Low- and mid-level equine assisted services improved mood and state anxiety levels in health-care workers

The aim of this study was to measure the effect of equine assisted services (EAS) on mood and anxiety in health-care workers. While the emotional toll of the COVID-19 pandemic has been felt in every aspect of our society, health-care workers have been hit especially hard. A survey conducted by Mental Health America during June - September in 2020, found 93% of health-care workers were experiencing stress and 86% reported experiencing anxiety. There is research to support a wide range of interventions to address stress, low mood, and anxiety, including pharmaceuticals, physical exercise, and animal interaction. While several studies have shown an improvement in anxiety and mood after interaction with horses, few studies have included a physically active control group to consider the effect of exercise on results. In this study conducted in October 2021, participants were recruited from area hospitals and randomly assigned to a control group (30-min guided walk with no horse interaction, n = 17), a low level EAS group (30-min self-guided farm tour, n = 20), or a mid-level EAS group (30 min of grooming a horse, n = 19). Before the intervention, participants completed a demographic survey. Pre and post activity, participants completed the Brief Mood Introspection Scale (BMIS) and State Anxiety Inventory for AdultsTM that measured currentfeelings of mood and anxiety, respectively. Data were analyzed using the repeated measures one-way ANOVA procedure in SPSS. This study was approved by the MSU Human Research and Protection Program and the Institutional Animal Care and Use Committee. Fifty-six health-care workers participated in the study, with 32% having worked in health care for less than 5 years and 33.9% having worked in health care for over 20 years. All participants had a significant improvement in State-Anxiety scores after completing their group activity (P < 0.001), with no differences among groups. Similarly, all groups had an improved BMIS score (P < 0.001). However, there was significantly greater improvement in BMIS scores in the mid-level EAS (P < 0.01) when compared with the control group. While all participants in this study improved both their current feelings of anxiety and mood after completing an activity on the farm, there was a greater improvement in mood in those individuals who spent 30 min grooming a horse when compared with the walk group without horse interaction. The results from this study provide further support for the impact of equine assisted services as a means of improving mood.Copyright © 2023

Developing students' self-regulation skills within and outside academic modules

COVID-I9 has accelerated the adoption of online learning, and the authors' university (like many others) is settling into a blended learning approach. In this chapter, the authors share their experiences in improving students' self-regulation of online learning. The first learning experience for most students at the Singapore Institute of Technology is in online, self-paced courses in Mathematics, Physics, and Chemistry. Beyond content, these courses provide students opportunities to embrace the 'norm' of self-paced, self-directed online learning and to expose and encourage them to develop self-regulation skills. Students are required to self-assess and refer to different learning resources independently, based on their identified needs. The authors have also developed another intervention based on Zimmerman's self-regulated learning model, guiding students to plan, monitor, and adjust their learning plans and develop self-efficacy through this process. For students to transfer these skills into their actual studies, the authors provide individual coaching sessions to facilitate students' implementation. © 2023, IGI Global.

Development of a Questionnaire on Access to Sickle Cell Disease Care in the Indigenous Tharu Population of Nepal

Purpose of Study Sickle cell disease (SCD) disproportionately affects the Tharu population of Nepal, a marginalized indigenous group concentrated in the Dang district. SCD is a structural hemoglobinopathy resulting in abnormal red blood cells with a tendency to occlude microvasculature. Since 2015, University of British Columbia medical students and a local community partner, Creating Possibilities, have improved access to SCD screening and diagnosis for the Tharu population. However, interviews conducted in 2016- 2017 found that SCD-afflicted community members encounter a number of challenges to obtain treatment once diagnosed. The purpose of this study was to develop a questionnaire on barriers to accessing SCD care in this community. Methods Used The Barriers to Accessing SCD Care Questionnaire was developed from items in existing scales, deductive and inductive item generation, and feedback from expert local partners. Reviewing literature on barriers to accessing healthcare in the Western region of Nepal informed region-specific questionnaire items, while literature on accessing SCD treatment in resource-limited settings informed SCD-specific questionnaire items. We also reviewed the literature on barriers to treatment for various stigmatized chronic health conditions in low-resource settings. Summary of Results Qualitative interviews with SCD-afflicted Tharu individuals in 2016-2017 identified inadequate local medical resources, transportation, financial strain, and limited awareness as barriers to care. Based on the literature review, we organized all survey items under the themes transportation, medical infrastructure, finances, community attitudes, and personal attitudes. The questionnaire includes closed-ended questions using a Likert scale, as well as open-ended interview prompts. It was made in collaboration with local community members to ensure it is culturally appropriate, needs-specific, and easily understandable. The questionnaire received ethics board approval, and interviews will begin once local health authorities lift COVID-19 restrictions. Conclusions Results from the Barriers to Accessing SCD Care questionnaire will guide future community-based interventions.

