Lessons Learned from the Educational Experience during COVID-19 from the Perspective of Latin American University Students

The COVID-19 pandemic impacted the educational context. University students were exposed to an educational transition from a face-to-face context to emergency remote teaching (ERT). This change affected the educational experience of students and teachers in general, and impacted their educational performance, as well as their emotional and mental health, among other aspects. However, learning from the successes during the ERT and reflecting on good and bad practices will allow us to configure effective learning scenarios that respond to the new normal. The objective of this paper is to describe and present the lessons learned during ERT from the experience of university students in Latin America who have already returned to face-to-face instruction. The study used a qualitative inductive approach and a phenomenographic design. The sample consisted of 640 undergraduate students (63% women) of higher education who experienced online education during the year 2021 and a face-to-face modality during the first semester of 2022, belonging to universities in Chile, Venezuela, and Ecuador. The results suggest that new learning scenarios should consider specific pedagogical practices, including active, collaborative, meaningful, and problem-based strategies, together with a diversity of feedback practices. It is concluded that the ERT brought good practices that should guide university educational policies. © 2023 by the authors.

DIFFERENCES IN CLINICAL CHARACTERISTICS, TREATMENT, AND OUTCOME OF PULMONARY EMBOLISM ACCORDING TO COVID-19 STATUS

SESSION TITLE: Expanding Considerations in Management of Pulmonary Embolism SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Patients with COVID have an increased risk of thrombotic events including pulmonary embolism (PE). The primary objective of this study was to understand the differences in risk factors, clinical presentation, treatment modalities, and outcomes in patients with PE who were COVID positive at time of admission compared to those who were not. METHODS: Patients diagnosed with PE and activated by the Pulmonary Embolism Response Team (PERT) at Spectrum Health hospital system between November 2019 through January 2022 were included. Clinical, demographic, laboratory, and therapeutic characteristics were compared between patients with COVID and without COVID. Continuous variables were evaluated by t-test and categorical variables by Chi square. Survival after PE was evaluated using Kaplan Meier survival analysis. RESULTS: Of the 479 PERT-activated patients at our institution, 84 (17.5%) were diagnosed with COVID upon admission. Demographics such as age, gender, BMI, and race were similar between patients with and without COVID (all p>0.05). Patients with COVID were less likely to have PE risk factors such as recent surgery (4.8% vs 16.2%, p=0.011), recent trauma (0% vs 8.1%, p=0.014), and reduced mobility (10.7% vs 26.6%, p=0.003) although they were more likely to be recently hospitalized (19.1% vs 8.9%, p<0.001). Patients with COVID were more likely to have a fever (7.1% vs 2.5%, p=0.045), hypoxia (60.7% vs 29.9%, p<0.001), tachypnea (high respiratory rate/min of 28.2 vs 24.8, p<0.001), and lower O2 saturation (low O2 mean of 87.3 vs 90.5, p<0.001) upon presentation. Compared to non-COVID patients, mean troponin (116.5 vs 83.6 ng/ml, p=0.033) was higher in patients with COVID. There was DVT in 36.9% of COVID patients and 30.63% of non-COVID patients (p=0.321). Severity of PE was similar between COVID and non-COVID patients (massive: 18% vs. 15%;sub-massive: 70% vs. 75%, p=0.661). COVID and non-COVID patients had similar rates of thrombolysis (4.7% vs 2.3%) and catheter-based interventions (56% vs 59%). Patients with COVID had longer ICU (10 vs 5.2 days, p=0.001) and hospital stays (10 vs 6.1 days, p=0.006) compared to non-COVID patients. Major bleeding in the follow-up period was higher in the COVID group (10.7% vs 3.5%, p=0.01). There was no difference in mortality between COVID and non-COVID patients at 30 days, (11.9% vs 7.6%), 90 days (15.5% vs 10.4%), or 1 year (16.7% vs 13.7%). CONCLUSIONS: Patients who presented with PE and COVID had less traditional risk factors for PE and were more hypoxemic and tachypneic at the time of PERT activation. They received similar treatment to non-COVID patients but had increased risk for major bleeding. There were no differences in short or intermediate term survival between COVID and non-COVID patients. CLINICAL IMPLICATIONS: Similar severity, treatment, and mortality show promise for PE patients with COVID but bleeding complications require further investigation. DISCLOSURES: no disclosure submitted for Wael Berjaoui;Speaker/Speaker's Bureau relationship with Bristol Myers Squibb Please note: 2015 to present Added 04/17/2022 by Trevor Cummings, value=Honoraria Speaker/Speaker's Bureau relationship with Pfizer Please note: 2015 to present Added 04/17/2022 by Trevor Cummings, value=Honoraria Speaker/Speaker's Bureau relationship with Inari Medical Please note: 2020 to Present Added 04/16/2022 by Trevor Cummings, value=Honoraria No relevant relationships by Catherine Kelty Consultant relationship with Inari Medical Please note: July 2020 - present Added 04/02/2022 by Michael Knox, value=Consulting fee No relevant relationships by marzia leacche no disclosure submitted for Renzo Loyaga-Rendon;No relevant relationships by James Morrison No relevant relationships by Joseph Pitcher No relevant relationships by Nabin Shrestha Consultant relationship with Inari Medical Please note: 1/2021 to current Added 04/08/2022 by Erin VanDyke, value=Consulting fee No relevant relationships by Glenn VanOtteren

