ABSTRACT
At King's College, Nepal, the "Integrated Course" is an experimental project-based learning program, which aims to integrate learning and action in the community with classroom-based education. Connecting classroom learning with the world beyond academia can increase motivation for students, provide familiar examples for study, open the classroom to a trove of resources, promote integration across subject areas, and facilitate transfer of learning. However, it is often challenging to make those connections, and the challenges became more acute during the COVID-19 lockdown. We discuss here the design and implementation of the course, including both positive outcomes and difficulties as well as the experiences of participants. In particular, we use both successes and failures of the course as a guide for understanding how this kind of educational reform can be accomplished.
ABSTRACT
Healthcare workers (HCWs) need to wear personal protective equipment (PPE) during the COVID-19 pandemic. Studies from China report high rates of irritant dermatitis in frontline HCWs (Pei S, Xue Y, Zhao S et al. Occupational skin conditions on the front line: a survey among 484 Chinese healthcare professionals caring for Covid-19 patients. J Eur Acad Dermatol Venereol 2020;Epub ahead of print). The British Society of Cutaneous Allergy conducted an audit of occupational dermatoses in HCWs. Eleven centres in the U.K. and Ireland organized occupational skin disease clinics to treat PPE-related dermatoses. A standardized proforma was completed, which included information about site, dermatological history, occupation, working environment, shift pattern, sick leave, PPE and handwashing practices. Diagnosis and treatment were advised during a virtual consultation. Each participating unit entered anonymized audit data into a spreadsheet. Data from 200 HCWs were collected in May and June 2020. Forty-three per cent (n = 86) worked in England;30.5% (n = 61) in Scotland, 13.5% (n = 27) in Ireland and 13.0% (n = 26) in Wales. Median age was 36 years. Ninety per cent (n = 180) were female;67.0% (n = 134) had nursing roles. The face was affected in 46.5% (n = 93) and hands in 46.0% (n = 92). In 94.0% of cases (n = 188) the clinical findings were felt to be occupational or partially occupational, with the most common diagnosis being irritant contact dermatitis: 59.0% of patients (n = 118). Seventeen per cent (n = 35) had required time off work (292.5 days in total;range 0.5-28). The mean number of hours of PPE wear per shift was 6.9 [median 7.5, interquartile range (IQR) 4-10]. Those who wore PPE for longer periods had more time off;each hour of wearing PPE during a shift increased the time off by 0.2 days [95% confidence interval (CI) 0.002-0.344;P = 0.048]. The mean number of handwashes with soap per day was 22.7 (median 20, IQR 10-30). Each handwash increased the expected number of days off by 0.03 (95% CI -0.013 to 0.069;P = 0.174). The mean number of uses of alcohol gel per day was 19.2 (median 10, IQR 5-30). There was an inverse association with use of alcohol gel and time off;each use of alcohol gel per day reduced the expected number of days off by 0.03 (95% CI 0.002-0.066;P = 0.04). These data indicate that the duration of wearing PPE, frequency of handwashing and use of alcohol gel have a significant effect on the time off work for HCWs.
ABSTRACT
Early in the COVID-19 pandemic, it was apparent that capacity for face-to-face (F2F) dermatology appointments would plummet. Within 2 weeks we introduced the National Health Service (NHS) Attend Anywhere video consultation platform. In the absence of a pilot project we undertook an analysis of our initial experience with the platform. Data were collected prospectively through a paper-based survey of clinical users within outpatients over 4 weeks in May 2020. We collected data on 103 virtual appointments. Twenty-six (25.2%) patients failed to attend. Of 77 consultations there were 33 general dermatology, 28 tumour, 12 allergy and four paediatric patients. Good video quality was reported in 34 of 77 consultations (44%). Good audio quality was reported in 47 of 77 consultations (61%). For general patients, 58% of consultations resulted in a subsequent F2F consultation, 21% further virtual consultation, 18% were discharged or received advice only and 3% attended for investigations. Forty-eight per cent of consultations were felt to be better than or as good as F2F. For tumour patients, 57% of consultations resulted in a subsequent F2F consultation, 29% went directly to surgery, 11% were discharged or received advice only, and 3% were referred to another specialty. All consultations were felt to be inferior to a F2F appointment. For allergy patients, 50% attended for further investigations. Thirty-three per cent of consultations resulted in a subsequent F2F consultation, 8.3% of patients had a further virtual consultation and 8.3% received advice only or were discharged. Sixty-six per cent of allergy consultations were felt to be better than F2F, often owing to the requirement for patient shielding. The remaining 34% of consultations were felt to be as good as F2F. Positive themes from users included a reduced need for F2F consultations, especially for patients who were shielding. In some cases, patients were referred directly for investigations or treatment, reducing the overall visits to the department. The main negative theme was that clinical examination was very limited. In particular, clinicians were concerned about the inability to palpate the skin, use dermoscopy and perform a full skin survey. NHS Attend Anywhere was introduced out of necessity. In our experience, it is not suitable for the assessment of patients with skin tumours. With F2F clinic capacity likely to be constrained for some time, the platform has some utility in the assessment of new general patients, allergy patients and in monitoring of existing patients, particularly those on immunosuppression.