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Purpose: The COVID-19 pandemic accelerated the utilization of hybrid-online and fully-online instruction in health professional education. Physical (PT) and occupational therapy (OT) programs have become increasingly reliant upon this mode of instruction. Therefore, it is important to understand advising strategies for this educational environment. Faculty advisors may endorse specific learning strategies over others. However, advising strategies of faculty are not well represented in the scientific literature. Methods: A qualitative phenomenological design used a six-item, open-ended questionnaire to purposefully survey faculty members teaching and advising students in hybrid-online PT and OT graduate programs during COVID-19. Dedoose® v.9.4 qualitative software (Los Angeles, CA;2021) was used to perform coding and thematic analysis. Three investigators performed data analysis to reach consensus on the organization of emerging codes and themes. Results: A sample of N = 36 participants was collected from three states: Florida 14 (38.9%);Texas 12 (33.3%);California 10 (27.8%). Total N (%) of PT and OT faculty enrolled were 26 (72%) and 10 (28%), respectively. Years teaching in hybridonline programs N (%) was: 1e4 years 20 (55.6%);5e9 years 8 (22.2%);10e14 years 5 (13.9%);15þ years 4 (11.1%). Thematic analysis revealed three major themes: Self-regulated Behaviors, Student Engagement, and Studying Strategies. Self-regulated Behaviors and Student Engagement were most prevalent among participant narratives. Coded responses such as " ‘time management', ‘preparedness', ‘chunking study time', ‘daily engagement with learning material', ‘work/ life balance', and ‘peer-to-peer teaching'” were positively associated with perceived student success. Conversely, "'procrastination/cramming', ‘poor work ethic', ‘lack of engagement', ‘lack of preparedness', and ‘rote memorization'” were negatively associated with perceived student success. Discussion: This study identified faculty perceptions of student strategies for success in hybrid-online health professional learning. The self-regulated behaviors of time management, preparedness, work/life balance, and the engagement behaviors of daily engagement with course materials, content application, class participation, and peer collaboration strongly emerged. These findings may help guide novice faculty advisors as hybrid-online instruction becomes more frequently leveraged across health professional education programs. © 2023 Association of Medical Education in the Eastern Mediterranean Region (AMEEMR).
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BACKGROUND: The adoption of sanitary measures due to the SARS-CoV-2 pandemic hampered teaching and learning methods in medicine. AIM: To communicate the results of a wound suture training workshop, based on the Basic Procedural Skills Training methodology and adapted to the pandemic context. MATERIAL AND METHODS: One hundred fourteen students were randomized in small groups due to sanitary measures and trained with a modification of the Basic Procedural Skills Training methodology. An informed consent was obtained from every student. The suturing skills were evaluated before and after the intervention with "The Objective Structured Assessment Of Technical Skills" (OSATS) instrument. The perception of the workshop and the implementation of the COVID-19 prevention measures were also evaluated. RESULTS: The students showed a statistically significant improvement after the intervention. In the OSATS verification list, the average score increased from 4.5 to 8.6 (p < 0.01). In the OSATS global scale, the average score increased from 13.0 to 25.3 (p < 0.01). The perception of the workshop and the prevention measures were well evaluated. CONCLUSIONS: Despite all the limitations of the pandemic context, we achieved a significant improvement after the intervention and a very good perception by the students.
