The effect of simulation-based flipped classroom on acquisition of cardiopulmonary resuscitation skills: A simulation-based randomized trial.

BACKGROUND: Cardiopulmonary resuscitation (CPR) is an essential skill required by critical care nurses. Evidence has shown that the use of a novel method called simulation-based flipped classroom (SBFC) can save training time in nursing laboratories and, to some extent, enhance social distancing during the current COVID-19 pandemic. AIM: To evaluate the effects of SBFC on nursing students' acquisition of CPR skills. STUDY DESIGN: A two-parallel prospective, single-centre, simulation-based, randomized, controlled trial. METHODS: The total sample size was 326 students. A CPR video was recorded and uploaded on Microsoft Teams channel for the SBFC group only. Thereafter, both groups demonstrated and redemonstrated the CPR procedure. Both groups were then compared according to the simulation experience satisfaction scale and CPR skills acquisition checklist. RESULTS: Two equally randomly selected groups of 163 undergraduate nursing students completed the study. The SBFC group had a significantly better satisfaction with the simulation experience than the traditional simulation (TS) group (p = 0.03). As regards the mean score of the CPR checklist after simulation, the SBFC group had a significantly higher score than TS group (p = 0.01). CONCLUSIONS: SBFC using a pre-recorded video can be an effective method that can reduce the time needed for CPR clinical simulation and can be used for the CPR simulation among critical care nurses. RELEVANCE TO CLINICAL PRACTICE: This study provides critical care nursing educators with a deep understanding regarding the benefits and value of utilizing the SBFC method in the clinical training of CPR skills. SBFC can be used to increase critical care nurses' satisfaction and skill acquisition during CPR training.

Predictors of critical care nurses' stress, anxiety, and depression in response to COVID-19 pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic directly affects the psychological well-being of critical care nurses. Several studies had investigated the psychological impact of the pandemic on nurses caring for patients with COVID-19, but few were conducted to identify the predictors of this impact. AIMS AND OBJECTIVES: The objective of this study is to identify the predictors of critical care nurses' stress, anxiety, and depression in response to the COVID-19 pandemic. DESIGN: A cross-sectional survey was conducted in five intensive care units in five hospitals in Alexandria, Egypt. METHODS: An online questionnaire was distributed. It included socio-demographic and work-related data and the depression, anxiety, and stress scale scores of the nurses under study. A multiple linear regression model was developed to identify the predictors of critical care nurses' stress, anxiety, and depression in response to the COVID-19 pandemic. RESULTS: Two hundred (64%) of 308 nurses completed the electronic questionnaire. Significant predictors of stress included the number of infected colleagues (P < .001) and availability of hospital resources (P = .01). Significant predictors of anxiety were age, gender, satisfactory income (P < .001), years of experience, time spent caring for patients with COVID-19 (P = .04), continuous training, number of infected colleagues (P = .01), and availability of hospital resources (P = .02). Finally, significant predictors of depression included gender, history of physical problems (P = .04), educational attainment, availability of hospital resources, history of psychological problems (P < .001), and number of infected colleagues (P = .001). CONCLUSION: The hospital's lack of human and physical resources and the number of colleagues infected with COVID-19 were the strongest predictors of stress, anxiety, and depression among nurses. RELEVANCE TO CLINICAL PRACTICE: Identifying the predictors of stress, anxiety, and depression among nurses who care for patients with COVID-19 is a vital step in developing mental health promotion strategies to support nurses during this pandemic.

Phonatory function and characteristics of voice in recovering COVID-19 survivors.

