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Clerkship on primary care and family medicine is multi-elemental and was very challenging during the COVID-19 pandemic. Some medical students postponed their graduation because the clerkship at the health center could not be carried out in a pandemic situation. This article aims to describe the community medicine clerkship (CMC) module and its implementation amidst the COVID-19 pandemic. This module was delivered by online and offline activities from 10th August to 13th September 2020. A total of forty students, twelve faculty mentors, and fifteen Primary Health Care (PHC) preceptors from ten PHCs in the Tangerang District, Indonesia were involved. Students could carry out activities and fulfil assignments given in the midst of a pandemic with a re-designing of the CMC module. The one-sample t-tests were employed to compare the difference between the study values and the values before the COVID-19 pandemic. The study showed that the scores of students participating in CMC module during the COVID-19 pandemic were significantly different from the scores before the pandemic in terms of both individual and group scores. The findings of the study clearly indicated that all clinical clerkship modules must be redesigned to suit the current conditions. Modifications and variations of various learning methods, guidance techniques, monitoring and coordination are all factors that must be considered in implementing changes to these modules. © 2023 Dwi Tyastuti, Risahmawati Risahmawati, Marita Fadhillah, Fika Ekayanti, Sity Kunarisasia & Ahmad A. Habibi.
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The current study examined factors affecting higher education students' use of a mobile-based Learning Management System (m-LMS) for distance education during the Corona Virus Disease 2019 (Covid-19). A survey instrument based on the Technology Acceptance Model (TAM) and the Theory of Planned Behavior (TPB) was established and validated. The primary data were gathered from 1032 responses. The data were computed in SmartPLS 3.2. Partial Least Square Structural Equation Modeling (PLS-SEM) procedures were conducted to assess the measurement and structural models. The proposed model is valid and reliable. Findings of the study show that relationships emerge in seven out of ten hypotheses. The strongest relationship is between Perceived Usefulness and Attitude while the weakest exists between Perceived Ease of Use and Attitude. This study emphasizes awareness about the use of m-LMS in education, especially during distance education due to pandemics like Covid-19. The model is expected to provide a useful base for future academicians interested in conducting similar topics of research.
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Introduction: The more controlled Covid-19 pandemic conditions had made face-to-face learning activities possible with emphasizes the implementation of health protocol. Students needed to adjust to the new learning method transition, which was originally a fully online learning, to a hybrid learning. This condition is likely to be correlated to student learning outcomes. The study aims to determine the correlation between students' self-adjustment during hybrid learning and students' test scores. Methods: This research was a correlation study. Participants were the second-year pre-clinical students who underwent the hybrid learning for the first time. Self-adjustment was measured using a self-developed questionnaire by the investigators. The instrument was a YES or NO questionnaire consisting of 23 questions. Learning outcomes were measured based on summative and practical test scores. Results: Eighty-eight participants had completed the data (response rate 79%). Participants consist of 18 males and 70 females. Most of them were in the range of 15-19 years of age. Majority of the student was in good self-adjustment (55;62.5%). Median self-adjustment score was 16 (range:2-23). The average score of the summative and practical exams were 58± 8.1 and 61±13.1, respectively. There was no significant positive correlation between self-adjustment and summative test (r=0.076;p=0,482). There was no significant positive correlation between self-adjustment and practical test (r=0,044;p=0.683). Conclusion: Most of students have good self-adjustment to this learning method transition. Therefore, it has no impact on test scores. The institution needs to pay more attention to the students who have adapting difficulties. © 2022 UPM Press. All rights reserved.
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Previous work suggests that both choir and mindfulness training may improve well-being and auditory skills in older adults. This randomized control trial investigated the effects of a 10-week online choir or mindfulness program on speech-in-noise (SIN) perception. We collected multiple measures of auditory perception and attention, and multiple measures of socioemotional well-being in adults (N = 61) aged 50–65. We observed that both interventions improved SIN perception in high-noise conditions, decreased anxiety, and increased global well-being, mindfulness, and self-transcendence. Choir participants, compared to their own performance, showed improvements in additional noise conditions of the SIN task relative to mindfulness participants. Choir training produced greater advantages than mindfulness training in reducing state anxiety and improving melodic interval discrimination. These findings provide preliminary evidence for improvements in selected well-being and auditory measures as a result of online singing and mindfulness interventions in middle-aged and older adults in the US during the COVID-19 pandemic. © The Author(s) 2022.