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COVID-19 , Students, Medical , Humans , Clinical Competence , Educational Measurement/methods , Pandemics/prevention & control , SARS-CoV-2ABSTRACT
Background/Purpose: Receiving a cancer diagnosis during adolescence and young adulthood (AYA;15-39) coincides with a period of pivotal developmental milestones. Coping with the stress of cancer diagnosis exacerbates risk for distress and feelings of isolation among AYAs. Mind-body resiliency programs may offer a compassionate approach for tackling these negative post-treatment psychosocial experiences. The present mixed methods study explores the acceptability of an 8-week, synchronous, virtual group Relaxation Response Resiliency Program (3RP) adapted to address the unique challenges facing AYAs (3RP-AYA). Method(s): Recruitment occurred at an academic hospital in Boston, MA from 03/2019 to 09/2020. Participants (N = 72, Mage = 23.8, female = 73.6%, non-Hispanic White = 59.7%, Hispanic/Latino = 20.8%, 1.6 years post-treatment) were randomized to receive 3RP-AYA immediately (intervention group;n = 35) or after 3 months (waitlist control;n = 37) via Zoom. Electronic surveys were collected before and after participants completed treatment;we report post-treatment survey data measuring acceptability across five domains (enjoyability, helpfulness, convenience, future use, and satisfaction) using 4-point Likert scales (1 = not at all to 4 = very). Qualitative post-treatment interviews further queried program acceptability. Result(s): Program acceptability responses indicated program satisfaction: enjoyability (M = 3.62, SD = 0.69), helpfulness (M = 3.45, SD = 0.75), and convenience (M = 3.67, SD = 0.71). More specifically, 76.7% of participants found the virtual delivery to be very convenient, and 71.7% rated the sessions as very enjoyable. 91.7% of participants reported they were likely/very likely to use learned skills in the future and 91.7% reported the intervention as helpful/very helpful. Additionally, 96.6% reported satisfaction with the overall content. Exit interviews highlighted session intergroup connectivity as a particular strength. Conclusions and Implications: Across multiple domains, the 3RPAYA was deemed acceptable by AYAs. Participants valued the opportunity to learn mind-body skills and connect with other young survivors. The synchronous virtual study platform showed promise for being a convenient and helpful tool to deliver mind-body programs to AYA survivors during the Covid-19 pandemic.
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Introduction: COVID-19 pandemic brought multiple negative consequences that go beyond the direct damage caused by the disease and that affect health systems as well. Complaints of attacks against health care workers became frequent and concerning. The objective of this survey was to characterize the frequency and type of violent behavior against front-line professionals in Latin America. Material(s) and Method(s): A cross-sectional electronic survey was carried out between January 11th to February 28th, 2022. Different health care workers from Latin America who have been delivering care at least from March 2020, regardless of whether they assist or not patients with COVID- 19 were included. A non-probabilistic snowball sampling was performed, and the survey was Results: The survey was responded by 3,544 participants from 19 countries (Figure 1);58.5% were women, and the mean age was 41.9+/-11 years. The 70.8% were doctors, 16% nurses, 3.4% physiotherapists, and the remaining 9.8% had other functions within the health team. About 85.1% of physicians were specialists: 33.9% were cardiologists, 14.4% were intensivists or emergency physicians, 10.9% had some surgical specialty, 7.7% were pediatricians or related subspecialties, and the remaining 33.1% had other specialties. The 36.3% and 28.8% worked in public and private practice respectively, the remaining worked in both. Direct and regular care to COVID-19 patients was provided by 74.7% of all contestants. Among the participants, 54.8% reported acts of violence: 95.6% suffered verbal violence, 11.1% physical violence, and 19.9% other types. 39.5% of respondents experienced it at least once a week. The acts of violence involved patients' relatives (32%), or patients together with their relatives (35.1%). The victims rated the stress level of these events with an average of 8.2+/-1.8 points (scale from 1 to 10). Approximately half of the health personnel who suffered an assault experienced psychosomatic symptoms after the traumatic event (Figure 2). Among the victims of violence, 56.2% considered changing their care tasks, and 33.6% abandoning their profession. However, only 23% of the health personnel attacked stated that they had made some type of legal action regarding these acts. In a logistic regression model, doctors (OR 1.95, p<0.01), nurses (OR 1.77, p=0.001), and administrative staff (OR 3.20, p<0.01) suffered more violence than other health workers. Women more frequently suffered violence (OR 1.56, p<0.01), as well as those who worked with patients with COVID-19 (OR 3.59, p<0.01). Conversely, a lower probability of violence was observed at older ages (OR 0.96, p<0.01). Conclusion(s): We detected a high prevalence of violence against health personnel in Latin America during the current pandemic. Those caring for COVID-19 patients, younger staff, and women were found to be more vulnerable. It is imperative to develop strategies to mitigate these acts and their repercussions on the health team. (Figure Presented) .
