A Comparison Between In-Person and Virtual OSCE on Advanced Communication Skills for Senior Medical Students (Sci200)

Outcomes: 1. Evaluate the effectiveness of a virtual communication workshop in comparison to prior in-person format. 2. Gauge medical students' level of emotional support during an advanced communication workshop in the virtual setting. Introduction: Medical schools rapidly adopted virtual learning in response to the COVID-19 pandemic. Many descriptions of virtual objective-structured clinical examinations (OSCE) have been published;however, there have been no studies comparing the effectiveness of in-person and virtual formats for medical students. Method(s): The investigators revised a previously conducted workshop from in-person to virtual format. The workshop is a five-station formative OSCE focused on advanced communication skills for senior medical students. After each station, examinees completed a self-assessment checklist (Communication Behavior Checklist;CBC) and received checklist-based assessments (CBC and modified Master Interview Rating Scale;mMIRS) from two same-level peers. Afterward, a faculty-led debrief was performed to review clinical cases, emotional responses, and student questions. A post-OSCE survey based on one collected after the prior in-person OSCE was distributed to students. Result(s): Eighty-three students participated in the virtual OSCE. Overall, CBC scores were lower in the virtual OSCE compared to in-person (p<0.05). There was no difference in mMIRS scores between virtual and in-person OSCE. Sixty-seven out of 83 (80.7%) students completed the post-OSCE survey. Results showed no difference between virtual and in-person OSCE in terms of educational value, whether the OSCE would change the way participants talk to patients, and preparedness to have serious conversations with patients. All 67 students somewhat or strongly agreed with feeling emotionally supported during the virtual OSCE. Discussion(s): In conclusion, a virtual OSCE on advanced communication skills was well received by students who reported similar educational value compared with a prior in-person OSCE. Students felt emotionally supported in the virtual format. While student performance related to interview process (mMIRS) was similar, scores on interview content (CBC) were significantly lower in the virtual environment compared with the prior in-person OSCE. For future virtual iterations, modifications may be necessary to ensure adequate instruction on interview content.Copyright © 2023

The role of feedback in building teaching presence and student self-regulation in online learning

In this research we studied usable strategies to promote student engagement and learning in the online classroom specifically connected to the development of teaching presence and student self-regulation. A design-based research approach (Barab & Squire, 2004) with multiple methods of data collection were used in the study's design, which was informed by the Garrison et al.'s Community of Inquiry framework and Zimmerman's cycle of self-regulatory phases. Qualitative sources of data included coursework and semi-structured interviews with three student participants, accompanied by text-based planning and debrief notes, and a semi-structured interview with one instructor. The study context was an online course connected to a Bachelor of Education program at a university in Ontario, Canada. Findings indicate students experienced teaching presence directly in the timely, strengths-based and personal feedback they received. Regular feedback helped students know their work was being seen and that they were "on the right track”. Strengths-based and personal feedback aided student motivation and self-regulation, which emerged as important for ongoing engagement and learning online. Recommendations that emerged from this study are of interest internationally to designers of online learning courses, online instructors and researchers in online learning. © 2023

Comparison of DDA, scanning window DIA, and HDMSE for assigning and quantifying glycopeptides

Amino acid substitutions to viral proteins can create or remove glycosites. While research groups have published assignment of viral protein glycosylation, there remains little consensus regarding how to quantify the glycosylation changes that occur among viral variants. This is because glycosylation is inherently micro-and macro-heterogeneous, making rigorous comparison of the complete glycosylated structures of viral proteins a statistical problem. In response, we have compared glycoproteomics data acquisition and bioinformatics methods for producing confident measurements of glycosylation similarity. We compared glycoproteomics assignments and quantification from data acquired with data-dependent acquisition (DDA), scanning window data-independent acquisition (swDIA), and broad mass range data-independent acquisition coupled with ion mobility spectrometry (HDMSE), respectively. We compared DDA, swDIA, and HDMSE mass spectral data to assign and quantify (i) the five N-linked glycosylation sites of the glycoprotein standard alpha-1-acid glycoprotein (AGP), (ii) the 12 sites of an influenza A virus hemagglutinin (HA) and (iii) the 22 sites of SARS-CoV-2 spike protein. For all three proteins, we observed that swDIA provided greater depth of coverage for glycopeptide precursor ions compared with DDA. The performance improvement of swDIA was mitigated to a degree by the difficulty of assigning low abundance precursor ions confidently. For this reason, we compared the performance of HDMSE data acquired using the Waters Cyclic IMS instrument, for which there is no precursor isolation step and no need for scanned quadrupole windows. The Cyclic IMS instrument alternated scans corresponding to low and high collision energy in a collision cell located after the mobility chamber. The resulting collision energy aligned retention time curves contained no missing data.Wedeveloped a glycopeptide-aware deconvolution approach to assign the HDMSE data accurately. For this, we connected precursors and product ions according to the combined retention time (RT) and ion mobility (IM) profiles. Using this approach, we demonstrated that HDMSE improved the coverage of glycopeptides over swDIA and DDA.

