Hopelessness among Medical Students Caused Due to COVID-19 Pandemic Linked Educational Hiatus: A Case Study of Bursa Uludag University, Tü,rkiye

The COVID-19 pandemic has caused disruptions in medical education, leading to feelings of hopelessness among students regarding their medical careers. However, effective institutional crisis-response approaches can mitigate these feelings of hopelessness. This study evaluated changes in the levels of hopelessness among Turkish medical students due to interruptions in their education caused by the pandemic between March and July 2020, using the Beck Hopelessness Scale in three selected periods. A statistical survey was conducted with a total of 3580 participants in three different periods to study the impact of various contributing factors, such as socio-economic status, family problems, health problems, and lack of working environment, on the levels of hopelessness in conjunction with active COVID-19 cases and the effect of institutional interventions for the continuation of medical education during the pandemic. The analysis revealed a direct relationship between contributing factors and hopelessness scores at the end of the selected three periods. Additionally, active COVID-19 cases and institutional crisis-response strategies were found to be indirectly associated with students' hopelessness. An increase in students' hopelessness was found to be related to an increase in active COVID-19 cases in the country, a lack of continuing education practices, and the role of contributing factors. Conversely, a decrease in hopelessness was associated with effective institutional crisis-response strategies. These findings suggest that educational settings dealing with practical subjects should prioritize preparedness for crisis situations.

Prognostic factors for COVID-19 patients.

INTRODUCTION: Determining prognostic factors in patients with coronavirus disease (COVID-19) can have great impact on treatment planning and follow-up strategies. Herein, we aimed to evaluate prognostic factors and clinical scores for confirmed COVID-19 patients in a tertiary-care hospital in the Bursa region of Turkey. METHODOLOGY: Patients who had been diagnosed with COVID-19 microbiologically and/or radiologically between March and October 2020 in a tertiary-care university hospital were enrolled retrospectively. Adult patients (≥ 18 years) with a clinical spectrum of moderate, severe, or critical illness were included. The dependent variable was 30-day mortality and logistic regression analysis was used to evaluate any variables with a significant p value (< 0.05) in univariate analysis. RESULTS: A total of 257 patients were included in the study. The mortality rate (30-day) was 14.4%. In logistic regression analysis, higher scores on sequential organ failure assessment (SOFA) (p < 0.001, odds ratio (OR) = 1.86, 95% CI = 1.42-2.45) and CURB-65 pneumonia severity criteria (p = 0.001, OR = 2.60, 95% CI = 1.47-4.57) were found to be significant in predicting mortality at admission. In deceased patients, there were also significant differences between the baseline, day-3, day-7, and day-14 results of D-dimer (p = 0.01), ferritin (p = 0.042), leukocyte (p = 0.019), and neutrophil (p = 0.007) counts. CONCLUSIONS: In our study of COVID-19 patients, we found that high SOFA and CURB-65 scores on admission were associated with increased mortality. In addition, D-dimer, ferritin, leukocyte and neutrophil counts significantly increased after admission in patients who died.

Effects of the COVID-19 pandemic on the follow-up and treatment of patients with idiopathic pulmonary fibrosis: a cross-sectional, multicentre phone call survey.