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Air pollution causes respiratory ailments and drives climate change. Air quality is driven by emissions from various sources, weather patterns, and transport of pollutants. Satellite analysis of pollutants in the atmosphere can provide temporally consistent and spatially wide measurements. In this study, the monthly concentrations of Nitrogen Dioxide (NO2), Sulfur Dioxide (SO2), Carbon Monoxide (CO), and Ozone (O3) from the Sentinel-5 Tropospheric Monitoring Instrument (TROPOMI) were analyzed in four major cities in the Philippines, representing different climate types. Satellite-based measurements of land surface temperature and rainfall were used to investigate meteorological effects to air pollutants. Seasonal patterns were observed in the time series of NO2, O3 and CO alongside rainfall and LST. During the dry season, high LST and low precipitation is observed to be associated with increase in NO2, O3, and CO concentrations. On the other hand, wet seasons show decreases in concentrations of air pollutants, consistent with the washout effect. The NO2 average concentration in NCR is 1.9, 2.1, 2.3 times higher than in Metro Cebu, Davao City, and Legazpi City, respectively. In contrast, SO2 average concentration is highest in Legazpi City due to the nearby active volcano by a maximum factor of 1.8 compared to other cities. In addition, air quality changes brought about by community quarantines were examined since the onset of the COVID-19 crisis. Transition from the pre-quarantine period to the first lockdown shows sudden decrease by 28% in satellite-based retrievals of NO2 in NCR, mainly due to reduced anthropogenic emissions. As tiers of community quarantines were introduced, an increase in pollutant concentrations was observed, returning to pre-pandemic air quality as the guidelines ease physical and economic restrictions. Monitoring and analyzing the patterns in concentration of air pollutants in relation to meteorological and anthropogenic drivers can help in the air quality management in the country. © 43rd Asian Conference on Remote Sensing, ACRS 2022.
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Introduction: COVID-19 pandemic brought multiple negative consequences that go beyond the direct damage caused by the disease and that affect health systems as well. Complaints of attacks against health care workers became frequent and concerning. The objective of this survey was to characterize the frequency and type of violent behavior against front-line professionals in Latin America. Material and methods: A cross-sectional electronic survey was carried out between January 11th to February 28th, 2022. Different health care workers from Latin America who have been delivering care at least from March 2020, regardless of whether they assist or not patients with COVID-19 were included. A non-probabilistic snowball sampling was performed, and the survey was Results: The survey was responded by 3,544 participants from 19 countries (Figure 1);58.5% were women, and the mean age was 41.9±11 years. The 70.8% were doctors, 16% nurses, 3.4% physiotherapists, and the remaining 9.8% had other functions within the health team. About 85.1% of physicians were specialists: 33.9% were cardiologists, 14.4% were intensivists or emergency physicians, 10.9% had some surgical specialty, 7.7% were pediatricians or related subspecialties, and the remaining 33.1% had other specialties. The 36.3% and 28.8% worked in public and private practice respectively, the remaining worked in both. Direct and regular care to COVID-19 patients was provided by 74.7% of all contestants.Among the participants, 54.8% reported acts of violence: 95.6% suffered verbal violence, 11.1% physical violence, and 19.9% other types. 39.5% of respondents experienced it at least once a week. The acts of violence involved patients' relatives (32%), or patients together with their relatives (35.1%). The victims rated the stress level of these events with an average of 8.2±1.8 points (scale from 1 to 10). Approximately half of the health personnel who suffered an assault experienced psychosomatic symptoms after the traumatic event (Figure 2). Among the victims of violence, 56.2% considered changing their care tasks, and 33.6% abandoning their profession. However, only 23% of the health personnel attacked stated that they had made some type of legal action regarding these acts.In a logistic regression model, doctors (OR 1.95, p<0.01), nurses (OR 1.77, p=0.001), and administrative staff (OR 3.20, p<0.01) suffered more violence than other health workers. Women more frequently suffered violence (OR 1.56, p<0.01), as well as those who worked with patients with COVID-19 (OR 3.59, p<0.01). Conversely, a lower probability of violence was observed at older ages (OR 0.96, p<0.01). Conclusion: We detected a high prevalence of violence against health personnel in Latin America during the current pandemic. Those caring for COVID-19 patients, younger staff, and women were found to be more vulnerable. It is imperative to develop strategies to mitigate these acts and their repercussions on the health team. Funding Acknowledgement: Type of funding sources: None.Figure 1Figure 2
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During the COVID-19 pandemic, universities were forced to implement new educational innovation strategies to avoid stopping the academic development of students. In this project, a dynamic, multidisciplinary, and experiential learning environment was created, compatible with the “new normality” with the aim of developing transversal skills and improving academic performance in students of biotechnology and mechatronics engineering careers. This objective is achieved by implementing challenges and projects related to the automation of a greenhouse and its use in experiments to analyze agricultural products. The development of the project took place during the COVID-19 pandemic, for which a large part of the work was carried out in a virtual format, resulting in a higher academic performance in the mechatronics students who worked in this environment, as well as the acquisition of knowledge about technological development in the area of biotechnology. © 2022, Associacao Iberica de Sistemas e Tecnologias de Informacao. All rights reserved.
