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INTRODUCTION: Disaster planning is of significant importance for the healthcare professional and the healthcare setting. Hospital-based disaster protocols form the cornerstone of disaster response. There is a paucity of data on disaster preparedness training using the virtual tabletop exercise (VTTX) module for interprofessional education from in-hospital and prehospital settings. With the coronavirus disease 2019 (COVID-19) pandemic, we have seen a paradigm shift of education strategies to the virtual realm. Here we attempt to study the impact of an online tabletop exercise workshop on the knowledge and confidence of disaster preparedness among Interprofessional trainees. MATERIAL AND METHODS: Interprofessional trainees from medical, dental, nursing, respiratory therapy, and paramedic domains who consented were included in this study. Institutional ethics committee approval was received and the study was registered with the clinical trials registry India (CTRI), before initiation. The VTTX module has been adapted from the World Health Organization (WHO) COVID-19 training resources. Three international experts from the disaster medicine domain validated the module, questionnaire, and feedback. Wilcoxon signed-rank test was used to compare the parameters (Knowledge and confidence level) pre and post-workshop. RESULTS: A total of 76 candidates with a mean age was 21.67 ± 2.5 (range:19-36) were part of the workshop. Comparison of the median scores and interquartile range of confidence level and knowledge respectively before [38 (29.25-45.75), 9 (7-11)] and after [51.50 (45-60), 11 (10-12)] the workshop showed vital significance (p-value < 0.001). All participants gave positive feedback on the workshop meeting the objectives. The majority agreed that the workshop improved their self-preparedness (90%) and felt that the online platform was appropriate (97.5%) CONCLUSIONS: This study sheds light on the positive impact of the online VTTX based workshop on disaster preparedness training among interprofessional trainees. Disaster preparedness training using available online platforms may be effectively executed with the VICTEr workshop even during the COVID-19 pandemic. The VICTEr workshop serves as a primer for developing online modules for effective pandemic preparedness training in interprofessional education. Copyright © 2023 Via Medica.
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Extracorporeal Membrane Oxygenation is a resource intensive therapy;heavily reliant upon specialized equipment, unique disposables, and skilled staff. The Covid-19 pandemic and following events exposed flaws in multiple phases of the care delivery system. The combination of high patient census, acuity, manufacturing delays, and supply chain disruptions led to our center's reassessment of the way in which limited resources are utilized. As a combined pediatric and adult center, we possess the ability to share resources amongst all patient populations. Currently, the majority of our equipment and disposables support a heavier use of Centrimag. We adjusted our general weight guidelines in order to best serve the most patients. (<8kg Sorin Rollerhead, 8-20kg Sorin Revolution, >20kg Centrimag.) Presently, a major challenge is the cessation of production of the -inch Better Bladder. The ECMO Coordinator team collaborated with key physician stakeholders. It was decided that the fluid reservoir and air trap benefits of a bladder outweighed the risks of running without one on our Sorin Rollerhead circuit. We designed a circuit with a 3/8 Bigger Better Bladder. Recognizing the increased risk of clotting with the 3/8 segment, we added a post-oxygenator shunt. This allows for adequate blood flow to maintain circuit integrity, while limiting the amount of flow to the patient. The nationwide nursing shortage is well-known. Though our multidisciplinary ECMO Specialist Team supports nursing and respiratory therapy, the nursing shortage still impacts our staffing models, resulting in the inability to safely staff bedside nurses and ECMO specialists. At times of high census, ECMO patients are cohorted into one geographical location. This allows for a temporary 2:1 staffing model for Centrimag patients. Our goal remains to staff pediatric cases as a 1:1 ECMO Specialist assignment. The ability to obtain this is assessed shift to shift;factoring patient stability, experience of the ECMO specialist, and unit staffing. The collaboration with ICU Nurse Managers, Hospital Supervisors and Central Staffing Office is imperative to the success of staffing model alterations. Our ECMO department has increased its FTEs, implementing a core team to be preassigned to two ECMO beds. The objective is to alleviate the burden on ICU staffing, limiting the number of nurses pulled from staffing grids. In uncertain times, flexibility is vital. It is important to remain vigilant and proactive. Our ECMO program feels that continuous assessment of supplies, equipment, and open communication has been the key to successfully serving our patients.