Return to University Classrooms With Blended Learning: A Possible Post-pandemic COVID-19 Scenario

After more than 2 years of the pandemic caused by COVID-19, a gradual return to face-to-face teaching has been taking place. Therefore, administrators need to establish procedures to facilitate and ensure the quality of teaching during this process. The purpose of this article is to describe the strengths and challenges of implementing Blended Learning (BL). The design used is consistent with a secondary investigation of a narrative review. As a result, several recommendations are presented for building institutional frameworks that enable the implementation of high-quality BL models in the context of a gradual return to face-to-face courses in higher education. From a theoretical and contextual perspective, considerations for transitioning to this model are discussed, based on lessons learned from emergency remote education. We conclude that the present post-pandemic scenario constitutes a pivotal moment for determining the way education is delivered in higher education.

ASSESSING PATIENT PERSPECTIVES ON RACIAL BIAS AT THE SFVA DOWNTOWN CLINIC: A TRAINEE-DRIVEN QI PROJECT

STATEMENT OF PROBLEM/QUESTION: Racial bias impacts health outcomes however, little is known about patient perspectives about this at San Francisco VA's Downtown Clinic (DTC), an urban clinic serving a higher proportion of Black and Latinx Veterans. DESCRIPTION OF PROGRAM/INTERVENTION: Patient satisfaction survey responses for DTC have historically been low with 34 patients (4%) completing surveys in 2019-20. To develop a novel survey assessing patient perspectives on satisfaction and the impact of bias and racism on care delivery in DTC, we modified two well-studied instruments, the Interpersonal Processes of Care (IPC-18) and Microaggressions in Health Care Scale (MHCS), and gave opportunities for free text feedback. We surveyed Veterans in 2021. Using root cause analysis, we identified barriers to survey response including those related to: process (surveys only sent via mail but many patients unhoused), patients (low motivation), providers/staff (no unified messaging about surveys, no interprofessional teamwork), and the COVID-19 pandemic (few in-person visits). Our interventions targeted: 1) ease of access: having electronic and paper surveys, and electronic tablets to use;2) maximizing patient engagement: surveys at COVID vaccine clinics and gifts for participation;and 3) communication/teamwork: posters advertising surveys, frequent staff check-ins. MEASURES OF SUCCESS: We assessed survey response rates and analyzed responses. FINDINGS TO DATE: N=236 Veterans completed surveys (25% of all clinic;93% male, 39% White). Overall, participants did not report microaggressions. On a 3-point scale (1=never happened, 2=happened but it didn't bother me, 3=happened & I was bothered by it) mean score on the MHCS=1.05 for the statement: “staff/providers were insensitive about your cultural group when trying to understand/treat your issues” and 1.02 for the statement: “staff/providers seemed to have stereotypes about your cultural group even if they did not express them directly”. Scores varied minimally by race. The Interpersonal Style domain of the IPC was scored the worst by African-American and Mixed Race Veterans, including that they felt the most discriminated against due to race/ethnicity (1.76 on a 1-5 scale, higher=worse). Patient-Centered Decision Making was scored worst by White Veterans, and overall Communication was scored the worst by Asian Veterans. N=18 (12% of respondents) preferred/strongly preferred a racially concordant PCP. N=10 (9%) disagreed/strongly disagreed that police officers at clinic treat all patients fairly with no significant differences by race using Fisher's exact test. Feedback mentioned: Veterans want providers to ask instead of assume about identities related to race, gender, sex, sexuality or those related to disabilities or chronic illnesses. Several suggested more minority representation in staff and trauma-informed care. KEY LESSONS FOR DISSEMINATION: Through accounting for multifactorial barriers to survey participation using Lean principles, we dramatically increased responses. Our survey elicited valuable perspectives to inform leadership.