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Case Report A male infant is born at 37w to a 34-year-old G3P2 mother by vaginal delivery after an uncomplicated pregnancy. Prenatal screens are negative. The patient had a birth weight of 2,620 g, with Apgar scores of 9 and 9. On day 2 after birth, had increased work of breathing which prompted transfer to a level II NICU for further management. On arrival to the unit, the infant is tachypneic with mild chest wall retractions and thick nasal secretions. A CBC and blood culture were collected and empiric antibiotic therapy was started. Respiratory viral panel and COVID test are negative. A chest radiograph shows a middle lobe opacity concerning for pneumonia (figure 1). His clinical status failed to improve and on day 4 after birth, supplemental oxygen was provided. The primary team consulted ENT and Pulmonology services. Flexible laryngoscopy showed a normal anatomy. Pulmonology recommended transferring to our NICU for a chest CT with bronchoscopy. Our differential diagnosis for this neonate with respiratory distress that fails to improve over time or with antibiotics was broad, but further testing revealed this infant's condition. A CBC, CRP and a blood gas were collected on admission and were normal. ID service was consulted. A Chest CT showed bilateral atelectasis. Bronchoscopy showed a normal anatomy. Bronchoalveolar lavage was sent. Umbilicus swab was positive for MRSA, nasal wash/sputum culture/bronchoalveolar fluid also grew moderate S. aureus. Nasal ciliary biopsy sent for electron microscopy. Positive umbilicus and nasal swab, and subsequently BAL for MRSA led to a diagnosis of MRSA neonatal rhinitis. Therapy with IV vancomycin was initiated and later changed to oral clindamycin to complete a total of 14 days of therapy. The neonate was weaned off oxygen support on day 11. His clinical symptoms improved. He was discharged on oral clindamycin with follow up appointments with pulmonology and ID clinics. His ciliary biopsy showed absence of outer and inner dynein arms, compatible with the diagnosis of primary ciliary dyskinesia (PCD) (figure 2). Genetic testing for PCD showed mutations in the DNAAF1 and CCDC40 genes. This neonate was diagnosed with primary ciliary dyskinesia (PCD) but his presentation at birth was nonspecific and the differential diagnosis was broad. There is no gold standard diagnostic test for PCD and high clinical suspicion is important. Since it is most likely an AR inheritance, screening of family members is essential. Initial management of neonates may include measures that manage the respiratory distress, airway clearance to prevent respiratory infections and treat bacterial infections. Chest physiotherapy may help if recurrent atelectasis. Flexible bronchoscopy and bronchoalveolar lavage may help both to diagnose and treat the underlying infection. Antibiotic therapy based on organism growth for exacerbations may prevent development of bronchiectasis. (Figure Presented).
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Background. Remdesivir (RDV) is a potent nucleotide prodrug inhibitor of the SARS-CoV-2 RNA-dependent RNA polymerase that has demonstrated efficacy in the treatment of patients hospitalized with moderate to severe COVID-19. This Phase 3 (GS-US-540-9012) double-blind, placebo-controlled study compared the efficacy and safety of 3 days of RDV to standard of care in non-hospitalized, high-risk participants with confirmed COVID-19. Methods. Participants were randomly assigned 1:1 to receive intravenous (IV) RDV (200 mg on day 1, 100 mg on days 2 to 3) or placebo. The primary efficacy endpoint was composite COVID-19 hospitalization or all-cause death by day 28 and compared using Cox proportional hazards model with baseline stratification factors as covariates. The primary safety endpoint was proportion of participants with treatment-emergent adverse events. Study enrollment was terminated early for administrative reasons in light of the evolving pandemic. Results. 562 patients underwent randomization and started their assigned treatment (279, RDV;283, placebo). Baseline demographics and characteristics were balanced across arms. Overall, 52% were male, 44% were Hispanic/Latino ethnicity and 30% were ≥ 60 years old. The most common comorbidities were diabetes mellitus (62%), obesity (56%;median BMI, 30.7), and hypertension (48%). Median baseline SARS-CoV-2 RNA nasopharyngeal viral load was 6.2 log10 copies/mL. Treatment with RDV significantly reduced COVID-19 hospitalization or all-cause death by day 28 (HR, 0.13;95% CI, 0.03 - 0.59;p = 0.008;Table 1) compared to placebo. Participants receiving RDV also had significantly lower risk for COVID-19-related medically attended visits or all-cause death by day 28 compared to placebo (HR, 0.19;95% CI, 0.07 - 0.56;p = 0.002;Table 1). No deaths occurred in either arm by day 28. There was no difference between arms in time-weighted average change in nasopharyngeal viral loads from baseline up to day 7. The proportion of patients with AEs was similar between arms (Table 1);the most common AEs in the RDV arm were nausea (11%), headache (6%), and diarrhea (4%). Conclusion. A 3-day course of IV RDV was safe, well tolerated and highly effective at preventing COVID-19 related hospitalization or death in high-risk non-hospitalized COVID-19 patients.