University of British Columbia Nepal Sickle Cell Project Status Report 2015-2020

Purpose of Study In 2015 the University of British Columbia partnered with Creating Possibilities (CP), a charitable organization located in Dang, Nepal. Each year, a team of medical students is sent to assist CP in the long term management of sickle cell disease (SCD) in rural Western Nepal. Due to COVID-19 limitations, we were unable to travel to Nepal this year for the field component of our project. Instead, we took this opportunity to reflect on the project as a whole and create a project status report, outlining the past five years of work. The purpose of this report included: summarizing overall project progress, identifying future project directions, and improving communication amongst project stakeholders. Methods Used To create the project status report, our team reviewed all project documents since 2015. We also conducted virtual interviews with previous team leads to clarify questions and fill in gaps. Project progress was assessed by comparing activities completed to date to the project's initial three main objectives. Summary of Results The first objective of characterizing the prevalence of SCD among the Tharu population is currently ongoing. Since 2015, we have conducted large-scale screening of the Tharu population, with 4483 individuals having been screened by our team. Thus far, a hemoglobin S prevalence of 9.3% has been estimated. Our second objective of identifying barriers to SCD management is also ongoing. Since 2016, yearly focus groups and needs assessments have been conducted with community members and health workers. Common themes of barriers included accessibility, financial limitations, and education. Finally, our third objective of implementing sustainable solutions for long term detection and management of SCD still needs to be addressed. Conclusions Screening and needs assessments will continue as we progress toward addressing our first two objectives. Following consultation with experts and a literature review, we have identified a pilot newborn screening program for SCD as the first step in addressing our third objective.

Prolonged Viable Viral Shedding in Immunocompromised Patients with Covid-19

Background: Immunocompromised patients with COVID-19 tend to shed viable virus for a prolonged period. Therefore, for moderately or severely immunocompromised patients with COVID-19, CDC recommends an isolation period of at least 20 days and ending isolation in conjunction with serial testing and consultation with an infectious disease specialist. However, data on viral kinetics and risk factors for prolonged viral shedding in these patients are limited. Method(s): From February 1, 2022 to April 1, 2022, we collected weekly saliva samples from immunocompromised patients with COVID-19 admitted to a tertiary hospital in Seoul, South Korea. Genomic and subgenomic RNAs were measured, and virus culture was performed. Result(s): A total of 41 patients were enrolled;29 (70%) were receiving chemotherapy against hematologic malignancies and the remaining 12 (30%) had undergone solid organ transplantation. Of the 41 patients, 14 (34%) had received 3 doses or more of COVID-19 vaccines. Real-time RT-PCR revealed that 7 (17%) were infected with Omicron BA.1, and 33 (80%) with Omicron BA.2. The median duration of viable virus shedding was 4 weeks (IQR 3-6). Patients undergoing B-cell depleting therapy shed viable virus for longer than the comparator (p=0.01). Multivariable analysis showed that 3-dose or more vaccination (HR 0.33, 95% CI 0.12 - 0.93, p = 0.04) and B-cell depleting therapy (HR 12.50, 95% CI 2.44 - 100.00, p = 0.003) independently affected viable virus shedding of SARS-CoV-2. Conclusion(s): Immunocompromised patients with COVID-19 shed viable virus for median 4 weeks. B-cell depleting therapy increases the risk of prolonged viable viral shedding, while completion of a primary vaccine series reduces this risk. Overall distribution of samples according to genomic viral copy number and culture positivity. Red dot indicates positive culture results, whereas blue dot indicated negative culture results. (Figure Presented).

