Digital approaches are increasingly common in clinical trial recruitment, retention, analysis, and dissemination. Community engagement processes have contributed to the successful implementation of clinical trials and are crucial in enhancing equity in trials. However, few studies focus on how digital approaches can be implemented to enhance community engagement in clinical trials. This narrative review examines three key areas for digital approaches to deepen community engagement in clinical trials-the use of digital technology for trial processes to decentralize trials, digital crowdsourcing to develop trial components, and digital qualitative research methods. We highlight how digital approaches enhanced community engagement through a greater diversity of participants, and deepened community engagement through the decentralization of research processes. We discuss new possibilities that digital technologies offer for community engagement, and highlight potential strengths, weaknesses, and practical considerations. We argue that strengthening community engagement using a digital approach can enhance equity and improve health outcomes. 

https://www.nature.com/articles/s41746-022-00581-1.pdf

Digital approaches to enhancing community engagement in clinical trials

Abstract COVID-19 has had an impact globally with millions infected, high mortality, significant economic ramifications, travel restrictions, national lockdowns, overloaded healthcare systems, effects on healthcare workers’ health and well-being, and large amounts of funding diverted into rapid vaccine development and implementation. Patients with COVID-19, especially those who become severely ill, have frequently developed dysphagia and dysphonia. Health professionals working in the field have needed to learn about this new disease while managing these patients with enhanced personal protective equipment. Emerging research suggests differences in the clinical symptoms and journey to recovery for patients with COVID-19 in comparison to other intensive care populations. New insights from outpatient clinics also suggest distinct presentations of dysphagia and dysphonia in people after COVID-19 who were not hospitalized or severely ill. This international expert panel provides commentary on the impact of the pandemic on speech pathologists and our current understanding of dysphagia and dysphonia in patients with COVID-19, from acute illness to long-term recovery. This narrative review provides a unique, comprehensive critical appraisal of published peer-reviewed primary data as well as emerging previously unpublished, original primary data from across the globe, including clinical symptoms, trajectory, and prognosis. We conclude with our international expert opinion on what we have learnt and where we need to go next as this pandemic continues across the globe. 

https://link.springer.com/content/pdf/10.1007/s00455-021-10396-z.pdf

An International Commentary on Dysphagia and Dysphonia During the COVID-19 Pandemic

In 2020, due to the COVID-19 pandemic, educational activities had to be done remotely as a way to avoid the spread of the disease. What happened was not exactly a shift to an online learning model but a transition to a new approach called Emergency Remote Teaching. It is a temporary strategy to keep activities going on until it is safe again to return to the physical facilities of universities. This new setting became a challenge to both teachers and students. The lack of interaction and classroom socialization became obstacles for students to continue engaged. Before the pandemic, hackathons -- short-lived events (1 to 3 days) where participants intensively collaboration to develop software prototypes -- were starting to be explored as an alternative venue to engage students in acquiring and practicing technical skills. In this paper, we present an experience report on the usage of an online hackathon as a resource to engage students in the development of their semester project in a distributed applications course during this emergency remote teaching period. We describe details of the intervention and present an analysis of the students' perspective of the approach. One of the important findings was the efficient usage of the Discord communication tool -- already used by all students while playing games -- which helped them socialize and keep them continuously engaged in synchronous group work, "virtually collocated".

Online Hackathons as an Engaging Tool to Promote Group Work in Emergency Remote Learning

China has low seasonal influenza vaccination rates among priority populations. In this study, we aimed to evaluate a pay-it-forward strategy to increase influenza vaccine uptake in rural, suburban, and urban settings in China.We performed a quasi-experimental pragmatic trial to examine the effectiveness of a pay-it-forward intervention (a free influenza vaccine and an opportunity to donate financially to support vaccination of other individuals) to increase influenza vaccine uptake compared with standard-of-care user-paid vaccination among children (aged between 6 months and 8 years) and older people (≥60 years) in China. Recruitment took place in the standard-of-care group until the expected sample size was reached and then in the pay-it-forward group in primary care clinics from a rural site (Yangshan), a suburban site (Zengcheng), and an urban site (Tianhe). Participants were introduced to the influenza vaccine by project staff using a pamphlet about influenza vaccination and were either asked to pay out-of-pocket at the standard market price (US$8·5-23·2; standard-of-care group) or to donate any amount anonymously (pay-it-forward group). Participants had to be eligible to receive an influenza vaccine and to have not received an influenza vaccine in the past year. The primary outcome was vaccine uptake. Secondary outcomes were vaccine confidence and costs (from the health-care provider perspective). Regression methods compared influenza vaccine uptake and vaccine confidence between the two groups. This trial is registered with ChiCTR, ChiCTR2000040048.From Sept 21, 2020, to March 3, 2021, 300 enrolees were recruited from patients visiting three primary care clinics. 55 (37%) of 150 people in the standard-of-care group (40 [53%] of 75 children and 15 [20%] of 75 older adults) and 111 (74%) of 150 in the pay-it-forward group (66 [88%] of 75 children and 45 [60%] of 75 older adults) received an influenza vaccine. People in the pay-it-forward group were more likely to receive an influenza vaccine compared with those in the standard-of-care group (adjusted odds ratio [aOR] 6·7 [95% CI 2·7-16·6] among children and 5·0 [2·3-10·8] among older adults). People in the pay-it-forward group had greater confidence in vaccine safety (aOR 2·2 [95% CI 1·2-3·9]), importance (3·1 [1·6-5·9]), and effectiveness (3·1 [1·7-5·7]). In the pay-it-forward group, 107 (96%) of 111 participants donated money for subsequent vaccinations. The pay-it-forward group had a lower economic cost (calculated as the cost without subtraction of donations) per person vaccinated (US$45·60) than did the standard-of-care group ($64·67).The pay-it-forward intervention seemed to be effective in improving influenza vaccine uptake and community engagement. Our data have implications for prosocial interventions to enhance influenza vaccine uptake in countries where influenza vaccines are available for a fee.Bill &amp; Melinda Gates Foundation and the UK National Institute for Health Research. 