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Introduction: It is estimated that for every patient in a dialysis or transplant program there are, in the general population, 100 patients with less severe chronic kidney disease (CKD) who will probably develop advanced CKD. These patients have an increased morbidity and mortality due to cardiovascular events and, in the most severe cases, a more rapid progression to renal replacement therapy. Screening, support treatment, prevention of complications and renal replacement therapy are strongly influenced by socioeconomic factors and health system organization resulting in inequalities even within the same territory. This situation may have worsened during the COVID‑19 pandemic due to the health emergency and the isolation experienced by people with severe chronic diseases. The General Pueyrredón District has 656,456 inhabitants and it is the 3rd most populated city in Buenos Aires. Approximately 45% of the population is treated in the public health sector. Objectives To describe the clinical-epidemiological characteristics of patients with pathological abnormalities in renal function tests and to identify the main difficulties in the access to diagnosis, follow-up and treatment at first level of care in the public sector from January to June 2021. Methods: The study was conducted in two phases. First, a cross-sectional study of patients with at least one measurement of plasma creatinine greater than 1.3 mg/dL and 1.5 mg/dL in women and men respectively, urine albumin‑to-creatinine ratio (ACR) greater than 30 mg/g and 24-h proteinuria greater than 300 mg. Second, a situational analysis of the municipal health system to identify the main obstacles to provide care to patients with KD. Results: A total of 306 patients with KD were identified in four months, 54.1% were women. The median age was 52 (IR 44-58) and 55 years old (IR 46.4-62) for women and men respectively. Most abnormalities were seen in ACR values, even in 58.5% of cases it was the only pathological value. Glycosylated hemoglobin (HbA1c) values greater than 7% were found in 17.7% of patients with KD. Peritoneal dialysis was used as replacement therapy only in 3% of the cases. Analyzing the difficulties within the health system, deficient articulation between 1st and 2nd levels, lack of consensus in clinical practice, delay in scheduling appointments resulting in a high demand, obstacles regarding patient care, insufficient follow-up of serious patients and delay in the delivery of laboratory results were observed. Conclusions: In this first study, it was observed that 50% of patients were 45‑60 years old and ACR might have been the most sensitive parameter to detect KD. There was a low prevalence of patients with pathological HbA1c values which may indicate an underdiagnose of KD in diabetic patients. An underutilization of peritoneal dialysis was also observed. From an analysis based on a strategic situational planning, it is proposed to adopt different approaches through the design and implementation of a Renal Care Program based on the integrated risk model suggested by KDIGO aimed at organizing the dispersed clinical practice, improving the efficiency of the system, promoting prevention practices and integrating the public sector with the university and private health institutions. No conflict of interest
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This paper investigates the Continuing Professional Development (CPD) experiences of performing arts professionals during the COVID-19 pandemic in Italy The research is aimed at examining actors' approaches and challenges to inform current and future CPD strategies, better suited to address the uncertainties of the social and economic juncture. The following four main themes are elicited by the research: the renewed need for self-directedness in CPD, the struggle to overcome the decrease in CPD opportunities in the workplace environment, the intensification of the use of social media for CPD purposes, and the role of CPD in the diversification of competencies. The investigation shows that CPD is still a relatively underdeveloped subject in the performing arts sector and that the attitudes towards, environments of, platforms for and focus on CPD will benefit from a critical re-evaluation in the postdigital context. Implications of these results for practitioners, policymakers, and public and private organisations are discussed.