Impact of Covid Vaccination on Hospitalized Covid-19 Patients - a Renal and Extra-Renal Outcome Study

Introduction: Covid-19 vaccinations are effective as preventive measures against the COVID-19 pandemic infection. There are different types of COVID-19 vaccines available worldwide. The impacts of different types COVID-19 vaccination on hospitalized patients remained uncertain at the early stage of the outbreak. This study examines the clinical outcomes of vaccinated and vaccine naive hospitalized COVID-19 patients. Method(s): This is a retrospective study of hospitalized COVID-19 patients admitted into University Malaya Medical Center from January 2021 until June 2021. Data on patients who were>= 18 years old and hospitalized for >= 48 hours for confirmed COVID-19 infection were captured. Clinical parameters and demographic of patients were collected from electronic medical records (EMR). Vaccine status was determined based on EMR entry and retrospective phone interviews. 2 cohorts of patients were classified based on their COVID vaccination status, and outcome analysis was done with appropriate statistical methods. Result(s): A total of 1529 patients were captured with a male-to-female ratio of 759 (49.6%) and 770 (50.3%). The median age was 55 (IQR: 36-66). 182 patients (12%) received COVID-19 vaccination before admission. The types of COVID vaccination received by patients were Pfizer (n=127;8.4%), AstraZeneca (n=27;1.8%), and Sinovac (n=28;1.8%) respectively.107 patients (7.1%) received two doses of vaccine, 72 patients had one dose (4.7%), and three were injected with three doses (0.2%). Biochemical analysis showed that the vaccination naive group has a higher median of lymphocyte counts (17 vs. 2.02;p<0.001), ferritin (363 vs 221;p=0.001), serum creatinine (67 vs 63;p=0.032). Renal outcome data revealed that unvaccinated patients had more incidence of acute kidney injury (AKI) (92.9% vs 7.1%;p=0.002) and increased level proteinuria (88.5% vs 11.5%;p= 0.011). Covid-19 vaccination group had lower incidence rate of pneumonia (8.9% vs 91.1%;p<0.001), lower ventilator use (4.8% vs 95.2%;p=0.01), and lower ICU admission (5.1% vs 94.9%;p<0.001) compared to vaccine-naive group. The mortality rate was lower 5.2% (n=7) in COVID-19 vaccination compared to 94.8% (n=127) vaccine-naive group;p=0.012. [Formula presented] Conclusion(s): In our study, COVID-19 vaccination effectively lowered the incidence of AKI, pneumonia, ICU admission, and mortality translating to better overall outcome. No conflict of interestCopyright © 2023

Aki in Hospitalized Covid-19 Patients- an Epidemiology Study in a Tertiary Center

Introduction: Coronavirus disease 2019 (COVID-19) related acute kidney injury (AKI) is a recognized complication of the disease and may result in high morbidity and mortality rate. The reported incidence and outcome vary worldwide. This study aimed to assess the AKI rate in hospitalized COVID-19 patients and identify risk predictors/prognosticator associated with the complication. Method(s): This is a retrospective study of hospitalized COVID-19 patients at the University Malaya Medical Center admitted from January 2021 until June 2021. Data on patients who were>= 18 years old and hospitalized for >= 48 hours for confirmed COVID-19 infection were captured. Clinical parameters and demographic of patients were collected from electronic medical records. The staging of AKI was based on criteria as per KDIGO guidelines. Result(s): A total of 1529 patients were found to have fulfilled the criteria for the study with a male-to-female ratio of 759 (49.6%) to 770 (50.3%). The median age was 55 (IQR: 36-66). 500 patients (32.7%) had diabetes, 621 (40.6%) had hypertension, and 5.6% (n=85) had pre-existing chronic kidney disease (CKD). The incidence rate of AKI was 21.1% (n=323). The proportion of different AKI stages of 1,2 and 3 were 16.3%, 2.1%, and 2.7%, respectively. A total of 15 hospitalized patients (0.98%) needed dialysis. 190 patients (58.8%) of AKI group had complete recovery of renal function. Demographic factors that were associated with an increased risk of developing AKI included: age (p< 0.001), diabetes (p<0.001), hypertension (p<0.001), CKD (p<0.001) and vaccination status (p=0.002). Analysis of biochemical parameters in AKI cohort revealed statistically significant lower lymphocytes & platelet counts, higher ferritin levels, and poorer renal function (creatinine based)) compared with the non-AKI cohort. Outcome analysis in our cohort revealed that AKI was associated with prolonged hospitalization (p<0.001) and higher mortality rates with P< 0.001). [Formula presented] Conclusion(s): AKI is a common complication among hospitalized COVID-19 patients. The increased risk was associated with underlying comorbidities and had an adverse outcome on patient morbidity and mortality. No conflict of interestCopyright © 2023