Making the shift to virtual professional learning

This qualitative research involved the development of 12 weeks of twice-weekly virtual maker professional learning (PL) sessions for K-12 and post-secondary educators at the beginning of the COVID-19 pandemic. The sessions were developed by four researchers from a maker lab in Ontario, Canada that moved entirely online in March 2020. The research question driving the study was: what are best practices related to virtual maker professional learning? Findings and implications related to this question include: a) technical issues should be anticipated and addressed in advance of each session;b) simple, hands-on activities are most effective for online maker professional learning;c) collaboration are pivotal to a rich online maker professional learning experience;d) using free, virtual tools is imperative for equitable access and learning;and e) adaptability is key when working with a diversity of learners/teachers from varied subjects and divisions.

International collaboration and development of a cystic fibrosis physiotherapy-specific telehealth toolkit

Objective: The COVID-19 pandemic triggered a worldwide need for telehealth services. Previously providing services in remote communities, virtual consultations were implemented to accommodate the needs of people with CF (pwCF) who were shielding and unable to attend faceto- face consultations. Method: This group has compiled a CF Physiotherapist’s toolkit of essential elements necessary to enable delivery and promotion of safe, equitable virtual sessions, specific to pwCF. Through international collaboration and shared experience, the toolkitwas developed to support physiotherapists working across paediatric and adults with CF. Results: Centres implementing telehealth into routine care need rigorous methods to evaluate safety and effectiveness ensuring optimal care. Using telehealth for joint sessions with shared care centres, or during transitional periods, should be considered ensuring equitable access and specialised care for all. The health benefits of telehealth, the coincident enhanced control of cross infection and resource savings, to the hospital and the person/family with CF in time and travel costs, are invaluable. A blend of virtual and faceto- face consultations could be the mainstay of future CF care. CFTR modulator therapy, improved specialised care, and improving life expectancy is compelling clinicians to review current services, improve efficiencies and continually optimise care and health outcomes. Telehealth, may provide an option for alternative models of care which may not be suitable for all but should be considered as an option in future CF services. Conclusions: Using this toolkit, the CF Physiotherapist is provided with relevant guidance and support for delivery of online/virtual respiratory review, spirometry assessment, evaluation of inhalation therapy, airway clearance and exercise opportunities. The toolkit promotes an equitable translation from face-to-face care to virtual care and includes strategies for risk mitigation in the virtual setting.

Impact of the covid-19 pandemic on the epidemiology of out-of-hospital cardiac arrest: A systematic review and meta-analysis

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has influenced epidemiology through direct and indirect effects, yet the impact on out-of-hospital cardiac arrest (OHCA) is unclear. We aimed to evaluate the impact of the pandemic on the incidence, characteristics, and clinical outcomes of OHCA. Hypothesis: We hypothesized that compared to the pre-pandemic period, the COVID-19 pandemic period was associated with increased incidence and case fatality rate (CFR) of OHCA, as well as decreased rates of intermediate clinical outcomes (termination of resuscitation [TOR], return of spontaneous circulation [ROSC], survival to hospital admission, and survival to hospital discharge). We further postulated that there was a change in the etiologies of OHCA during the pandemic as well as a decline in the rate of shockable rhythm as the initial presenting rhythm. Methods: In this systematic review and meta-analysis, five scientific databases were searched from inception to May 3, 2021. Meta-analyses were performed for the primary outcomes, secondary outcomes, and clinical characteristics. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021253879). Results: The search yielded 966 articles. 20 articles were included for analysis. The COVID-19 pandemic was associated with a 39.5% increase in pooled annual OHCA incidence (p<0.001). Pooled CFR was increased by 2.65% (p<0.001), with an odds ratio (OR) of 1.95 for mortality (95% confidence interval [95%CI] 1.51-2.51). There was increased field TOR (OR=2.46, 95%CI 1.62- 3.74). There were decreased ROSC (OR=0.65, 95%CI 0.55-0.77), survival to hospital admission (OR=0.65, 95%CI 0.48-0.89), and survival to discharge (OR=0.52, 95%CI 0.40-0.69). There was decreased shockable rhythm (OR=0.73, 95%CI 0.60-0.88) and increased asphyxial etiology of OHCA (OR=1.17, 95%CI 1.02-1.33). There was moderate-to-high statistical heterogeneity. Findings were robust to sensitivity analyses, with no publication bias detected. Conclusions: The COVID-19 pandemic was associated with significant changes in OHCA epidemiology. Compared to the pre-pandemic period, the pandemic period was associated with increased OHCA incidence and worse outcomes.