Measuring College Students' Experiences with Virtual Education During the Pandemic by COVID-19

Due to the COVID-19 pandemic, young university students had to adjust to the emergency remote education provided by the online education modality. To know about the impact of this situation, the objective of this work was to validate the Scale of Experiences of University Students in Virtual Education (EEEV). A total of 2841 Chilean university students participated, with a mean age of 23.42 years (SD=7.72), of which 20% were engineering students. The EEEV arose from the adaptation of the questionnaire of expectations towards virtual education in university students during the COVID-19 pandemic, composed of six dimensions (Relationship with peers, Online learning, Online teaching, Self-efficacy for online learning, Online evaluation, and Comparison with face-to-face education). The psychometric properties of the EEEV version were verified. Validity estimations were performed using confirmatory factor analysis, finding a good fit, and maintaining the original version's factors. As for the dimensions, the internal consistency coefficient for the total scale was adequate. Therefore, it is concluded that the EEEV is a valid and reliable scale for measuring the experiences of university students in the context of emergency remote education.

ASSOCIATED FACTORS WITH ACUTE DIARRHEA IN SARS-COV-2 INFECTION: A CASE-CONTROL STUDY

Introduction: Gastrointestinal symptomatology in SARS-CoV-2 infection is a common clinical presentation, reported in up to 61% in those affected, being the presence of acute diarrhea one of the most common symptoms, reported in up to 33.7%. There are multiple theories about physiopathological mechanisms of diarrhea associated with SARS-CoV2 infection, but there is not enough evidence to attribute this symptom only to the infection without the influence of host and environment factors. Objective: Determine the associated factors with acute diarrhea in Mexican population with SARS-CoV-2 infection. Methods: A case-control cross-sectional study was performed to analyze the factors associated with acute diarrhea in patients with SARS-CoV-2. This research was carried out during the 2020-2021 in five states of Mexico. An online survey was applied to 784 patients, selected by randomized sampling of whom sociodemographic data, medical history, and symptoms related to SARSCoV- 2 infection were collected. A univariate and multivariate logistic regression analysis was performed applying a χ2 test with 95% confidence intervals to determinate the association of acute diarrhea in SARS-CoV-2 infection with other symptomatology and possible nonhost contributing factors for its presentation. Results: A total of 784 patients were analyzed with a mean age of 29 ± 8 years, predominantly female with 75.4% (591). The most frequently described symptom was fatigue in 75% (588) followed by anosmia and myalgias with 67% (525) and 65.5% (514) respectively. Acute diarrhea was present in 28.6% (321) of our population during the acute phase of SARS-CoV-2 infection. The most used drugs were acetaminophen (79.2%) and azithromycin (29.7%). The multivariate logistic regression analysis showed a statistically significant association between acute diarrhea and the use of macrolides, mainly with clarithromycin with an OR of 2.96 (95% CI of 1.26-6.95, p = 0.001) followed by azithromycin with an OR of 1.47 (95% CI 1.035-2.091, p = 0.031). In this same analysis, there was no significant association of acute diarrhea with the rest of SARS-CoV-2 infection symptoms. Discussion: This study demonstrates the association of acute diarrhea in SARS-CoV-2 infection with the concomitant use of macrolides, without finding any association with described SARS-CoV-2 viral symptoms. According to the previously mentioned, we propose that a proportion of acute diarrhea associated with SARSCoV- 2 infection may be secondary to inappropriate macrolide prescription and not due to the viral disease itself.