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Introduction: Coronavirus disease 2019 (COVID-19) is a contagious with speed transmission and cause pandemic around the globe. A real-time polymerase chain reaction (RT-PCR) has become the major diagnostic method for COVID-19. Some believe that releasing patient from isolation or evaluating clinical progression could be made based on cycle threshold (CT) values. Here, we aimed to compare CT-value to the clinical insight using three different PCR's kit. Method: We collected 48 patients with confirmed COVID19 positive, then we divided into three groups that were (1) pneumonia, (2) non-pneumonia and (3) asymptomatic. The specimens came from nasopharyngeal and oropharyngeal swabs, were extracted using the same matrix column method and then detected by RT-PCR using different kit. The kits were commercially that detect Orf1ab, E gene (kit A);Orf1ab, N, E gene (kit B) and Orf1ab, N gene (kit C). Thus, we compared the result using comparation analysis based on CT-value and clinical groups by using SPSS 20.0 Result: From those patients there were 23 asymptomatic (48%), 9 symptomatic non-pneumonia (19%) and 16 pneumonia cases (33%) respectively. The mean difference of CT-values within three kits were wide and convergence. There were also significantly different (Kruskal-Wallis Test) between clinical course and CT-value in three PCR's kit even from the same detected gene (p< 0.005). Conclusion: This study conclude that CT-value cannot be the only determination to exclude patient from the isolation or to predict the clinical manifestation in COVID-19 since it has wide variation within same sample in different PCR kits. © 2022 UPM Press. All rights reserved.
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Evaluating the learning outcomes of a certain course implementation can improve the quality of education. This study is focused on Indonesian EFL undergraduates’ perceptions of the relationships between teacher performance, technological resources, online project-based learning (OPJBL), and ESP learning outcomes. Participants of the study have attended English for specific purposes (ESP) online courses during school closures due to Covid-19. A survey was addressed to 350 undergraduates after a one-semester implementation of the OPJBL. The students were requested to rate their perceptions on validated items using a 7-point Likert-type scale for the data collection. The data were modelled and computed through partial least square structural equation modelling (PLS-SEM). The main findings of the study revealed that teacher performance and technological resources were significant in predicting OPJBL. Similarly, OPJBL was found to play a significant role in affecting ESP learning outcomes. Teacher performance and technological resources were also correlated to ESP learning outcomes. Significant differences were found among students’ locations for all variables. The findings highlight the benefits of the SEM approach for establishing the proposed framework and assessing the links between variables concerning the OPJBL and learning outcomes. © 2022, Syiah Kuala University. All rights reserved.
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Objectives: The symptoms of COVID-19 resemble those of a variety of mild to severe clinical conditions. Having epidemiological knowledge of the clinical symptoms of COVID-19 and associated factors may help health workers to diagnose and manage the disease. Assessment of COVID-19’s clinical symptoms is therefore necessary to support health workers in Banten, Indonesia. Materials and Methods: In this descriptive cross-sectional study, we purposively analysed 1492 medical records from our online COVID-19 database. All data were analysed in a consecutive manner and were shown as percentages or significances. Results: Medical records revealed that 577 patients (39%) were male and 915 (61%) were female. Our sample contained 106 patients (7%) who tested positive for COVID-19. Among these 106 patients, 70 were asymptomatic (66%) while the rest (34%) had single or multiple clinical symptoms. The most common symptom was fever (16%), followed by cough (15%), fatigue (11%), headache (11%), dysphagia (10%), rhinorrhoea (8%), nausea (7%), dyspnoea (4%) and diarrhoea (2%). Subsequently, gender differences were found to be significantly associated with positive cases (p<0.05), the appearance of clinical symptoms (p<0.05), and decision whether to hospitalize or self-isolate (p<0.05). Conclusion: Fever, cough and fatigue predominated in the COVID-19 symptoms reported by our patients. Additionally, gender differences should be carefully considered in developing better management processes.