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Background: Inflammatory bowel disease (IBD) is a global problem and Australia has amongst the highest prevalence rates. This study looked to assess the quality, safety and equity of care across four specialised IBD centres in Australia over a 12-month period using the cloud-based IBD clinical management system called Crohn's Colitis Care (CCCare). This study aimed to define existing care at each centre and the range of performance across each centre to propose potential benchmarks for optimal quality IBD care. Method(s): The study was conducted across four tertiary IBD centres in Australia (Centres A, B, and C were public hospitals and D was a private centre). De-identified data within the backend CCCare research registry was audited between 1st of July 2021 to 31st August 2022. People with IBD who had a clinical assessment documented within the platform during this 12-month period were included. We assessed quality of IBD care using disease activity based on patient reported outcome measures (PROMs), biomarkers and endoscopy;surgery rates;health maintenance indicators including vaccination and skin cancer screening rates and;key performance indicators including steroid use, smoking rates and current opioid use. Safety of care was assessed using adverse events from therapy and hospital admission due to therapeutic complications. Equity of care examined education levels and ethnicity. Result(s): A total of 1889 patients were included. 63% had Crohn's disease and 37% had ulcerative colitis. 51% of the cohort was female. The median age was 39 years (IQR 30-53) and the median disease duration was 8.4 years (IQR 3.3-15.7) (Table 1). Current steroid use was between 6% to 15.4%. Faecal calprotectin (FCP) remission rates (250mug/mg) were between 65-84% and patient reported outcome (PRO-2) remission rates were between 76-88% with the highest rates observed at Centre D (Figure 1). 74 patients underwent a surgical procedure. COVID-19 vaccination rates were between 40.1% to 88.8% with the highest rates once again observed at Centre D. 3% of the cohort was documented as currently using opioid medications. 12.2% were recorded as currently smoking at Centre A compared to 2.6% at Centre D. 55 medication related adverse events were recorded and 94 patients had a hospital admission during the study period. Conclusion(s): This study showcases how CCCare can readily provide researchers with granular, real-world data to audit the quality of IBD care at 4 specialised centres in Australia over a 12-month period. While there were some differences (higher vaccination rates, lower smoking and steroid use rates at Centre D), quality and safety of care was still fairly uniform across the various sites and can serve as a standard of care for IBD patients in Australia.
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The key to fight against a global pandemic such as COVID-19 is to have low-cost, reliable and fast response diagnostic tools. Electronic biosensors are preferred because of their ease of integration into current centralized health care networks and integration with modern point-of-care testing (POCT) devices. Printed electronic sensors provide a sensitive and reliable diagnostic platform to aid in controlling transmissible diseases. In this work, we demonstrate a fully printed capacitive biosensor. The sensor uses coplanar electrodes, coupled with capture antibodies immobilized on microporous Polyvinylidene-fluoride (PVDF) film to detect the SARS-CoV-2 spike protein in spiked buffer solutions. Antibody immobilization on PVDF surface is confirmed with confocal fluorescent imaging microscopy. Gold nanoparticle (GNP) tagged detection antibodies are also introduced to provide increased sensitivity. The gold nanoparticles provide a reflectance layer which leads to increased capacitance. This increased capacitance can be measured directly and has demonstrated the ability to screen for spiked samples with statistical significance. This fully printed capacitive immunoassay has the potential to be used as a transmissible disease screening and vaccine efficacy assessment tool for resource-limited areas. IEEE
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This chapter introduces an innovative and transformational model of applied engineering education, the BRAVE Model of Educational Transformation. Incorporating five distinct concepts, Belonging, Relationships, Authenticity, Variety and Employability, the model is introduced and discussed in detail. Set within a prestigious Russell Group University, WMG is one of the largest Applied Engineering Faculties within the UK;it is home to five distinct Research Directorates, fourteen applied graduate programmes and five work-based undergraduate programmes. Written during a time of unprecedented social crisis, in terms of the global Covid-19 Pandemic, this chapter outlines how transformational change has been brought about within WMG (formerly Warwick Manufacturing Group) through the development and application of the BRAVE Model. Students’ perspectives are provided through the use of a short survey examining their views of some aspects of each strand of the model. The impact of using the model as a basis for transformational change on colleagues’ approaches to education is also discussed. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Introduction: Disaster planning is of significant importance for the healthcare professional and the healthcare setting. Hospital-based disaster protocols form the cornerstone of disaster response. There is a paucity of data on disaster preparedness training using the Virtual Tabletop exercise (VTTX) module for interprofessional education from in-hospital and prehospital settings. With the COVID-19 pandemic, we have seen a paradigm shift of education strategies to the virtual realm. Here we attempt to study the impact of an online tabletop exercise workshop on the knowledge and confidence of disaster preparedness among Interprofessional trainees. Methods Interprofessional trainees from medical, dental, nursing, respiratory therapy, and paramedic domains who consented were included in this study. Institutional ethics committee approval was received and the study was registered with the clinical trials registry India (CTRI), before initiation. The VTTX module has been adapted from the WHO COVID-19 training resources. Three international experts from the disaster medicine domain validated the module, questionnaire, and feedback. Wilcoxon signed-rank test was used to compare the parameters (Knowledge and confidence level) pre and post-workshop. Results A total of 76 candidates with a mean age was 21.67 ± 2.5 (Range:19–36) were part of the workshop. Comparison of the median scores and interquartile range of confidence level and knowledge respectively before [38 (29.25–45.75), 9 (7–11)] and after [51.50 (45–60), 11 (10–12)] the workshop showed vital significance (P-value
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Background. In order to mitigate the spread of SARS-CoV-2 and the COVID-19 pandemic, public health officials have recommended self-isolation, self-quarantine of exposed household contacts (HHC), and mask use to limit viral spread within households and communities. While household transmission of SARS-CoV-2 is common, risk factors for HHC transmission are poorly understood. Methods. In this prospective cohort study, we enrolled 37 households with at least one reverse transcription polymerase chain reaction-confirmed (RT-PCR) COVID-19 index case from March 2020 - March 2021, in order to calculate secondary attack rates (SAR) and define risk factors for secondary infections. Participants were tested daily for SARS-CoV-2 via RT-PCR, using self-collected lower nasal samples. Households were followed until all members tested negative for seven consecutive days. We collected demographics, medical conditions, relationship to index case, and socioeconomic indicators. Subgroup data analysis was conducted and stratified by positivity status. Results. Of 99 enrolled participants, 37 were index cases and 62 were household contacts (HHC), of whom 25 HHC were infected (40.3%). Secondary attack rate (SAR) was highest among adults caring for a parent (n=4/4, 100%) and parents of index cases (5/10, 50%). Households whose income came from service work had greater risk of transmission compared to households whose primary income was technology (n=5/7;71.4% vs 3/8;37.5% respectively). Pediatric contacts were at lower risk of infection when compared to adult contacts (n=5/18, 27.8% vs n=20/44, 45.5% respectively). Conclusion. This study suggests that household transmission represents a key source of community-based infection of SARS-CoV-2. Allocating resources for education/ training regarding prevention among infected individuals and their close contacts will be critical for control of future outbreaks of SARS-CoV-2.
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The key to fight against a global pandemic such as COVID-19 is to have low-cost, reliable, fast response diagnostic tools. Electronic biosensors are preferred because of their ease of integration into current centralized health care networks and integration with modern point-of-care testing (POCT) devices. Printed electronic sensors provide a sensitive and reliable diagnostic platform to aid in controlling transmissible diseases. In this work, we demonstrate a fully printed capacitive biosensor. The sensor uses coplanar electrodes, coupled with capture antibodies to detect the SARS-CoV-2 spike protein in spiked buffer solutions. Gold nanoparticle (GNP) tagged detection antibodies are also introduced to provide increased sensitivity. The gold nanoparticles provide a reflectance layer which leads to increased capacitance. This increased capacitance can be measured directly and has demonstrated the ability to screen for spiked samples with statistical significance. This fully printed capacitive immunoassay has the potential to be used as a transmissible disease screening and vaccine efficacy assessment tool for resource-limited areas. © 2021 IEEE.