INTRODUCTION: This study aimed to evaluate the phonatory function of recovered COVID-19 survivors. The universal outbreak of COVID-19 led to the occurrence of otolaryngological manifestations that raised concerns about the assessment of the phonatory function in recovering patients. METHODS: This is a prospective, cross-sectional, case-controlled study carried out on 364 laboratory-confirmed non-critical COVID-19 survivors and 100 as healthy controls. The study participants were classified into two groups according to the disease severity. Group1 comprised 212 survivors who recovered from pneumonia and group 2 was made up of 152 survivors of severe pneumonia. All patients were subjected to an auditory perceptual assessment of the voice (APA) and Maximum Phonation Time (MPT) measurements. RESULTS: Phonasthenic manifestations were significantly more frequent in COVID-19 survivors than in controls (P < 0.000) with a higher percentage recorded among severe pneumonia survivors (87.5%) than among pneumonia survivors (60.8%) with a P value of < 0.01. Dysphonia and excessively soft loudness were significantly more common among survivors than among controls (P < 0.002 and P < 0.000, respectively) with no significant difference between the patient groups. The MPT was significantly shorter among survivors than among controls (P < 0.000). The mean MPT was 15.97 s in the control group, 10.72 s in the pneumonia group, and 8.88 s in the severe pneumonia group, with the differences between the groups being statistically significant (P < 0.000), suggesting a higher impairment of lung volume and phonatory function in severe cases. CONCLUSIONS: Phonasthenia, dysphonia, and decreased MPT could be otolaryngological manifestations of COVID-19. Laryngeal function assessment should be considered in COVID-19 survivors.

Part of the solution: A survey of community organisation perspectives on barriers and facilitating actions to Advance Care Planning in British Columbia, Canada.

BACKGROUND: Despite the established benefits of Advance Care Planning (ACP), engagement remains low in British Columbia. Since 2016, a growing number of community-based nonprofits have offered ACP education. To date, no study has focused on the perspectives of nonprofits on ACP in British Columbia. OBJECTIVE: This study aimed to identify barriers and facilitating actions to ACP as perceived by British Columbian nonprofits. DESIGN: A mixed-methods design was used. Data were collected through online surveys and telephone interviews. SETTING AND PARTICIPANTS: Staff and volunteers from British Columbian nonprofits that are providing or interested in providing public education on ACP were recruited for this study. RESULTS: The lack of public awareness of ACP, the emotional difficulty of the conversation, the complicated ACP process, the belief that ACP is synonymous with completing a medical order form, the challenge of introducing ACP in different cultural contexts and the siloed approach to ACP education were rated as the most important barriers to ACP engagement. The most important facilitating actions were developing clear messages, improving ACP literacy, reframing ACP as part of life planning, simplifying ACP documentation and transfer, integrating ACP conversations into clinical practice and better collaboration between the health system and nonprofits. DISCUSSION: This study identifies numerous opportunities to improve ACP engagement in British Columbia from a community lens. To maximize ACP engagement, community-led ACP education should be offered in coordination with the health system. CONCLUSION: Community-led ACP education as well as collaboration and consultation with nonprofits are part of the solution to the low ACP engagement in British Columbia. PUBLIC CONTRIBUTION: Study participants, including staff and volunteers at nonprofits, are members of the public.

Impact of the COVID-19 pandemic on health-related quality of life and anxiety in pediatric hematology/oncology patients.

Since the World Health Organization declared the COVID-19 pandemic in March 2020, the strain on healthcare services affected patients suffering from various comorbidities and added to the psychological burden. The study aimed to assess the health-related quality of life (HRQoL) and anxiety levels of pediatric Hematology/Oncology patients during the COVID19 pandemic and evaluate the association between anxiety levels and physical, emotional, and social aspects of HRQoL. A cross-sectional study was conducted on 292 children between 2.5 - 13 years with chronic hematological/oncological disorders. Pediatric Quality of Life Generic Core Scale and Spence Children's Anxiety Scale were used for assessment of HRQoL and anxiety, respectively. Linear regression was performed to assess the association between background and COVID-19 related factors with anxiety level. Multivariate Analysis of Variance (MANOVA) was performed to assess the association between the three HRQoL dimensions with child anxiety and different independent variables. Transfusion-dependent patients had lower anxiety levels than patients receiving chemotherapy (B=-14.45, 95% CI=-21.94,-6.95).Children who were aware of the pandemic had lower anxiety scores than those who were not, while those suffering from canceled clinic days had higher anxiety levels (B=-8.66,95% CI=-14.86,-2.45, and B = 7.33,95% CI =1.22,13.45, respectively). Anxiety significantly reduced the three HRQoL domains (B=-0.36, 95% CI=-0.47, -0.24 for physical functioning, B=-0.45, 95% CI =-0.56, -0.33 for social functioning and B=-0.50, 95% CI=-0.63,-0.38 for emotional functioning). This study highlights the effect of the pandemic on the anxiety level and hence the HRQoL of chronic hematological/oncological pediatric patients for guiding policies and interventions to maintain their psychological well-being.