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Background: One of the most common symptoms of COVID-19 infection is Olfactory Dysfunction (OD). Objectives: This study aims to investigate OD and phantosmia in COVID-19 cases from northern Iran. Materials & Methods: In this cross-sectional study, participants were 400 patients with COVID-19 infection in Rasht, Iran from March 2019 to September 2020. All the patients were evaluated in terms of OD and then followed up for 3 months face-to-face, by telephone call, or online. Results: Among 400 patients, 37.75% had OD (19% hyposmia, 10.75% primary phantosmia, and 8% anosmia) during the initiation of the disease, but 121 (30.25%) including nearly 65% of anosmic and/or hyposmic cases reported phantosmia at different time intervals of followup visits. Moreover, 65.38% of patients reported acute onset of OD. The prevalence of OD was significantly higher in patients aged <40 years (P=0.001) and in females (P=0.002). OD improved in about 90% of patients within 3 months. Peripheral oxygen saturation was better in anosmic cases and C-reactive protein level was higher in normosmic cases at their first visit. No significant difference was found in terms of other laboratory results. Conclusion: OD is a common complication of COVID-19 infection, but seems not to be permanent. It is more common in young patients, females, and those with mild COVID-19 infection. © 2022. Guilan University of Medical Sciences. Published by Guilan University of Medical Sciences
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The integration of STEM education has been promoted to improve the quality of education in the 21st century, with its usage leading to emphasis on the factors influencing the intentions of preservice teachers. Therefore, this study aims to determine the factors influencing preservice teachers' intentions, as well as the effects of gender and age on the implementation of STEM education. The Theory of Planned Behavior (TPB) was adopted to predict the relationship between knowledge, social influence, attitude, perceived usefulness, control, and behavioral intention (BI) of using STEM education among preservice secondary school teachers. A total of 30 item questionnaires on behavioral intentions were distributed to 201 respondents, with data being analyzed using the Structural Equation Model (SEM). The results showed that perceived usefulness had a positive significance, and a relationship with the attitudes of preservice teachers toward STEM education. Habit had a positive significance in influencing teachers' behavioral intentions and implementation. Subjective norms did not have a significant correlation with BI and implementation. These results are recommended for providing solutions to analytical problems, and to successfully improve future learning through an educational approach.
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Nearly 35 million cases and one million deaths over the nine months of the COVID-19 pandemic have been reported worldwide. Africa and some countries with endemic parasitic infections had a low incidence of COVID-19. By contrast, the United States and several European countries, having a non-endemicity of parasitic infections, recorded a high incidence of COVID-19. Some parasites have an immunomodulatory mechanism that can induce an immune tolerance state in the infected persons by balancing pro-inflammatory and anti-inflammatory responses. Emerging reports also stated that COVID-19 and helminth co-infections may have more hidden outcomes than predictable ones. Hence, the aim of this literature review is to show and identify that an increase in the number of regulatory immune cells due to the immunomodulatory role of a pre-existing parasitic infection could reduce the risk of COVID-19. This study explored the existing literature to determine the role of parasitic infections in modulating the immune response and possibly reduce the risk of COVID-19 infection in endemic countries. The mechanism of immunomodulation by parasites is the increased numbers of Treg cells, M2 macrophages, eosinophils, the Th2 cytokines IL-4 and IL-5, and the pro-inflammatory downregulation of IFN lambda, TNF alpha, and IL-6, which play an essential role in inducing cytokine storms in COVID-19 infection. This condition will probably occur in an individual with parasitic infection in a community with limited facilities and infrastructure to treat parasitic infections, particularly in developing countries. To conclude, in endemic areas, the immunomodulatory effect of parasitic infection to reduce the risk of COVID-19 cases/deaths is a possibility if the host is immunocompetent. Herein, the current knowledge on the immunomodulatory role of COVID-19 and helminth co-infections will be discussed.
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This survey study utilized an extended Technology Acceptance Model (TAM) to understand factors affecting Social Media Use in Teaching English as a Foreign Language (SMU-TEFL) during the COVID-19 pandemic to help improve the integration of effective and efficient technology with traditional education methods. The initial survey instrument that was used was adapted from prior studies and was validated through content validity, piloted, and distributed to 287 EFL faculty members from ten Indonesian universities. Factor analyses (exploratory and confirmatory) were conducted to purify the instrument. Path analysis through Covariance-Based Structural Equation Modelling (CB-SEM) was used to assess correlations of the hypotheses which were supported by the Pearson correlation coefficient. The findings of the study informed a valid and reliable model that sufficiently explains variance to measure factors affecting SMU-TEFL during the Covid-19 pandemic. Six significant relationships out of eight hypothetical statements were confirmed and elaborated. It is recommended that future research be conducted in order to improve the integration of technology into TEFL courses, especially in pandemic situations. © 2022, Teaching English with Technology. All Rights Reserved.