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Background: Many studies on COVID-19 outcomes in patients with RMD have either restricted to COVID positive RMD patients or compared them to the general clinic population as a comparator. Given heterogeneity in behaviors and risks, clinical characteristics associated with a positive diagnosis among patients with RMD seeking testing for Sars-CoV-2 remain less well studied. Objectives: Among patients with RMD receiving a Sars-CoV-2 PCR test, we aimed to identify RMD-related factors associated with a positive test result. Methods: Among patients seen at least once in the University of Washington (UW) rheumatology clinics between March 2018 to March 2020, we reviewed electronic medical records to identify patients undergoing Sars-CoV-2 PCR testing from March 1 through October 31, 2020. Patients with RMD were categorized into two groups: those who tested positive for Sars-CoV-2 and those who tested negative. We randomly selected patients from the negative group in a 2:1 ratio for further data abstraction. Student's t-test and Chi-squared tests were used to compare continuous and categorical variables, respectively, between the groups. To determine the correlates of testing positive for Sars-CoV-2, specifically RMD medication use and disease activity, we constructed different multivariable logistic regression models adjusted for age, sex, race/ethnicity, presence of comorbidities, body mass index, and smoking. Results: A total of 2768 RMD patients underwent SARS-CoV-2 PCR testing within the UW system, of whom 43 (1.5%) were positive at least once. Three patients with incomplete information were excluded. Patients who tested positive had higher prevalence of end stage renal disease (ESRD)/chronic kidney disease (CKD) (24% versus 11%), had higher rates of active disease (24% versus 20%), were older (>55 years) (mean age 57.3 versus 54.8 years), male (63% versus 55%), non-white race/ethnicity (32% versus 26%), and higher prevalence of multiple comorbidities (42% versus 31%) (Table 1). In the multivariable models, neither RMD medication use (versus no use, Table 1) nor high disease activity (vs low disease activity/remission) were statistically significantly associated with COVID-19 positivity. Among the 41 COVID-19 positive patients, a majority recovered without specific treatments, although approximately one third of the positive patients were hospitalized and three deaths were observed. Conclusion: In this study, patients who tested positive did not differ in many ways from those who tested negative. (Figure Presented).
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Introduction: As of December 19th 2020, Coronavirus Disease 2019 (COVID-19) has resulted in approximately 17.6 million cases and 315,000 deaths in the United States. The hospitalization rate for COVID-19 in the US continues to rise and is currently around 295.8 hospitalizations per 100,000 population. Despite the increasing number of individuals who are contracting and recovering from this disease, little is known about their functional recovery. Understanding functional outcomes in these patients is critical to address their rehabilitation needs. The purpose of this study is to characterize the 30-day patient-reported functional outcomes of older and younger adults following acute hospitalization for COVID-19. Methods: A single-center prospective cohort study was performed from April to October 2020 of adult survivors of hospitalization for COVID-19 (n=28). A standardized telephone questionnaire was administered 30-days after hospital discharge to participants addressing their ability to perform basic activities of daily living (ADLs), instrumental ADLs, mobility, fatigue symptoms (Patient-Reported Outcomes Measurement Information Systems-PROMIS) and general disability (Health Assessment Questionnaire Disability Index - HAQ-DI). Results: Participants' were 23-95 years old. Twenty-one (75%) were less than 65 years old. Fifteen (54%) were female and 19 (68%) were white. Mean hospital length of stay was 11.3 days and 10 (36%) participants required ICU admission. Among adults aged <65 years, 76% developed new functional impairments and 14% developed new dependence (requiring help to perform a task) post-COVID compared to pre-hospitalization baseline. In comparison, 71% of adults aged >65 years developed new impairments and 29% new dependence. The most common new impairments in both age groups were transferring for basic ADLs and preparing meals and grocery shopping for instrumental ADLs. Seventy-one percent of older and 76% of younger adults experienced a decline in at least one mobility task (getting up from a chair, walking up 10 stairs, or walking mile). Seventy-six percent of younger adults and 43% of older adults experienced a clinically significant worsening (> 5 points) in their PROMIS fatigue scores. Sixty-two percent of younger adults and 43% of older adults experienced a clinically significant worsening (> 0.22 points) in their HAQ-DI scores. Conclusions: Among adults hospitalized with COVID-19, the majority experienced a decline in ≥1 functional task 30 days after discharge compared to pre-hospitalization. Younger adults had similar to worse impairment in physical functional outcomes than older adults. These results indicate all adults, regardless of age, are at risk for prolonged, clinically significant functional impairment following hospitalization for COVID-19.