Bluetooth Technology, Smart Phone Application and Remote Diabetes Management in Reduction of Hba1c in Type 2 Diabetes Mellitus Patients on Intensive Insulin Regimen (Cloud-Dm Study)

Background and Aims: The burden of uncontrolled DM amongst insulin users in Malaysia is great. Structured Self- Monitoring of Blood Glucose (SMBG) that are stored in cloud, simplified into visual charts, graphs coupled with a diabetes management system (DMS) that allows remote insulin titration can lead to improvement of glycemic control. Method(s): 124 Type 2 DM outpatients with HbA1C > 8% on intensive insulin therapy were recruited in this 26 weeks, multicenter, double arm, randomized controlled study. The patients were randomized to control arm which used traditional logbook and intervention arm which received remote insulin titration with a Bluetooth glucometer coupled with a DMS. The primary objective was to compare reduction of HbA1C and the secondary objective was to compare the change in Diabetes Distress Scale (DDS) between the control and intervention arm. Result(s): There was significantly higher mean reduction of HbA1C in the intervention group ;-2.016+/-1.60 versus - 1.326+/-1.51 in the control group (p = 0.027) by week 14 and was maintained till Week 26. There was no significant difference between the reduction of DDS between both groups. The mean frequency of SMBG in the intervention group was significantly higher than the control group;339.656+/-171.14 (intervention) versus 216.716+/-96.40 (control) [p < 0.001]. Conclusion(s): Remote insulin titration has been proven effective especially during COVID-19 whereby there was imminent need for reduction of physical visits to the hospital. This has led to improvement of glycemic control but could translate to lesser waiting time and reduction of cost in the long term.

ISSUES AND WAY FORWARD FOR THE SMART SUSTAINABLE CITIES AND COMMUNITIES STANDARDS: THE MALAYSIAN CASE IN THE POST-COVID-19 ERA

Governing a city's development with the use of standards started relatively recently, in the mid-2010s. However, the issues of such city standards in systematically governing future smart cities remains largely unknown under the digital infrastructural stress of the post-COVID-19 era. Therefore, this paper aims to examine the issues and directions in developing the Malaysian smart sustainable cities and communities standards that suit the post-COVID-19 era. This study applied the multiple case study method to compare the international literatures and the local smart city webinars. The results showed that smart city standards were welcomed by policymakers and practitioners, although issues such as learning, connectivity, and citizenship rationale need to be addressed. More focus should be put on how humans relearn and responsibly participate in the post-COVID-19 cyber-physical ecosystem in order to create a healthy and sustainable digital-based society. This paper has contributed as one of the first researches examining the role of smart city standards in Malaysia. © 2022 by MIP.

Empirical Study of U-Net Based Models for 2D Face Recovery from Face-Mask Occlusions

Human face related digital technologies have been widely applied in various fields including face recognition based biometrics, facial landmarks based face deformation for gaming, facial reconstruction for those who are disfigured from an accident in the medical field and others. Such technologies typically rely on the information of a full, uncovered face and their performance would suffer varying degrees of deterioration according to the level of facial occlusion exhibited. 2D face recovery from occluded faces has therefore become an important research area as it is both crucial and desirable to attain full facial information before it is used in downstream tasks. In this paper, we address the problem of 2D face recovery from facial-mask occlusions, a pertinent issue that is widely observed in situations such as the Covid-19 pandemic. In recent trends, most researches are carried out through deep learning techniques to recover masked faces. The whole process consists of two tasks which are image segmentation and image inpainting. As U-Net is a typical deep learning model for image segmentation, but it also helpful in image inpainting and image colorization, so it has been frequently used in solving face recovery problems. To further explore the capability of U-Net and its variants for face recovery from masked faces, we propose to conduct a comparative study on several U-Net based models on a synthetic dataset that was generated based on public face datasets and mask generator. Results showed that Resnet U-Net and VGG16 U-Net had performed better in face recovery among the six different U-Net based models. © 2022 IEEE.

