIPANTS: Data were drawn from the 2017 PH WINS of governmental health department employees, including state health agency and local health department staff. PH WINS excludes local health departments with fewer than 25 staff members or serving fewer than 25 000 people. PH WINS included responses from 47 604 staff members, which reflected a 48% overall response rate. RESULTS: The generations that were examined (millennials, Generation X, and baby boomers) were similarly satisfied with their jobs, organizations, and pay security, and millennials intended to leave their jobs for similar reasons as other generations. Millennials reported more strongly than other generations that their supervisors treated them with respect, that they had sufficient training to utilize technology, that their training needs are assessed, and that creativity and innovation were rewarded. They, however, reported less strongly that they were completely involved in their work and determined to give their best every day. CONCLUSIONS: Millennials in governmental public health agencies (excluding local health departments with <25 staff members or serving <25 000 people) may not be as different from other generations as previously thought. Governmental public health agencies should focus on highlighting workplace environment factors rated highly by millennials and on showcasing how careers in governmental public health could be attractive career options for millennials.

Attracting New Talent to the Governmental Public Health Workforce: Strategies for Improved Recruitment of Public Health Graduates.

CONTEXT: Governmental public health (GPH) agencies need a diverse, skilled, and motivated workforce to advance health and well-being, but they face a number of recruitment challenges. While there has been massive growth in public health degree programs and graduates, those with a degree in public health are underrepresented in the GPH workforce. OBJECTIVES: This study evaluates potential reasons undergraduate and graduate public health degree holders are underrepresented in the GPH workforce, assesses student awareness of and interest in GPH jobs, and identifies strategies for improved recruitment. DESIGN: We conducted pilot focus groups to explore public health students' interest in working for GPH agencies, obstacles to employment, and how this career path could be better promoted. SETTING AND PARTICIPANTS: Eight focus groups were conducted with a total of 33 participants at 3 universities and at the Annual Meeting of the American Public Health Association. Participants were enrolled full-time in or graduated within the last year from a public health bachelor's degree program or a public health master's degree program. Undergraduates had declared a public health major and were in their senior year; graduate students were in their second year and actively job seeking; or participants graduated within the past 12 months. MAIN OUTCOME MEASURES: The focus groups sought to capture students' perspectives of GPH agencies and how they believe recruitment can be improved. RESULTS: Participants described attractive job attributes including fulfilling, meaningful work; a position at a mission-driven organization; and the opportunity to make an impact on their community. Governmental public health agencies were viewed as bureaucratic, lacking innovation, and underresourced. Participants reported difficulties accessing and finding relevant job postings. CONCLUSIONS: Key to effectively recruiting and retaining new graduates is understanding their perceptions about/experiences with GPH agencies. While GPH jobs have desired attributes, participants reported that health departments are not effectively recruiting them.

The effectiveness of interventions and behaviour change techniques to reduce stress in student nurses: A systematic review.

BACKGROUND: Student nurses experience stress leading to poor health and course attrition (Lovegrove, 2018). OBJECTIVES AND DESIGN: This systematic review aimed to evaluate the effectiveness of interventions and 'behaviour change techniques' (BCTs) to reduce student nurse stress. BCTs are active components of interventions that are observable, replicable, irreducible and designed to change behaviour (Michie et al., 2013). DATA SOURCES: Thirteen databases were searched from inception to May 2020. REVIEW METHODS: The interventions were classified according to their target: 'stressors', 'coping', 'cognitive reappraisal' or a combination of these (Lazarus and Folkman, 1984). BCTs were coded using the BCT taxonomy: a hierarchical framework of BCTs (Michie et al., 2013). RESULTS: 28 interventions reported in 23 articles were included in the review. A positive effect was identified in 22 interventions. There were no studies addressing the stressors in isolation and the interventions targeting stressors in combination with coping (n = 1) or cognitive reappraisal (n = 1) found no significant effects. In contrast, 74% of those targeting coping alone (n = 14/19), 100% of those addressing coping and cognitive reappraisal together (n = 4/4) and 66% addressing all three targets together (n = 2/3) were successful. The most common BCTs provided students with information and skills relating to stress management, with 18/21 being successful >50% of the time. CONCLUSIONS: Overall, most interventions aimed to teach students skills to cope with stress, with the majority having a short-term effect. However, as some interventions and BCTs were infrequently used or poorly described and all studies had a medium-high risk of bias, there is a need for longitudinal high-quality studies.

Impact of hospital transfer on testicular torsion outcomes: A systematic review and meta-analysis.