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Focusing on what is an almost universal facet of graduate level education, the 'Research Dissertation', this paper examines how students are prepared to conduct an independent piece of research in three areas of study associated with engineering or industrial management. Focusing on the provision of 'Study Skills and 'Research Methods' training, 62 UK universities were identified as offering courses in one or more of the following programme areas: MSc Engineering Management: MSc Supply Chain and / or Logistics Management: MSc Project and / or Operational Management. An analytical framework was developed and data collected. This paper presents the data before discussing how one large engineering education department in the UK has completely reviewed and revamped how students are prepared for their dissertation. Attention is given to the pedagogic approach and academic content whilst the paper brings the issues up to date by briefly touching on how the students are being supported during the Covid19 Pandemic. © 2020 SEFI 48th Annual Conference Engaging Engineering Education, Proceedings. All rights reserved.
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Background and Aim: Medication non-adherence is common among patients with inflammatory bowel disease (IBD) and has been associated with worse outcomes. As studies examining the frequency and severity of coronavirus disease 2019 (COVID-19) infection in immunosuppressed populations are currently lacking, both medical and consumer communities have varying views on the role of immunosuppression during this pandemic. We aimed to examine medication adherence and complementary and alternative medication (CAM) usage during the COVID-19 pandemic among patients with IBD. Methods: We undertook an internet-based questionnaire of patients with IBD from two South Australian tertiary IBD units. Demographics, disease activity by Harvey-Bradshaw Index (HBI) and Simple Clinical Colitis Activity Index (SCCAI), IBD medication use, medication non-adherence attributed to COVID-19, and CAM usage frequency were determined. Validated scores of medication adherence and beliefs about medicines, including concern score, necessity score, harm score, and overuse score, were obtained. Results: Of 262 respondents (median age, 46 years;55% female;response rate, 30.4%), some 7% reported self-initiated missed doses or dose reduction of IBD medications directly attributable to the COVID-19 pandemic. Stopped medications included immunomodulators and steroids, and medications deliberately omitted or dose-reduced included immunomodulators and biological agents. Positive associations with medication non-adherence included low validated medication adherence score (P<0.001), higher concern over medicines score (P = 0.007), current corticosteroid requirement (P = 0.036), and active disease (P = 0.04), but not medication necessity score (P = 0.59). Regular CAM usage was present in 26% and was frequently aimed at treating mental health (92%) and IBD (66%), but not COVID-19 (3%). Frequent use of CAM was associated with higher disease activity score (P = 0.036), low medication adherence score (P = 0.003), higher harm of medicines score (P = 0.02), and concern over medicines score (P = 0.02), but not necessity of medicines score (P = 0.6). Rates of COVID-19 in South Australia at the time of the survey were low, ranging from 0 to 11 new cases per day, with minimal or no community transmission. Conclusion: Even in the setting of low COVID-19 prevalence, the pandemic influenced IBD medication adherence negatively in 1 in 14 patients. Importantly, this non-adherence was associated with deleterious outcomes, such as increased disease activity and corticosteroid use. Individuals using CAM cited more concerns and more perceived harm from conventional medication and were more likely to report medication non-adherence. Understanding underlying beliefs driving IBD medication non-adherence is crucial to identifying patients at risk of adverse IBD outcomes.