Can we attend anywhere? Evaluation of multidisciplinary team (MDT) remote consultations

Objectives: To assess the value of remote consultation (RC) for people with cystic fibrosis (pwCF). A pilot of physiotherapy/dietitian-specific clinics found RC to be an acceptable alternative to standard clinics. Due to COVID19, RC was introduced to replace MDT face-to-face (F2F) clinics. Methods: RC's were run 2x weekly. 117 pwCF were surveyed to evaluate previous experience of RC, usefulness of this consultation and preference in continuing. We asked 9 MDT members about their perception and opinion of RC. Results: 55% pwCF and 100% MDT responded.100% found RC useful and 90% stating time efficiency despite 62% having no previous experience. 80% of pwCF preferred video over telephone calls. 72% of respondents had concerns re: lack of lung function measurement, 56% were concerned re: lack of physical examination which was also raised by the MDT. Confidentiality was identified as a concern but 72% of pwCF felt they had no problem discussing sensitive issues but these would be preferable F2F. Benefits included reduced clinic time (80%), convenience of not travelling/parking at hospital (90%) and ease of clinic allocation irrespective of microbiology infection control concerns (70%). Flexibility of access, not requiring time off work, a relaxed discussion of more relevant issues and improvements in clinical flow were noted. F2F consultations remain valuable as these build relationships and allow thorough examination. Conclusion: 64% pwCF and all MDT agreed that alternating RC would be a preferable format, with frequency depending on clinical need. This would minimise travel and cross infection risks whilst continuing optimal clinical care. RC were well received and a viable option to increase review when clinical space is limited. Concern over lack of objective measurement is important as these are clinically required and should be obtained. Technical issues e.g. poor connection, lack of equipment and training should be considered when planning this type of consultation.

Using remote access musculoskeletal consultations within a cystic fibrosis specialist physiotherapy service: a pilot

During COVID-19, musculoskeletal (MSK) physiotherapists were redeployed to supplement acute staffing. Virtual clinics (VC) were used by the cystic fibrosis (CF) MDT to assess and monitor patients. Objectives: To scope benefits of providing MSK physiotherapy to allow pwCF to self-manage their condition and improve their quality of life (QOL). Methods: VC for MSK pain were offered for 6 weeks. Patient satisfaction and perceived resolution of symptoms was assessed. Results: 15 patients had an average of 1.5 treatment sessions. MSK problems included peripheral joint pain n = 12;spine n = 2 and TMJ. 91% of pwCF were seen within 3 days of referral with remainder seen within 1 week. 55% responded to a satisfaction survey. 83% of pwCF felt a 58% improvement in symptoms. 50% felt the support received was sufficient with 50% requiring additional follow-up. Future access to CF MSK services was considered favourably. 33% stated a preference for face-to-face consultation, with 50% finding VC to be a ‘convenient alternative’. PwCF have an increased prevalence of spinal deformities such as kyphosis and scoliosis, the same prevalence of MSK pain as age-matched controls and pain in pwCF rising with age and associated co-morbidities. 94% of pwCF may experience pain limiting airway clearance and subsequent QOL. PwCF often describe the negative impact pain has on their ability to stay active and function in daily life. UK national standards of care recommend that ‘all individuals with CF should be screened for MSK signs and symptoms, with referral pathways to access MSK specialists where appropriate’ suggesting that MSK specialist input within CF centres would be ideal. In Glasgow, there is currently no specialist CF MSK physiotherapy provision and local specialist services have a current waiting list of 44 weeks. Conclusion: This study demonstrated that pwCF feel specialist CF MSK input is valuable and significantly reduced their pain within a short period of time, thus maintaining their QOL.