INTRODUCTION: Testicular torsion is an emergent condition requiring prompt treatment. Previous studies have suggested transfer of pediatric testicular torsion cases may be detrimental to patient outcomes. Findings have not reached statistical significance. No study has quantitatively analyzed all literature reporting outcomes for transferred torsion patients. The aim of this study was to elucidate the impact of hospital transfer on pediatric testicular torsion outcomes through a systematic review and meta-analysis. METHODS: A predefined study protocol registered with PROSPERO was developed according to PRISMA. A comprehensive literature review of articles investigating outcomes for pediatric testicular torsion for transferred and non-transferred (treated "directly" at presentation institution) patients with orchiectomy as the primary outcome was conducted by systematically searching PubMed and Embase. Potential studies were screened against a predefined study protocol. Meta-analysis using a random effects model with transferred status as the "intervention" was performed using Review Manager 5.3. RESULTS: Of 18 eligible studies, 9 retrospective studies comprised of 2564 patients (532 transferred and 2032 direct) were suitable for quantitative analysis. Main analysis showed transfer status does not have a significant effect on torsion outcomes (RR 0.96 [95% CI 0.78-1.17]; I2 = 44%). Subgroup analysis for torsion patients presenting within 24 h of symptom onset shows patients who are transferred to another facility for management are more likely to undergo orchiectomy than those treated at their presenting institution (RR 0.35 [95% CI 0.24-0.51]; I2 = 4%). CONCLUSIONS: In this meta-analysis, hospital transfer does not affect orchiectomy rate in pediatric patients with testicular torsion when pooling data from all presentation timeframes. Subgroup analysis of patients presenting with testicular torsion in an acute setting (<24 h of symptom onset) suggests the delay associated with hospital transfer has a deleterious effect on testicular viability.

Robot-Assisted Laparoscopic Resection of the Mesonephric Duct Remnant in a Patient with Zinner Syndrome.

Introduction: A 17-year-old male with Zinner syndrome, a right seminal vesicle cyst, and a solitary left kidney presented with chronic pelvic pain. Previous surgeons had attempted robot-assisted laparoscopic seminal vesicle cyst aspiration and transurethral resection of the ejaculatory duct. Neither surgery provided sustained symptom relief. Abdominal and pelvic MRI showed a cystic structure lodged between the prostate and bladder. The right seminal vesicle, kidney, and ureter were not observed. Materials and Methods: A robot-assisted laparoscopic seminal vesiculectomy was planned. Dissection distal to the right vas deferens and between the bladder neck and prostate revealed a cystic seminal vesicle-like structure. Attached to this was a tubular structure coursing deep to the vas deferens from the right renal fossa. This was presumed to be a dysplastic ureter. The dysplastic ureter was transected from the seminal vesicle and the seminal vesicle was marsupialized to the deep pelvis. Proximally, the dysplastic ureter was transected and left open. Results: Histologic assessment of the specimen revealed an ∼12.1 cm tubular mesonephric remnant. The postoperative course was uncomplicated. At 6 months follow-up, the patient remains free of symptoms with preserved ejaculatory volume. Conclusions: Mesonephric duct abnormalities and symptoms present on a spectrum. We present a safe and effective resection of a mesonephric duct remnant from a 17-year-old male with Zinner syndrome. A robotic approach localized to the right allowed for excellent observation without compromising left-sided genitourinary anatomy. In males presenting with renal agenesis and pelvic symptoms, clinicians should be suspicious of Zinner syndrome and other mesonephric abnormalities.

The development of clinical thinking in trainee physicians: the educator perspective.

BACKGROUND: An important element of effective clinical practice is the way physicians think when they encounter a clinical situation, with a significant number of trainee physicians challenged by translating their learning into professional practice in the clinical setting. This research explores the perceptions of educators about how trainee physicians develop their clinical thinking in clinical settings. It considers what educators and their colleagues did to help, as well as the nature of the context in which they worked. METHOD: A qualitative approach was used in this study with in depth interviews carried out with educators as key informants. Rich data derived from 15 interview transcripts were analysed thematically in a rigorous and iterative process. RESULTS: Three broad and overlapping themes were identified: working in an educationally minded culture; proximity of the educator to the trainee physician; and trajectory of the trainee physician. The departments in which these educators worked emphasised the importance for the education of trainee physicians. All members of the team were responsible for education of the team, and all members, particularly senior nurses, were able to give feedback upon the trainee physicians' progress. Educators described working side by side with their trainee physician and frequently being in close proximity to them which means that the educator was both easily accessible and spent more time with their trainee physicians. They described a trajectory of the trainee physicians through the placement with close monitoring and informal assessment throughout. CONCLUSION: Recommendations are made as to how trainee physicians can be supported to develop their clinical thinking. Educators and managers can analyse their own and their department's practice and select the recommendations relevant to their local circumstances in order to make change. This study adds the educator perspective to a body of literature about the importance of context and supportive learning environments. As such the discussion is applicable to the education of other health professionals.