Impact of COVID-19 pandemic on rheumatoid arthritis from a Multi-Centre patient-reported questionnaire survey: influence of gender, rural-urban gap and north-south gradient.

During the coronavirus disease-2019 (COVID-19) pandemic there were several barriers to treatment access and medication adherence in rheumatoid arthritis (RA) patients. There is no information regarding the RA patient health status in Egypt during the COVID-19. Thus,the aim of this work was to study the impact of the pandemic on RA patients through a patient-reported questionnaire and to determine the influence of gender, geographic regions. This multi-centre study initiated by the Egyptian College of Rheumatology (ECR) was conducted on 1037 RA patients attending rheumatology clinics from 10 governorates. The questionnaire provided covered socio-demographic data, health/disease status, information/knowledge about COVID-19 and medical/family history of the infection. Patients mean age was 44.2 ± 12.3 years;855 females and 182 males; 539(52%) from rural and 497(48%) from urban areas. 41.8% reported a striking difficulty to obtain hydroxychloroquine during the pandemic. The majority (70%) considered maintaining a regular visit to the rheumatologist in addition to remote contact mainly by phone (44.4%) or via WhatsApp (33.1%), in particular among male and urban patients. Urban patients were more likely to be infected by COVID-19 (12.9% vs 6.2%; p < 0.0001) than rural. Northern cities had more patients with suspected COVID-19 (13.9% vs 6.1%; p < 0.0001); was significantly associated with more disease flares (30.8% vs 5.8%) with subsequent change in the RA treatment (20.9% vs 6.4%; p < 0.0001). Patients with RA faced remarkable difficulty to obtain their medications with subsequent change in their disease status. The challenges of the pandemic have hastened changes in the way we deliver health care.

Rheumatologists' practice during the Coronavirus disease 2019 (COVID-19) pandemic: a survey in Egypt.

The aim of this work is to trace how rheumatologists all over Egypt are approaching the COVID-19 pandemic and what changes it has brought about in the patients' care with special attention to its effect on vulnerable rheumatic disease (RD) patients. This survey further aims to help inform the rheumatology community about the changes in practice during the COVID-19 pandemic. The survey included 26 questions distributed to University staff members across Egypt members of the Egyptian College of Rheumatology (ECR). It takes 5-10 min to fill out. The practice setting of participating rheumatologists included University Teaching Hospitals that are the main rheumatology and clinical immunology service providers for adults and children RD patients. There was an overall agreement across the country in the responses to the survey that took a median time of 7 min to fill in. Potential changes in rheumatology outpatient practice by staff members evolved since the COVID-19 pandemic. None of the university rheumatology staff members has prescribed chloroquine or HCQ to prevent or treat COVID-19 in a non-hospitalized patient who was not previously on it. Twenty-three recommended decrease/avoid NSAIDs if the RD patient had confirmed COVID-19 or symptoms. There is an agreement to the key emerging frontline role of rheumatologists in treating COVID-19. During the pandemic, RD cases requiring admission were dealt with by several modified strategies. The overall agreement among the different university rheumatology departments during such critical situation has provoked the ECR to consider providing provisional guidelines for dealing with RD patients during this global catastrophe.