Qualitative exploration of the physical activity engagement among college students with intellectual disabilities

Higher education institutions today have offered a range of postsecondary transition programs for adults with.intellectual disabilities (ID). Applying the social-ecological framework, this study was aimed to analyze qualitative data about the experiences and perceptions of physical activity (PA) among eight college students with ID at a post-secondary transition program in the United States. The phenomenological approach was utilized to describe participants' lifeworld experience of PA. Results indicated that the most PA opportunities on campus merely derived from the availability of adapted programs. Only one participant met the minimum requirement of engaging moderate-intensity exercise weekly. Based on the analysis using the social-ecological framework, the results include twelve themes at the intrapersonal level (self-efficacy, personality, emotion, past experiences, knowledge, and time), interpersonal level (family support and friend support), and institutional level (specifically, university recreation center, available adapted programs, adverse weather, and COVID effect) that influenced their PA participation. The current transition program seemed to promote sedentary behaviors during school hours. Strategies to enhance PA engagement for this population should include increasing students and parents' knowledge of PA and health, providing adequate social support from college mentors and more adapted PA opportunities and alternative options on campus. These recommendations could boost PA self-efficacy and overcome barriers at multiple levels in students with ID.Copyright © The British Society of Developmental Disabilities 2023.

Pathophysiologic mechanism for MYOcarditis in COVID-19 VAccinations ('MYOVAx' Study)

Objective: This is the first prospective cohort study in Singapore to investigate the COVID-19 vaccine-associated myocarditis to understand its pathophysiology. Introduction: Acute myocarditis and other cardiovascular symptoms have been observed to be associated with the two mRNA-based coronavirus disease 2019 (COVID-19) vaccines-namely Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273)-currently in-use in Singapore. The mechanisms through which myocarditis occurs are unknown, hence our study aims to understand the pathophysiology of myocarditis associated with COVID-19 vaccines. Method(s): Patients with onset of cardiac manifestations were recruited from multiple hospital outpatient clinics between November 2021 and September 2022. Clinical history and physical examination data was collected with blood sample collection, echocardiography, 12-lead electrocardiogram (ECG), coronary angiography and magnetic resonance imaging (MRI) at recruitment and 6-month follow-up. Analysis of biomarkers, genetic, serological and MRI data was conducted. Result(s): As of 6 September 2022, a total of 5 patients have been enrolled (4 males, 1 female). The most commonly reported symptoms across all patients were chest pain/discomfort (80%), followed by palpitations (40%). MRI evidence of myocarditis has been detected in 2 (50%) of the male patients, of which both reported two or more symptoms occurring 1-2 days post-vaccination. Both patients have each received at least two doses of either the Pfizer-BioNTech BNT162b2 vaccine or Moderna mRNA-1273 vaccine. Their MRI findings were consistent with myocarditis. On late gadolinium enhancement (LGE) imaging, epicardial enhancement at the basal inferolateral segment and mid-wall enhancement at the apical anterior, lateral and inferior walls were observed in one patient. Patchy, mid-wall LGE in the basal inferior/inferolateral wall was observed in the other patient. No MRI evidence of myocarditis was available for the sole female patient. Conclusion(s): While more data is needed to definitively prove the association of the two mRNA-based Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273 COVID-19 vaccines with post-vaccination myocarditis, we believe our findings may support further investigations to enable risk stratification for vaccine-associated myocarditis and identify potential preventative strategies accordingly.

Data-informed building energy management (DiBEM) towards ultra-low energy buildings