Pediatric Robot-Assisted Laparoscopic and Ureteroscopic Ureterolithotomy and Ureteroplasty.

Background: Pediatric urolithiasis may coexist with congenital urinary tract abnormalities, complicating conventional methods of stone treatment. Here, we present an effective case of robot-assisted laparoscopy and simultaneous ureteropyeloscopy for the definitive management of pediatric urolithiasis complicated by a congenital ureteral stricture. Case Presentation: A 3-year-old girl presented to clinic with an outside noncontrast CT scan showing two 6-7 mm nonobstructing calculi in a mildly distended upper pole moiety of a duplex left kidney. Ureteral duplication status was unclear. The patient had suffered multiple febrile urinary tract infections throughout her life. Retrograde ureteropyelogram showed a stenotic waist in the upper pole ureter just proximal to the duplex ureteral convergence, and flexible ureteroscopy confirmed a congenital ureteral stricture. Simultaneous robot-assisted laparoscopic and ureteroscopic ureterolithotomy and ureteroplasty were offered and performed using a 3-armed robotic approach. The precise location of the stricture was identified robotically with simultaneous left ureteroscopy. A medial 1.5 cm longitudinal ureterotomy was made through the ureteral stricture to facilitate upper moiety ureterorenoscopy. The calculi were visualized in the upper moiety and retrieved in whole using a stone basket. The calculi were passed via the ureterotomy to the robotic instruments intraperitoneally. The longitudinal ureterotomy was closed transversely. A ureteral stent was placed, and indocyanine green was administered intravenously to confirm good perfusion of the ureteroplasty segment via fluorescence imaging. The stent was removed at 4 weeks. Retrograde ureterography and flexible ureteroscopy revealed complete patency of the anastomosis. At 11 months, the upper pole moiety remained decompressed on ultrasonography. The patient has remained off antibiotic prophylaxis without further infection. Conclusion: Robot-assisted approaches can be primary or adjunct tools in the definitive treatment of pediatric urolithiasis with concomitant urinary tract abnormalities.

How Do Contexts Affect Physicians' Clinical Reasoning? A Narrative Review.

This article was migrated. The article was marked as recommended. Background Research about clinical reasoning has tended to focus on the individual, assessing their ability to perform clinical reasoning tasks. However, recent studies have noted that clinical reasoning varies with the clinical context. Objectives The purpose of this narrative review is to examine how the context can affect physicians clinical reasoning skills. Methods A narrative literature review was conducted by searching PubMed, PsycINFO and Embase via Ovid using the search terms clinical OR critical AND thinking OR judgement OR reasoning. Of 22,296 results found, 25 studies were found to be relevant to our review. Results Most studies focused on diagnostic skills. Contexts affecting clinical reasoning fell into three broad categories: patient, physician and environmental (the physical and social setting) factors. Patient contexts researched included factors both personal to the patient and their physical disease manifestations. Physician contexts included experience, age, exposure to similar diagnoses, incorrect diagnostic suggestion, emotions, and the use of reflection and checklists. Environmental contexts included time pressure, unfamiliarity with surroundings, dealing with uncertainty and high-stakes outcomes. The effect of applying more than one contextual factor increasing cognitive load, was explored. Conclusion This original review suggests that the context can affect a physician's clinical reasoning abilities. This review identifies areas for continued research, including which contexts have a negative or positive impact, and the effect of multiple contexts (cognitive loading) on clinical reasoning. Further empirical research is needed to investigate these areas in more depth and to establish how far these benefits have an impact in practice.

A literature review of interventions to reduce stress in doctors.