http://www.thelancet.com/article/S1473309922003462/pdf

Effectiveness of a pay-it-forward intervention compared with user-paid vaccination to improve influenza vaccine uptake and community engagement among children and older adults in China: a quasi-experimental pragmatic trial

Purpose of the study Burnout is an increasingly recognised phenomenon in acute healthcare specialities and associated with depersonalisation, ill health and training programme attrition. This study aimed to quantify contributory physiological variables that may indicate stress in newly qualified doctors. Study design Post Graduate Year 1 doctors (n=13, 7 f, 6 m) were fitted with a VivaLNK wellness device during four prior induction days, followed by their first 14 days work as qualified doctors. Minute-by-minute Heart Rate (HR), Respiratory Rate (RR), and Stress Index (SI) data were correlated with Maslach Burnout Inventories, Short Grit Scales (SGS) and clinical rota duties: Induction vs Normal Working-Day (NWD) versus On-call shift. Results In a total 125 recorded shift episodes, on comparing Induction versus NWD versus On-call shift work, no variation was observed in HR above baseline (25.47 vs 27.14 vs 24.34, p=0.240), RR above baseline (2.21 vs 1.86 vs 1.54, p=0.126) or SI (32.98 vs 38.02 vs 35.47, p=0.449). However, analysis of participant-specific temporal SIs correlated with shift-related clinical duties; that is, study participants who were most stressed during a NWD, were also more stressed during Induction (R2 0.442, p=0.026), and also during On-call shifts (R2 0.564, p=0.012). Higher SGS scores were inversely related to lower SIs (coefficient −32.52, 95% CI −45.881 to 19.154, p=0.001). Conclusion Stress and burnout stimulus appear to start on day one of induction for susceptible PGY1 doctors, and continues into front-line clinical work irrespective of shift pattern. Short Grit Scale questionnaires appear an effective tool to facilitate targeted stress countermeasures.

Trainee burnout: when does the fire start?

What are the new findings? ►► The COVID-19 pandemic prevented physical innovation formats and virtual innovation strategies such as the virtual hackathon proposed in this article may address this challenge ►► Virtual interdisciplinary collaboration between students and early career professionals can ead to rapid innovations to address urgent unmet clinical needs in times of global emergencies How might it impact on healthcare in the future? ►► Innovation pathways should be augmented with virtual innovation strategies to break down barriers to engagement in healthcare innovation, improve global interdisciplinary collaboration and enhance rapid innovation adoption moving into the future ►► Particular healthcare technologies likely to be positively impacted by this include those in digital health, global health and medical device sectors © 2021 Georg Thieme Verlag All rights reserved

https://innovations.bmj.com/content/bmjinnov/7/2/284.full.pdf

Virtual hackathon to tackle COVID-19 unmet needs

https://innovations.bmj.com/content/bmjinnov/7/2/308.full.pdf

Modified full-face snorkel mask: Answer to the PPE crisis?

Introduction There is a reduction in Foundation trainee applications to speciality training and this is attributed to an administrative job role, with subsequent fears of burnout. This pilot study presents the findings of a real-time self-reporting tool to map a group of Foundation doctors’ elective activities. Self-reporting is efficient, low cost to run and allows for repeated measures and scalability. It aimed to example how a time-map could be used by departments to address any work imbalances and improve both well-being and future workforce planning. Method Foundation doctors’, at a busy District General Hospital, were asked to contemporaneously report their work activities over an ‘elective’ day. Outcomes measures included the mean duration per task and the time of day these were performed. Results Nine Foundation doctors’ returned 26 timesheet days. Foundation doctors’ time was split between direct patient tasks (18.2%, 106.8 min per day), indirect patient tasks (72.9%, 428.6 min per day) and personal or non-patient activities. Indirect tasks were the most frequent reason for Foundation doctors leaving late. No clinical experience was recorded at all and only an average of 4% (23.4 min per day) of a Foundation doctors’ time was spent in theatre. Conclusions This particular cohort performed a high proportion of indirect tasks. These have been associated with burnout. Time-mapping is a low-cost, acceptable and seemingly scalable way to elucidate a clearer understanding of the type of activities Foundation doctors may perform. This methodology could be used to modernise the traditional Foundation doctor job description.

https://pmj.bmj.com/content/postgradmedj/early/2020/03/26/postgradmedj-2020-137506.full.pdf

Ryan Kerstein

Papers

Virtual hackathon to tackle COVID-19 unmet needs

Modified full-face snorkel mask: Answer to the PPE crisis?

Understanding the role of Foundation doctors through a self-reported time-mapping pilot study.