Publications by authors named "Bruce B Struminger"

The use of digital learning in healthcare is expanding in a range of contexts including for settings of armed conflict. Humanitarian emergencies and war often lead to a surge of traumatic injuries, emotional distress, and disruption to health systems risking neglect and exacerbations of chronic illness, and acute infectious disease outbreaks, often requiring an international response. On the ground humanitarian response is often essential though logistical and security challenges can delay these responses, and the reliance on an international workforce unfamiliar with local cultures can create challenges in response efforts.

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The current landscape of clinician burnout is prompting the need for our health care system to revise its approach toward complex conditions such as long coronavirus disease (COVID), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and other postinfectious fatiguing illnesses (PIFIs). We discuss our efforts here at Family Health Center of San Diego (FHCSD) to help share insight and glean perspective from clinicians who have participated in our Centers for Disease Control and Prevention (CDC)-funded 3-year continuing professional development initiative. The Long COVID and Fatiguing Illness Recovery Program uses multidisciplinary team-based case consultation and peer-to-peer sharing of emerging best and promising practices (ie, teleECHO [Extension for Community Healthcare Outcomes]) to support the management of complex cases associated with long COVID, ME/CFS, and other PIFIs.

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Learning collaboratives are seldom used outside of health care quality improvement. We describe a condensed, 10-week learning collaborative ("Telemedicine Hack") that facilitated telemedicine implementation for outpatient clinicians early in the COVID-19 pandemic. Live attendance averaged 1688 participants per session.

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Background: The clinical burden of Long COVID, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and other post-infectious fatiguing illnesses (PIFI) is increasing. There is a critical need to advance understanding of the effectiveness and sustainability of innovative approaches to clinical care of patients having these conditions.

Methods: We aim to assess the effectiveness of a Long COVID and Fatiguing Illness Recovery Program (LC&FIRP) in a two-arm, single-blind, pragmatic, quality improvement, professional cluster, randomized controlled trial in which 20 consenting clinicians across primary care clinics in a Federally Qualified Health Center system in San Diego, CA, will be randomized at a ratio of 1:1 to either participate in (1) weekly multi-disciplinary team-based case consultation and peer-to-peer sharing of emerging best practices (i.

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Article Synopsis
  • * Clinicians reported a significant increase in their knowledge after each session, with 75.8% indicating they would likely apply what they learned in practice, and 94.6% felt it improved their patient care.
  • * The findings suggest that COVID-19 Clinical Rounds could serve as an effective model for peer-to-peer tele-mentoring, particularly when timely, evidence-based practices are lacking.
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Persistent gaps exist in healthcare workers' capacity to address HIV and tuberculosis in Asia and Africa due to constraints in resources and knowledge. Project ECHO (Extension for Community Healthcare Outcomes) leverages video-enabled technology to build workforce capacity and promote collaboration through mentorship and case-based learning. To understand current perceptions of ECHO participants and develop a comprehensive evaluation framework for ECHO implementation, we utilized modified appreciative inquiry guided focus group discussions (FGD) in India and Tanzania and called it SCORE (Strengths, Challenges, Opportunities, Results, and Evaluation).

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Background: Project Extension for Community Healthcare Outcomes (Project ECHO) is a telementoring, case based virtual community of practice training and education model connecting experts to primary care clinicians (PCCs). Project ECHO has good evidence for favorable treatment outcomes on wide range of diseases. Since 2017, Tanzania hosts multidrug resistant tuberculosis (MDR TB) ECHO with hub at Kibong'oto Infectious Diseases Hospital.

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Article Synopsis
  • - The US Department of Health and Human Services teamed up with the University of New Mexico's Project ECHO and various organizations to launch the COVID-19 Clinical Rounds Initiative aimed at enhancing dynamic learning health systems during the pandemic.
  • - This initiative addresses three key areas of COVID-19 care: out-of-hospital/emergency services, emergency departments, and inpatient critical care, fostering a large network for real-time information sharing.
  • - From March 2020 to February 2021, the initiative conducted 125 learning sessions, resulting in over 58,000 learner-hours of engagement across all 50 states and more than 100 countries.
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The Corona Virus Disease 2019 (COVID-19) pandemic has rapidly spread in Africa, with a total of 474,592 confirmed cases by 11 July 2020. Consequently, all policy makers and health workers urgently need to be trained and to access the most credible information to contain and mitigate its impact. While the need for rapid training and information dissemination has increased, most of Africa is implementing public health social and physical distancing measures.

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Introduction: A major challenge with current systems of CME is the inability to translate the explosive growth in health care knowledge into daily practice. Project ECHO (Extension for Community Healthcare Outcomes) is a telementoring network designed for continuing professional development (CPD) and improving patient outcomes. The purpose of this article was to describe how the model has complied with recommendations from several authoritative reports about redesigning and enhancing CPD.

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Including target populations in the design and implementation of research trials has been one response to the growing health disparities endemic to our health care system, as well as an aid to study generalizability. One type of community-based participatory research is "Patient Centered-Research", in which patient perspectives on the germane research questions and methodologies are incorporated into the study. The Patient-Centered Outcomes Research Institute (PCORI) has mandated that meaningful patient and stakeholder engagement be incorporated into all applications.

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Objectives: Vietnam has significantly scaled up its national antiretroviral therapy (ART) program since 2005. With the aim of improving Vietnam's national ART program, we conducted an outcome evaluation of the first five years of the program in this concentrated HIV epidemic where the majority of persons enrolled in HIV care and treatment services are people who inject drugs (PWID). The results of this evaluation may have relevance for other national ART programs with significant PWID populations.

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