AIM: Stress is prevalent among doctors, and interventions are offered, often as part of their continuing professional development, to help doctors learn in the workplace about the recognition, prevention and management of the harmful effects of stress. The aim of this review was to examine existing research to ascertain the features of successful educational interventions with practising doctors and any factors that may affect outcomes. METHODS: We searched key databases for papers published between 1990 and 2017 on the themes of stress that included an education-based intervention and practising doctors. Using an inclusive approach to the review, a broad evaluation was made of the primary research using both quantitative and/or qualitative evidence where the study reported a positive outcome in terms of stress management. RESULTS: Review criteria were met in 31 studies of 1,356 originally retrieved. Three broad categories of interventions emerged from the coding process: mindfulness-type (n = 12), coping and solutions focused (CSF) (n = 12) and reflective groups (n = 7). There is evidence that these interventions can be successful to help doctors deal with stress. Based on the results from this review, an original guide is advanced to help educators choose an educational intervention. CONCLUSION: Although evidence for some interventions may be 'hierarchically stronger', it is misleading to assume that interventions can be imported as successfully into any context. Factors such as medical specialty and health care systems may affect which intervention can be used. The guide offers an evidence base on which further research can be built.

Musculoskeletal (MSK) practitioners in primary care: an evaluation of a MSK core capabilities framework and review process.

The General Practice Contract 2019/20 established first contact musculoskeletal (MSK) physiotherapists in primary care. This paper describes an evaluation exploring the feasibility of using the MSK Core Capabilities Framework and a peer review process to evidence capability. It discusses how this process may be developed to ensure MSK practitioners are able to evidence the level of practice required within the complex environment of primary care. MSK practitioners were supported to evidence their capabilities against the MSK Framework. Twenty-two participants took part in the evaluation of this intervention via semi-structured interviews. A robust and iterative process of qualitative data analysis was undertaken. The findings are framed in terms of Davis' Technology Acceptance Model of evaluation (i.e. user perceptions).There were a range of perceived benefits of the Framework including as a means of quality assurance, career progression, the promotion of knowledge consolidation and reflective practice. There were however, a number of 'translation into practice' issues. Given the newness of the MSK Framework, it is perhaps not surprising there is a need for refinement. This evaluation highlights key enablers for reviewing capabilities of MSK practitioners: a curriculum; educational supervision; and accreditation. Learning also applies more widely to other emerging role opportunities.

Unleashing the Creativity and Innovation of Our Greatest Resource-The Governmental Public Health Workforce.

CONTEXT: Creativity and innovation in the governmental public health workforce will be required to generate new ideas to solve complex problems that extend beyond traditional public health functions such as disease surveillance and monitoring. Creativity and innovation can promote and advance necessary organizational transformation as well as improve organizational culture and workplace environment by motivating employees intrinsically. However, there is little empirical evidence on how rewarding creativity and innovation in governmental public health departments is associated with organizational culture and workplace environments. OBJECTIVE: This study describes (1) the degree to which creativity and innovation are rewarded in governmental public health agencies and (2) associations between rewarding creativity and innovation and worker satisfaction, intent to leave, and workplace characteristics. DESIGN: The cross-sectional Public Health Workforce Interests and Needs Survey (PH WINS) was administered using a Web-based platform in fall 2017. SETTINGS AND PARTICIPANTS: Data used for these analyses were drawn from the 2017 PH WINS of governmental health department employees. This included state health agency and local health department staff. PH WINS included responses from 47 604 staff members, which reflected a 48% overall response rate. PH WINS excludes local health departments with fewer than 25 staff or serving fewer than 25 000 people. RESULTS: Fewer than half of all workers, regardless of demographic group and work setting, reported that creativity and innovation were rewarded in their workplace. Most measures of worker satisfaction and workplace environment were significantly more positive for those who reported that creativity and innovation were rewarded in their workplace. CONCLUSION: This research suggests that promoting creativity and innovation in governmental public health agencies not only could help lead the transformation of governmental public health agencies but could also improve worker satisfaction and the workplace environment in governmental public health agencies.

Doctors with Asperger's: the impact of a diagnosis.

BACKGROUND: Asperger syndrome (AS) is part of a spectrum of disorders encompassing difficulties with social interaction that may result in specific educational needs for doctors in training. There is currently limited research on the impact of AS on working as a doctor. METHODS: This is a qualitative study using semi-structured interviews to explore the perceptions of trainees diagnosed with AS following input from a professional support service, and the perspectives of the staff involved in their professional development. FINDINGS: Receiving a diagnosis of AS was viewed as a double-edged sword, allowing the development of insight into lifelong difficulties, but also creating the potential for prejudice. Understanding AS traits provided an explanation for challenges in the workplace and therefore opportunities to find solutions. Understanding AS traits provided an explanation for challenges in the workplace DISCUSSION: This study explores the benefits and disadvantages of defining and labelling a specific professional support need for a group of trainees. It also reveals the need for improved awareness of AS amongst all clinical educators.