Mixed-methods Feasibility Trial of an Adaptive Electronic Learning Curriculum for Tanzanian Pediatric Health care Workers in the Time of COVID-19

Background: Millions of children in low- and middle-income countries (LMICs) die each year from preventable illness. Evidence-based guidelines (EBGs) from the World Health Organization reduce this amenable burden of disease, but utilization among healthcare workers is variable. Existing inperson training strategies like Emergency Triage Assessment and Treatment (ETAT) improve provider knowledge, adherence to EBG, and patient outcomes but are limited by labor intensity and implementation costs. Leveraging increasing mobile internet access in LMICs could speed dissemination of EBG to medical providers in a way that overcomes the limitations of in-person training. Adaptive electronic learning (AEL), which uses digital algorithms to deliver custom activities to individual learners, is shown to outperform traditional training among healthcare workers in high-income countries but is yet to be evaluated in LMICs. We propose to address the existing gap in LMIC healthcare worker training through a mixed-methods feasibility trial of an AEL curriculum designed to deliver EBG training to medical providers in Tanzania. Methods: Curriculum development: We sought to create a multi-module AEL course addressing context-specific gaps in healthcare worker training. A review of leading regional causes of pediatric mortality was performed to identify priority content areas. Source material was. selected to reflect EBG use at our study site. Training modules were created by pediatricians with expertise in both AEL and EBG. Module approval occurred through an iterative process of review by local stakeholders and international EBG experts. Mixed-methods feasibility trial: We are undertaking a parallelgroup, double-blinded randomized trial to evaluate our AEL curriculum (Figure 1). 30 medical interns will be randomized to either an adaptive or a non-adaptive electronic learning curriculum. The primary outcome is knowledge acquisition, defined by standard mean difference in pre- and postknowledge assessments scores between groups. Qualitative evaluation of the implementation process will be based on normalization process theory. All aspects of recruitment, quantitative, and qualitative data collection will be done remotely in accordance with local social distancing standards and international travel restrictions. Results: Curriculum publication: Our process of content identification, topic selection, and module development yielded an 11-module AEL curriculum. Priority content areas include the triage of acutely-ill children as well as the assessment, diagnosis, and management of pediatric pneumonia and hypovolemic shock based on current World Health Organization and Tanzanian guidelines (Figure 2). Mixed-methods feasibility trial: At present, we have enrolled 17 medical interns. Pre-knowledge assessment scores range from 6-60%. One intern has completed the curriculum to date and experienced a 30% increase in knowledge. Conclusion: We expect to complete this feasibility trial by August of 2021. Findings will inform the design of a large-scale implementation trial that will support the development of innovative solutions and low-cost implementation strategies for improving the care of seriously-ill children worldwide.

[Urologic cancer care during the first wave of the COVID-19 pandemic : Role of federal cancer registration in Germany]. / Uroonkologische Therapie in der ersten Welle der COVID-19-Pandemie : Was sagen uns die Krebsregister der deutschen Bundesländer?

Urologic cancer care needs to be prioritized despite multiple health care restrictions during the coronavirus disease 2019 (COVID-19) pandemic. However, therapies and procedures may be delayed and complicated. In Germany, analysis of the multiple cancer registries provides insights into the actual numbers of treated patients. We provide a review on the registration of urologic cancer care during the first wave of the COVID-19 pandemic in Germany and on potential surgical complications of urologic interventions. We found that during the year 2020 there were generally fewer registrations of newly diagnosed patients with major urologic neoplasms in a representative federal database. The number of surgical interventions in patients with renal cell carcinoma and urothelial bladder cancer decreased, whereas equal numbers of radical prostatectomies were performed when compared to the year 2019. COVID-19 may increase non-urological postoperative complications following surgical treatment of urologic malignancies; however, available data are still very limited.