Exercising online a “Beaming” good initiative

Objective: Evaluating the impact of 6 weeks of LIVE online exercise classes in the West of Scotland Adult CF Unit using the Beam platform for people with cystic fibrosis (pwCF). Methods: 63 pwCF enrolled for the classes via Beam. In addition, questionnaires were completed prior to and during shielding to establish motivation and personal objectives with exercise allowing therapists to structure sessions. 28 exercise and 12 education sessions focussing on the health and well-being of the pwCF were delivered. Exercises were adapted to all abilities through a variety of activities eg. yoga, strength and conditioning (S&C), easy exercise and high intensity interval training (HIIT). Results: 26 pwCF attended for 1 or more exercise sessions and 37 attended education sessions. Due to CF cross-infection limitations existing prior to COVID-19, group sessions were previously prohibited. These virtual classes allowed us to be 5× more time efficient with exercise and 12× more efficient when delivering education in a group setting than if they were delivered face-to-face. The post pilot questionnaire showed 64% were exercising on BEAM with their CF physio. The greatest uptake was HIIT (82%) followed by S&C (45%) with other options being equivocal. Motivation (measured using a VAS) increased from 5.75 (SD 2.67) pre-pilot to 7.18 (SD 2.36) post p = 0.189. Levels of perceived fitness also increased from 4.12 to 5.9 post-pilot p = 0.62. Personal fitness goals were fully or partially achieved by 91% of respondents and when asked comments were very positive: “This has been fantastic, especially during a difficult mental and very limiting physical lockdown period.” Conclusion: The implementation of BEAM Live online exercises for pwCF was found to be a satisfactory and convenient way to deliver exercising allowing for optimisation and progression of pwCF perceived exercise tolerance and motivation towards exercise. The sample size was small which may account for the lack of statistical significance.

Influenza vaccination, airways disease and the risk of COVID-19 related mortality

Introduction UK public health policy emphasises the need for increased influenza vaccination during the COVID-19 pandemic. However, there are claims on social media that influenza vaccination increases risk of adverse outcomes in SARSCoV- 2 infection that may compromise uptake, especially in high risk groups such as those with airways disease. There is also emerging evidence that inhaled corticosteroids (ICS) may modify this risk. We therefore sought to urgently assess the risk of morbidity and mortality in individuals admitted with COVID-19, and whether this influenced by influenza vaccination, airways disease and ICS use. Method We examined data in patients admitted to a large acute hospital with microbiologically proven COVID-19 infection (positive PCR) between 23/01/2020 to 21/06/2020. Demographic and outcome data was extracted from discharge summaries, death certificates and electronic patient records. Multiple logistic regressions was performed using STATA version 12, and results for inpatient mortality expressed as odds ratios, and length of stay (morbidity) as coefficients with 95% CIs. Results 525 patients were hospitalised with COVID-19 of whom 451 had a vaccination record available and 64% had been vaccinated. 22% had airways disease (10% asthma, 12% COPD) and 17.5% were on an inhaled corticosteroid. Increasing age (OR=1.04 [1.02, 1.05], p<0.001) and male gender (OR=2.26 [1.5, 3.4], p<0.001) were important predictors of inpatient mortality. Previous influenza vaccination (OR=0.99 [0.6, 1.6], p=0.98), the presence of airways disease (Asthma OR=0.74 [0.4, 1.5], p=0.41, COPD OR= 1.1 [0.6, 2.0], p=0.68), and ICS use (OR=0.84 [0.3, 2.1], p=0.71) did not increase risk of in-hospital mortality and were not associated with an increased length of stay, after adjusting for age and gender. Further sub-analysis including type of airways disease and dose of ICS did not change the risk. Conclusions Advancing age and male gender increased the risk of in-hospital mortality from COVID-19. Furthermore previous influenza vaccination and the presence of airways disease and/or the use of ICS did not impact morbidity or mortality. Whilst this requires replication using national data sets, it is reassuring data from a single centre that supports the current public health message.