To support building operations in reaching ultra-low energy targets, this paper proposes a data-informed building energy management (DiBEM) framework to improve energy efficiency systematically and continuously at the operation stage. Specifically, it has two key features including data-informed energy-saving potential identification and data-driven model-based energy savings evaluation. The paper demonstrates the proposed DiBEM with a detailed case study of an office and living laboratory building located in Cambridge, Massachusetts called HouseZero. It focuses on revealing the performance of the energy-efficient interventions from two-years' building performance monitoring data, as well as evaluating energy savings from the interventions based on the data-driven approach. With Year 1 as baseline, several interventions are proposed for Year 2 including improvements to controls and operation settings, encouragement of occupants' behavior for energy savings, and hardware retrofitting. These were deployed to heating/cooling, domestic hot water, lighting, plug and other loads, and photovoltaic (PV) systems. To quantify the impacts of different interventions on energy end uses, several data-driven models are developed. These models utilize linear regression, condition model, and machine learning techniques. Consequently, the heating/cooling energy consumption that was already ultra-low in Year 1 (12.8 kWh/m2) is further reduced to 9.7 kWh/m2 in Year 2, while the indoor thermal environment is well maintained. The domestic hot water energy is reduced from 2.3 kWh/m2 to 1.2 kWh/m2. The lighting energy is only increased from 0.3 kWh/m2 in pandemic operations without occupancy in Year 1 to 0.8 kWh/m2 in partial normal operations in Year 2, while the indoor illuminance level meets occupants' requirements. Combined with other relatively constant loads and the reduction of plug and other loads due to COVID building operation restrictions, the total energy use intensity is thereby reduced from 54.1 kWh/m2 to 42.8 kWh/m2, where 5.4 kWh/m2 of energy reduction for Year 2 is estimated to be contributed by the energy-efficient interventions. PV generation is 36.1 kWh/m2, with an increase of 1.4 kWh/m2 from a new inverter. In summary, this paper demonstrates the use of DiBEM through a detailed case study and long-term monitoring data as evidence to achieve ultra-low energy operations. © 2022 Elsevier B.V.

Growth hormone deficiency and SHOX variants present in 2 siblings short for the family target

P1 was referred with short stature aged 2.4 yrs (HtSDS -2.1). Mother's height 165cm (+0.5 SD), father's 185cm (+1.55 SD). Growth hormone (GH) deficiency was diagnosed following two GH stimulation tests (peak GH 6.8 ng/ml at 3.2 yrs, 5.17 ng/ml at 3.7 yrs) IGF1 4.6 nmol/L (1.7-27.6) at 2.5 yrs. Pituitary MRI was normal. GH treatment was started at 5 years at HtSD -2.2. Once P1 demonstrated catchup growth (up one centile in 7 months), P1's older sister P2 was referred for investigation of short stature (HtSDS -1.5). She was not dysmorphic but her mother noted antenatal scans had short foetal femur lengths on the 5th centile. Birth weight was on the 10th centile at 2.65kg at 38 weeks gestation. Short stature was present from age 3 with height tracking along the 2nd centile. Her GH was 7.17 ng/ml at time 0 on a growth hormone stimulation test, IGF1 25.9 nmol/L (3.1 - 51.9). This was performed during the COVID pandemic and could not be repeated. It was felt that GH deficiency was unlikely so a skeletal survey was requested. This showed mild Madelung deformity and short 4th/5th metacarpals. Subsequent SHOX analysis revealed that she was heterozygous for 2 SHOX dosage abnormalities in cis. The first was a deletion located between 133 kb and 163 kb downstream of the SHOX gene. The second was a duplication that included the final exons of the SHOX gene (exons4-6a). Family testing revealed the same SHOX variants in P1's father, who was the smallest in class in early childhood and had grown late into adulthood, reaching a tall final height at aged 21. Mother and P1 did not have these SHOX variants. P1 has demonstrated excellent catch-up growth on GH treatment, HtSDS +0.4. IGF1 36.5 nmol/L (2.7-45.5) at 7.3 years. P2 has been on GH treatment for over a year, latest HtSDS - 1. Conclusion(s): Both siblings were short for the family target. Following a diagnosis of GH deficiency in one sibling, the investigative pathway for the other was assumed. Routine karyotype was performed after GH stimulation test with SHOX analysis requested after the skeletal survey report. The siblings' father has the same SHOX variants as P2 and is tall. Biological effects of SHOX deletion appears to be variable in this family and is present in P2 radiologically. The duplication is of uncertain significance.