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Background/Case Studies: Due to physical distancing measures implemented in March 2020 to mitigate the spread of the COVID-19, over 4,000 community blooddrives were cancelled resulting in more than 100,000 fewer blood units collected in the US during the initial outbreak (1). Here we describe a successful partnership between a large academic medical center and a major blood provider to help prevent a critical blood shortage in our community. Study Design/Methods: Vanderbilt University Medical Center (VUMC), a large academic medical center including the only level I trauma center in metropolitan Nashville, Tennessee, partnered with the American Red Cross (ARC) to increase the number of blood drives on-campus with hospital leadership support to overcome administrative and logistical barriers quickly with increased media communications to faculty and staff through the hospital media team. Prior to the COVID-19 pandemic, oncampus blood drives averaged twice per month, but in March of 2020, our teams were able to increase oncampus blood drives to 2 to 3 times weekly safely and in compliance with guidelines recommended by the Centers for Disease Control and Prevention (CDC). The number of whole blood units collected during comparable months in 2018, 2019 and 2020 were compared. Results/Findings: From March through July of 2018, ten blood drives were held yielding a total of 212 units of whole blood. From March through July of 2019, ten blood drives were held yielding a total of 249 units of whole blood. From March through July 12 of 2020, 41 blood drives were held yielding a total of 1,167 units of whole blood (see Table 1). Whole blood units collected from March 1 to July 12, 2020 increased 550% compared with March to July 2018 on-campus. Conclusions: During the initial COVID-19 pandemic outbreak in the United States, the blood supply was severely threatened due to mass cancellations of donor blood drives. We demonstrated a very successful partnership between a large academic medical center and a major blood provider to substantially increase the frequency of on-campus blood drives which resulted in a significant increase in the number of whole blood units collected compared with prior years. Hospital leadership and media team support to overcome many logistical and administrative barriers was key to quickly implementing blood drives on-campus and increasing donor turnout.
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Background: This case series evaluates the safety and effectiveness of chest physiotherapy (CPT) on COVID19 patients requiring Veno-venous ECMO (VV-ECMO). Within our centre we identified patients by expert assessment who had sputum plugging and associated lobar collapse amenable to CPT. Previously CPT has been of unclear benefit in Severe Acute Respiratory Failure (SARF)supported by VV-ECMO outside of expert opinion. Methods: Retrospective review of electronic patient notes and CXR. Summary: 17 patients were admitted to ICU from April-June 2020 who required VV-ECMO as treatment for COVID19. All patients had daily physiotherapy assessment and treatment as indicated;three of these patients had a significant positive impact from CPT. These patients all had sputum plugging and radiological evidence of associated lobar collapse and consolidation. CPT involved manual techniques and ventilator manipulation to optimise expiratory flow bias and lung recruitment. All treatments were agreed by the MDT. We were able to demonstrate a positive impact in these patients with improvements in trends of compliance, tidal volumes and CXR changes. Main complications of treatment were transient loss of tidal volumes and transient drop in ECMO flows (<3 seconds);however, no sustained adverse effects were attributable to CPT. Discussion: Our clinical experience suggests that CPT is safe, and may have played a role in facilitating lung volume recovery in COVID19 patients with high secretion loads, potentially aiding VV-ECMO weaning. Further research should investigate optimal treatment interventions and timing in this emerging population in light of the probability of an ongoing high clinical load.
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While the fields of work-integrated learning (WIL) and career development share common goals, WIL literature tends to focus on student employability more than students' ability to manage their careers. The Leading Edge program at a Canadian institution, the University of Victoria, brings together these two disciplines as it draws from theory and methodology in WIL and career development to strengthen student experiential learning and prepare students for meaningful careers. Four reflective questions form the core of the program, and support students to become pro-active experiential learners, embrace diversity and become career-ready during their academic journey. The authors present the theoretical underpinnings in career development, WIL and experiential learning that inform the program development, and analyse its strengths and challenges. The paper concludes with an exploration of how the Leading Edge, an online program, can support learners to navigate the challenges of the current labour market conditions created by COVID-19. © 2020 International Journal of Work-Integrated Learning. All rights reserved.