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INTRODUCTION Vaso-occlusive crisis (VOC), hallmark of sickle-cell disease (SCD), is the first cause of patients' emergency room (ER) admissions and hospitalizations. Acute chest syndrome (ACS) is a life-threatening complication that can occur during VOC and prolong hospitalization and is one of the main causes of death in SCD patients. The PRESEV score, established by team members and colleagues, assesses the risk of developing ACS (Bartolucci et al., 2016). In addition, the score has been validated by an international multicenter study, involving 13 centers, distributed in five different countries (PRESEV 2 - ASH 2020). Throughout the first wave of the Covid-19 pandemic, VOC management for SCD patients was a major concern. Our sickle cell referral center set up a hotline to monitor patients suffering from VOC daily, and organized the deployment of home-care services when required. The success of this system during the first wave of the pandemic led to the establishment of DREPADOM, a home-care and hospitalization protocol for VOC management in patients who are at a low risk of developing ACS, as standard care. DESCRIPTION OF SETTING Patients eligible for DREPADOM are patients that arrive at the ER for a VOC with a low PRESEV score, meaning low risk of developing ACS;or patients that are discharged early following hospitalization for VOC. After physical examination and calculation of the PRESEV score, DREPADOM home hospitalization is systematically offered to patients arriving to the ER with a PRESEV score ≤ 5. If the patient agrees, the DREPADOM nurse coordinator then acts as a link between the pharmacist, the oxygen supplier, the homecare provider, and the DREPADOM medical platform to activate the home hospitalization protocol. This entails the delivery of oxygen supply at the patient's house, dispatch of a medical prescription of opioids and parenteral treatments, twice/thrice-daily visits from homecare nurses, and an on-call SCD expert. DREPADOM relies on a system of daily telephone calls with three levels of expertise and warning and a decision-making algorithm. This is supervised by SCD experts, who arbitrate according to the evolution of the situation (stopping the follow-up, continuing the follow-up as an outpatient, hospitalization) (Fig.1). Furthermore, nurses enter patient vitals in real-time during their daily visits on a dedicated online platform (Link4Life) that contains an integrated automatic alert system. Additionally, a daily phone update between the DREPADOM coordination and the homecare provider's coordination concerning status and evolution of the patient's global condition takes place. RESULTS Over a 6-month period, 39 patients were included in the DREPADOM home hospitalization protocol, 3 of which were included multiple times for a total of 42 inclusions. Mean age was 40 years old [±9], sex ratio was 14/25 (male/female), ER vs early discharge ratio was 21/22, and mean homecare follow-up was 3 days (±1) for both, patients arriving from the ER and early discharge patients. Throughout the third wave of the pandemic, when hospital saturation was a major concern, patients with PRESEV scores 5 ≤ 11 were also offered DREPADOM. Three patients were hospitalized (7%): one for an ACS, who was included during the 3 rd wave of the pandemic with a PRESEV score of 8;one for pyelonephritis unrelated to the VOC;and one for difficulties with venous access. No death was reported. PERSPECTIVES Preliminary satisfaction surveys show a great enthusiasm for DREPADOM, partly due to the high standard of care received, but also due to the shorter length of hospitalization. In fact, median hospital stay for VOC is 4 [3-7] days (Bartolucci, 2016) whereas median homecare follow-up was 3 [1-6] days. [Formula presented] Disclosures: Bartolucci: Hemanext: Consultancy;Jazz Pharma: Other: Lecture fees;AGIOS: Consultancy;F. Hoffmann-La Roche Ltd: Consultancy;Emmaus: Consultancy;GBT: Consultancy;INNOVHEM: Other: Co-founder;Bluebird: Consultancy, Research Funding;Novartis: Consultancy, Membership on an entity's B ard of Directors or advisory committees, Other: Lecture fees, Steering committee, Research Funding;Addmedica: Consultancy, Other: Lecture fees, Research Funding;Fabre Foundation: Research Funding.