Changing Undergraduate Medical Students' Perception of Online Learning and Assessment During the Covid-19 Pandemic: a One Year Follow-up Study

Introduction: Like most educational institutions, our medical school transitioned to online learning during the COVID-19 pandemic in March 2020. An initial survey of 192 undergraduate medical students conducted in June 2020 revealed a low acceptance of online assessments, lack of work-readiness, perception of online discussions as being inferior to face-to-face, and prevalent anxiety. Following this, we implemented pedagogic changes to encourage independent learning, improve patient contact, and increase social interactions between students. Methods: A follow-up study was conducted 12 months later in the same student population, excluding those who had graduated. The same 14-item anonymized survey questionnaire was administered, and comparisons were made between the follow-up and initial responses. Results: At follow-up, 45.6% of participants felt that online assessments can adequately and fairly assess students' performance compared to the initial study (26.2%, p = 0.002). Participants at follow-up were generally more agreeable that discussion using an online learning platform was as effective as face-to-face learning compared to before (p = 0.017). Subgroup analysis showed that this was only true for Year 2 - 4 students. Year 5 students perceived online learning as less effective then face-to-face, reported lower confidence in their ability to apply their knowledge, and an increased in anxiety compared to before. Conclusion: While perception of online learning and assessment had improved at follow-up, the ramifications from restrictions to medical education over the past two years are now being felt most severely by the current final year students, emphasizing the importance of anticipating and addressing these concerns much earlier. © 2022 UPM Press. All rights reserved.

Outcomes of a "hospital at home” programme for the supervised home recovery of COVID-19 patients in Singapore

Background: The Singapore General Hospital COVID-19 Virtual Ward is a "hospital at home” (HaH) programme for the supervised home recovery of higher-acuity COVID-19 patients from the hospital and the community. Objective: To describe how an existing HaH programme was redesigned so that COVID-19 patients could be remotely monitored at home and report the outcomes of the first 100 patients in this Virtual Ward. Methods: Patients received an admission package comprising instructions and equipment for home monitoring, and uploaded their parameters into a clinical dashboard via a secure messaging app. Medical staff conducted video or telephone consultations daily. Patients were discharged according to time-based criteria, although some required SARS-CoV-2 PCR testing, which were conducted at home by a third-party medical provider. De-identified data of the first 100 patients were analysed by demographic details, indication for enrolment into the Virtual Ward, and the need for subsequent inpatient readmission. Results: Of the first 100 patients admitted into the Virtual Ward, 58 were female, mean age was 63.1 years old (23–95 years), and 76 were fully vaccinated. There were 77 hospital referrals and 23 community referrals. The number of days of inpatient hospitalisation avoided was 717 days (average of 7.9 days per patient). Three hospital referrals (3.9%) were readmitted, while seven community referrals (30.4%) required subsequent hospitalisation. Conclusion: The Virtual Ward programme demonstrates that selected COVID-19 patient can safely recover at home with remote medical support and monitoring, thereby expanding hospital capacity.

Using the technology acceptance model to examine acceptance of telemedicine by cancer patients in an ambulatory care setting

Background: Telemedicine has demonstrated benefits for cancer patients including the potential to improve care coordination and patient outcomes. Since June 2020, teleconsultations have been implemented in the National Cancer Centre Singapore. Objective(s): This study aims to assess cancer patients acceptance of telemedicine as a complement to traditional in-person care and identify factors affecting their acceptance. Method(s): An online self-administered questionnaire was designed using a modified technology acceptance model (TAM) previously validated to predict acceptance of telemedicine by patients and factors affecting acceptance. Descriptive statistics were used to summarise data on demographic factors and TAM construct scores. Univariate and multivariate logistic regression were used to determine how demographics factors and TAM constructs influenced acceptance. Result(s): Respondents (n = 278;mean age 59 years) were mostly female (67.6%), Chinese (86.3%) and received parenteral chemotherapy (72.6%). Technology access and confidence were generally moderate to high, while past telemedicine use was low (18%). Overall, more than half (59.7%) expressed acceptance. The odds of acceptance were significantly higher if respondents agreed that their healthcare access would improve by using telemedicine (OR 4.17, 95% CI 1.71-10.16) or they would have the necessary resources for using telemedicine (OR 4.54, 95% CI 2.30-8.97). Conclusion(s): Acceptance of telemedicine was high amongst respondents. Facilitating conditions such as having necessary resources and perceived improved access were identified as main predictors of high acceptance. Telemedicine services should work to improve these aspects, leverage on advantages and address disadvantages brought up by patients. Copyright © The Author(s) 2022.