OBJECTIVE: To learn about the attitudes and behaviours of patients with idiopathic pulmonary fibrosis (IPF) in relation to the difficulties experienced during the COVID-19 pandemic. DESIGN: A cross-sectional, multicentre phone call survey. SETTING: Four university hospitals in Turkey. PARTICIPANTS: The study included patients with IPF receiving antifibrotics for at least 3 months and with doctor appointment and/or scheduled routine blood analysis between March and May 2020 (the first 3 months after the official announcement of the COVID-19 pandemic in Turkey). INTERVENTIONS: Phone calls (a 5 min interview) were performed in June 2020. A questionnaire and the Hospital Anxiety-Depression Scale were applied. MAIN OUTCOME MEASURES: Patients' preferences for disease monitoring, patients' attitudes and behaviours towards IPF, drug continuation, COVID-19 diagnosis and anxiety/depression status. RESULTS: The study included 115 patients with IPF (82 male; mean age, 68.43±7.44 years). Of the patients, 73.9% had doctor appointment and 52.2% had scheduled routine blood testing; 54.5% of patients with doctor appointment self-cancelled their appointments and 53.3% of patients with scheduled routine blood testing did not undergo testing. Of the patients, 32.2% were on nintedanib and 67.8% were on pirfenidone; self-initiated drug discontinuation rate was 22.6%. The percentage of patients communicating with their physicians was 35.7%. The route of communication was by phone (34.8%). The frequency of depression and anxiety was 27.0% and 38.3%, respectively. The rates of drug discontinuation (35.1% vs 16.7%, p<0.05) and depression (37.8% vs 21.8%, p=0.07) were higher in nintedanib users than in pirfenidone users. Only two (1.7%) patients had COVID-19 diagnosis. CONCLUSIONS: During the COVID-19 pandemic, a significant proportion (>50%) of patients self-cancelled their appointments and nearly a quarter of patients discontinued their medications. Providing a documentation of the problems experienced by patients with IPF about management of the necessary requirements during the COVID-19 pandemic, this study may be a model for patients with chronic diseases.

Distance education perception scale for medical students: a validity and reliability study.

BACKGROUND: There are major changes in education strategies as higher education institutions urgently need to adopt distance education tools and practices due to the Covid-19 pandemic. Medical education is also trying to get out of this emergency using distance education. In this study, we aimed to develop a reliable and valid scale in order to evaluate the perceptions of medical students towards distance education. METHODS: The students taking part in the study were in the first five academic years of the medical faculty in Bursa in Turkey. At first, 57 items were determined to evaluate students' perceptions. Content validity was examined according to the assessment of the expert team. Construct validity of these items was examined by exploratory and confirmatory factor analysis. Also, Cronbach's alpha coefficients were calculated for reliability analysis. The medical students' responses were scored using a five-point Likert scale. RESULTS: When the content validity was examined, the number of items was determined to be 38 items. Construct validity of these items was examined by exploratory and confirmatory factor analysis. Because of the exploratory factor analysis performed on the responses of 429 medical students, 22 items were included in four factors. This four-factor model was applied to 286 medical students and validated by confirmatory factor analysis. Also, Cronbach's alpha coefficients were calculated for reliability analysis and values were between 0.713 and 0.930. CONCLUSIONS: This study demonstrated validation and reliability of perceptions of distance education for medical students. We suggest a 22-item model with a four-factorial scale.

Laboratory findings in predicting intensive care need and death of COVID-19 patients

INTRODUCTION: The ability to predict the course of COVID-19 is very valuable in terms of the optimal use of health resources. The aim of this study was to examine the value of biochemical and hematological parameters in the estimation of hospital stay, disease severity, and likelihood of death. METHODS: Routine blood analysis data of confirmed COVID-19 cases (n=222) were collected and analyzed. The patients were divided into 3 groups: outpatient, inpatient, and patients requiring intensive care. RESULTS: There were significant differences between the 3 groups in terms of age, lymphocyte, neutrophil, hemoglobin, hematocrit, mean corpuscular volume (MCV), red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-monocyte ratio (NMR), platelet-to-lymphocyte ratio (PLR), procalcitonin, C-reactive protein (CRP), and D-dimer values. Univariate analysis for mortality revealed significant differences in neutrophil, NLR, PLR, NMR, procalcitonin, and CRP values. Multivariable logistic regression yielded significant differences in only NMR and procalcitonin values. A positive correlation was determined between the length of hospital stay and age, MPV, procalcitonin, and D-dimer values. DISCUSSION AND CONCLUSION: The neutrophil count was the most appropriate parameter to predict the need for intensive care (area under the curve: 0.782, sensitivity: 73%, specificity: 75%, with a cutoff of 4.43). The NMR and procalcitonin values were significant to predict death in multivariate analysis. Age, CRP, and D-dimer values were the parameters most associated with the duration of hospitalization.