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Introduction Sickle cell disease is a genetic disease with acute and chronic complications. Pediatric mortality has decreased in recent decades with the introduction of systematic antibiotic therapy, preventive management of cerebral vasculopathy and therapeutic education of families. However, in the absence of cohort follow-up at birth, life expectancy, which is a different concept from age at death, cannot be assessed. In this retrospective, monocentric study, we describe causes and circumstances of death, acute chronic complications, long-term treatments and baseline biology of these patients. It seems important to analyze the risks of morbidity and mortality in order to decide on the necessary preventive measures. Material and method: Records of patients deceased between 2000 and 2020, from the national referral center (Henri Mondor Hospital), were retrospectively reviewed. The referral center follows 3500 patients. All deaths reported to the hospital, by families, other hospitals and health professionals were retrieved from computerized records. Deaths published by the INSEE (National Institute of Statistical and Economical study) from 2000 to December 2020 were accessible and compared with our databases to identify all our deceased patients. All patients with a medical record in our center were included for the study. Patients who had never visited our center were excluded. Results: During this period 226 patients including 128 women and 138 men are recorded. Genotypes for these patients were 204(76%) SS, 41 (15%) SC, 14(5%) Sβ°thalassemia and 7 (2%) Sβ+thalassemia. The median age at death was 41 years with an IQR [32-51]. 186 (70%) patients were hospitalized, 129 (70%) of whom were admitted to intensive care. 36 (13%) patients died at home, including 15 with opioid addiction and 5 patients with psychiatric pathology, and 4 patients on dialysis. This information was not available for 44 (16%) patients. The causes of death were vaso-occlusive complications with multivisceral failure in 44 cases, 42 sepsis, among which there were 11 renal failures, 9 of which were dialyzed. 5 patients died of COVID 19. Cerebral hemorrhage and neurological accident occurred in 22 cases, 4 of which were known to have macrovasculopathy. 25 patients died of a direct complication of renal failure, of which 17 were dialysed, 8 pre-dialysed and 3 transplanted. Acute liver failure in 16 cases, 10 precapillary pulmonary hypertension, 14 DHTR, 10 end-stage heart failure were noted. Two road accidents, 2 suicides, 1 dementia are repoted. For 51 cases, there was no information on the cause or circumstance of death. The causes of death according to genotype is on Table 1. Concerning the chronic complications, 94/266 (35%) patients had significant chronic organ damage. Sixteen patients had required renal or liver transplantation in their history. End-stage organ damage was frequent, 42 had end-stage renal failure, 21 had major liver failure, of which five were transplanted and 16 were awaiting transplantation. Twenty-one patients had known heart failure, 10 of which were associated with end-stage renal disease. Ten patients were followed for significant precapillary pulmonary hypertension. Transfusion difficulties due to a history of DHTR were found for 33 patients. Fourteen patients had an opioid addiction. Nine patients were pregnant and nine had received corticosteroids. Discussion: Causes of death have changed and chronic organ failure is the leading cause of death, especially in patients with kidney, liver and heart disease. This study does not calculate life expectancy, but there was an increase in age at death of about 1/4 of the patients who were between 51 and 81 years old.The management of sickle cell disease has progressed in recent years and new therapies are being proposed. Prevention of the development of these complications is one of the new challenges, especially for renal disease, which is associated with premature mortality. DHTR and cerebral hemorrhage, Covid-19 are new entities and DHTR was probably underdiagnosed in p evious publications. Pregnancy remains a period at risk, for which surveillance should be reinforced. The analysis is ongoing and correlations are currently being investigated between different parameters to find risk factors for mortality. [Formula presented] Disclosures: Habibi: Novartis: Consultancy, Honoraria;bluebird bio: Consultancy, Honoraria, Research Funding. Audard: Addmedica: Consultancy. Michel: Novartis: Consultancy;Amgen: Consultancy;Rigel: Honoraria;Alexion: Honoraria;UCB: Honoraria;Argenx: Honoraria. Galactéros: Addmedica: Membership on an entity's Board of Directors or advisory committees. Bartolucci: INNOVHEM: Other: Co-founder;Bluebird: Consultancy, Research Funding;F. Hoffmann-La Roche Ltd: Consultancy;GBT: Consultancy;Jazz Pharma: Other: Lecture fees;AGIOS: Consultancy;Hemanext: Consultancy;Emmaus: Consultancy;Fabre Foundation: Research Funding;Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Lecture fees, Steering committee, Research Funding;Addmedica: Consultancy, Other: Lecture fees, Research Funding.
ABSTRACT
The current study examined factors affecting higher education students’ use of a mobile-based Learning Management System (m-LMS) for distance education during the Corona Virus Disease 2019 (Covid-19). A survey instrument based on the Technology Acceptance Model (TAM) and the Theory of Planned Behavior (TPB) was established and validated. The primary data were gathered from 1032 responses. The data were computed in SmartPLS 3.2. Partial Least Square Structural Equation Modeling (PLS-SEM) procedures were conducted to assess the measurement and structural models. The proposed model is valid and reliable. Findings of the study show that relationships emerge in seven out of ten hypotheses. The strongest relationship is between Perceived Usefulness and Attitude while the weakest exists between Perceived Ease of Use and Attitude. This study emphasizes awareness about the use of m-LMS in education, especially during distance education due to pandemics like Covid-19. The model is expected to provide a useful base for future academicians interested in conducting similar topics of research. © The Author(s) 2021.