Téléconsultation médicale en audiologie. Conseils de bonnes pratiques de la Société française d’audiologie (SFA) et de la Société française d’ORL et de chirurgie cervico-faciale (SFORL)

Résumé Objectifs Durant l’épidémie de Covid-19, l’accès au diagnostic et aux soins des pathologies relevant de l’audiologie médicale a régressé en France, posant un risque de perte de chance pour le patient. Ce guide de conseils de bonne pratique vise à répertorier les solutions techniques existantes permettant d’examiner à distance le patient présentant une plainte en audiologie et à décrire leurs intérêts et, le cas échéant, leurs limites. Méthodes Les conseils ont pu être élaborés à la fois à partir de l’expérience clinique des experts médicaux ayant participé à la rédaction du guide, et d’une revue extensive de la littérature portant sur les recommandations de pratique clinique en télé-audiologie. Les solutions de télé-audiométrie ont été recensées sur la base d’une requête par moteur de recherche effectuée en avril 2020, avant vérification de leur disponibilité sur le marché européen. Résultats Des solutions de vidéo-otoscopie permettent la télé-transmission d’images compatibles avec un diagnostic de qualité soit en se connectant via internet à une plate-forme de télé-soin, soit via un smartphone ou une tablette utilisant un système d’exploitation iOS ou Androïd. Selon les mêmes modalités, il est possible de réaliser à distance un examen audiométrique tonal dans les règles de l’art, une audiométrie vocale dans le silence ou dans le bruit ainsi que des explorations fonctionnelles objectives de l’audition. Les examens cliniques et paracliniques peuvent être consultés par le médecin de façon différée pour être interprétés (télé-audiologie asynchrone). Ils peuvent aussi être réalisés en temps réel chez un patient, à tout âge de la vie, à condition qu’un aidant puisse être présent durant l’installation des transducteurs ou la réalisation de l’acoumétrie (télé-audiologie synchrone). Les solutions de téléaudiologie trouvent également une application dans la formation à distance des futurs professionnels de santé engagés dans la prise en charge des pathologies de l’audition. Conclusion Dans la législation française, la télé-otoscopie est un acte médical qui relève soit de la télé-expertise (avis asynchrone) soit d’un acte de téléconsultation (avis synchrone). L’évaluation subjective et objective de la fonction auditive du patient est aujourd’hui possible à distance à condition de respecter les précautions listées.

Telemedicine in Audiology. Best practice recommendations from the French Society of Audiology (SFA) and the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL).

OBJECTIVES: Access to diagnosis and treatments for auditory disorders and related pathologies has regressed in France during the COVID-19 pandemic, posing a risk to the patient's chance of recovery. This best practice recommendations guide aims to list the existing technological solutions for the remote examination of a patient with hearing complaint, and to outline their benefits and, where applicable, their limitations. METHODS: The recommendations were developed both from the clinical experience of the medical experts who drafted the guide, and from an extensive review of the literature dealing with clinical practice recommendations for tele-audiology. Tele-audiometry solutions were identified on the basis of a search engine query carried out in April 2020, prior to verification of their availability on the European market. RESULTS: Video otoscopy solutions allow for the teletransmission of images compatible with a high-quality diagnosis, either by connecting via internet to a tele-health platform or using a smartphone or a tablet with an iOS or Android operating system. Using the same telecommunication methods, it is possible to remotely conduct a pure-tone audiometry test in accordance with standard practice, a speech-in-quiet or a speech-in-noise audiometry test, as well as objective measures of hearing. Clinical and paraclinical examinations can be accessed by the physician to be interpreted on a deferred basis (asynchronous tele-audiology). Examinations can also be conducted in real time in a patient, at any age of life, as long as a caregiver can be present during the installation of the transducers or the acoumetry. Tele-audiology solutions also find application in the remote training of future healthcare professionals involved in the management of deafness and hearing impairment. CONCLUSION: Under French law, tele-otoscopy is a medical procedure that is either a tele-expertise (asynchronous adive) or a teleconsultation act (synchronous advice). Subjective and objective evaluation of the patient's hearing functions can be done remotely provided that the listed precautions are respected.