Effects of an internationalization at home (IAH) programme on cultural awareness among medical and nursing students in Hong Kong and Indonesia during the COVID-19 pandemic: a mixed-methods study.

BACKGROUND: The COVID-19 pandemic has severely impacted the learning experience of students by limiting their opportunities for face-to-face intercultural exchanges. Given the importance of cultural competence in medical education, there is a need to develop a programme that promotes cultural awareness, but that offers more flexibility in terms of outbound mobility. This study aims to evaluate the effectiveness of an internationalization at home programme and to explore the learning experiences of medical and nursing students from Hong Kong and Indonesia. METHODS: Students were recruited from two universities in Hong Kong and Indonesia. They attended an online internationalization at home programme designed by members of the research team from both countries. A mixed-methods study was conducted using a concurrent triangulation approach. A pre-test post-test design was used to evaluate the effects of the programme on cultural awareness, and four focus groups were conducted to explore the students' experiences in the programme. Quantitative and qualitative data were analysed by T-test and reflexive thematic analysis, respectively. Data were integrated and triangulated using joint displays by comparing findings from both sources. RESULTS: One hundred and forty-eight students from Hong Kong and Indonesia participated in the study. After the programme, there was a significant improvement in cultural awareness. Three themes were identified: (1) learning process: enjoyable, but a desire remains for face-to-face cross-cultural communication; (2) learning outcomes: gained cultural awareness, developed cultural sensitivity, had an opportunity to practice language and learn about new learning styles; (3) factors influencing learning outcomes: facilitators (micro-movie and active communication) and barriers (language barrier, inappropriate time arrangement, insufficient prior briefing). CONCLUSION: This programme achieved the learning outcomes by successfully enhancing the cultural awareness of students during a time of pandemic when outbound student exchanges were not possible. Further adaptations of the programme are required to enhance different learning outcomes.

Chest imaging for early diagnosis of COVID-19 on a patient without respiratory symptoms: A case report

The Coronavirus 2019 disease (COVID-19) is transmitted through droplets and aerosol from the respiratory tract of an infected person;and fomites from infected linen and surface. On August 1 2020 in Yogyakarta there were 741 confirmed positive cases of COVID-19 and it is still possible to increase. In the time of understanding COVID-19 there are many cases with atypical presentation including gastrointestinal symptoms. Objective: To describe a COVID-19 case without respiratory symptoms and the role of radiology in detecting COVID-19. Case Description: A 55-year-old male patient came to the hospital complaining of nausea and loss of appetite. Based on the results of the physical examination there was flatulence. Initial investigations revealed a non-reactive SARS CoV 2 IgG and IgM result. Further non-contrast MSCT Thorax showed infiltrates with bilateral subpleural posterolateral consolidation particularly the left showing typical pneumonia. Multiple blebs were also found denoting bronchiectasis. Confirmatory RT-PCR result was positive for SARS CoV 2. Conclusion: COVID-19 usually presents with common respiratory symptoms. However some patients also experience gastrointestinal symptoms that initially were not detected as COVID-19. In time of COVID-19 pandemic persistent gastrointestinal symptoms in high-risk patients warrant further chest imaging and RT-PCR of SARS CoV-2 to detect or exclude the possibility of COVID-19 diagnosis.

Appropriate laboratory and imaging approach for early diagnosis in hospital setting

The main objective of global health is to reduce preventable death equally throughout the world. One important strategy is primary prevention through health promotion and early detection. Early diagnosis is defined as several methods to determine in patients the nature of a disease or disorder at its early stage of progression. In a referral health system such as Indonesia early diagnosis could be implemented both in primary care and secondary or tertiary referral hospitals. Primary care centers screen fatal diseases such as cancer and cardiovascular risk factors mostly in asymptomatic patients with identified risk of having the diseases. Accordingly, the early detection programmed has been designed for a large population in a community setting. It is uncommon for hospitals in Indonesia applying primary prevention where most of the patients are referred with at least a couple of differential diagnoses. Subsequently early diagnosis in a hospital setting would be defined either as accelerating the diagnosis confirmation or detecting any uncommon findings on patients with atypical presentation. In some situation early detection of life-threatening conditions at hospital would prolong or even prevent death. Aside from accurate history taking and comprehensive physical examination, advanced laboratory procedure and imaging might assist in early detection at hospital settings. This time our issue presents case reports on the benefit of early detection in the management of rare disease anemia and COVID-19 pandemic among patients without symptoms or with atypical presentation. In developed countries most known congenital diseases were screened prenatally or immediately after delivery. The most common practice in Indonesia is a regular prenatal ultrasound and through physical examination of the baby in their first week. However, this approach would still miss many rare diseases with delayed presentation such as Legg-Calve-Perthes Diseases (LCPD). Pradyana and Astuti1 discussed a pediatric case of LCPD highlighting the difficulty in diagnosis confirmation on a limp gait symptom. Serial imaging is not only important in case follow-up but also to detect newly existing abnormalities which verify the presence of LCPD. Iron deficiency anemia (IDA) primarily affects women and children in Indonesia. Currently school-based screening of hemoglobin in teenage girls could prevent the sequelae of IDA through iron supplementation. Early detection in anemia would determine the presence of IDA before the declined hemoglobin. Recently international investigators discovered a novel biomarker to detect the presence of IDA in asymptomatic patients. Fenty described the potential of using reticulocyte hemoglobin equivalent (Ret-He) to characterize IDA amongst asymptomatic patients in hospital settings.2 This approach would be beneficial for screening purposes in high-risk populations both in community and hospital setting. During COVID-19 pandemic early diagnosis is a necessity to reduce the infection rate with early quarantine. However challenging situations might come in patients with atypical presentations such as gastritis. Widiastana et al describe the later COVID positive result on patients with gastritis which are nonresponsive to general treatment.2 The patients did not have any classical signs and symptoms of COVID-19 hence in the community misdiagnosis of similar conditions might exacerbate the rising infection cases.