Psychometric characteristics of a virtual education expectations questionnaire for university students during the COVID-19 pandemic

The primary aim of this research study was to design a questionnaire that measures expectations towards online education for university students during the COVID-19 pandemic. Due to the COVID-19 pandemic, university authorities faced the challenge of providing online training programs that were specifically adapted to meet student expectations. In total, 8265 students (4627 women) from a Chilean university participated in the study. The mean age was 21.53 years (SD = 2.87) and 33.1% of the students were in their first academic year. A questionnaire was designed based on a scientific literature review and was validated by expert judgment. Validation estimates with exploratory and confirmatory factor analyses were performed. The results showed an adequate fit and a model with six derived factors in a hierarchical solution. Internal consistency coefficients were adequate. In conclusion, the virtual education expectations questionnaire for university students is valid and reliable for Chilean higher education. © 2022

FACTORS RELATED TO NEW ONSET DYSPEPSIA AFTER COVID 19 INFECTION IN MEXICAN POPULATION

ntroduction: Since the COVID 19 infection has been declared a pandemic by the World Health Organization, the spectrum of symptoms have been described, however, the presence of digestive symptoms as part of the probable sequelae of the disease has not been well studied. Objective: To determine the variables present during the active stage period of the COVID 19 infection and their association with symptoms of dyspepsia during the recovery period. Material and methods: An online survey was conducted to patients recovered from COVID 19 infection during the months of May and June 2020, evaluating the demographic variables of age, sex and comorbidities, the presence of COVID 19 infection symptoms during the disease active stage and digestive symptoms during recovery. Using SPSS version 22, univar-iate and multivariate logistic regression analysis was performed to determine the variables associated with the presence of dyspeptic symptoms such as early satiety, epigastric pain and postprandial fullness during recovery from the disease (4 weeks after the infection resolved). Results: A total of 315 patients recovered from COVID 19 infection were evaluated, mainly 59.6% from Baja California, 12.2% from Sonora, 7.8% CDMX, 6% Sinaloa, 3% Veracruz with an average age of 35.7 ±11.5 years of age, 65.4% female, with obesity comorbidities in 19.6% of cases, high blood pressure in 10.9%, asthma in 7.1% and diabetes mellitus in 2.2%. The most frequent symptoms reported of the disease were headache 79.5 %, myalgias 64.1%, diarrhea 60.9%, anosmia 62.2%, fever 57.1%, ageusia 58.7%, odynophagia 56.1%, arthralgias 54.7%, anorexia 52.6%, cough 49.7%, chest pain 39.4%, dyspnea 28.5%. Dyspep-sia in the recovery period was reported with pain in 18.6%, postprandial fullness 34.3%and early satiety in 52.2%. It was found that the variables independently associated with the presence of postprandial fullness during recovery from the disease are male (OR 0.544,IC 0.309-0.958, P = 0.035), anorexia (OR 3.07, IC 1.73-5.45, P <.001) and diarrhea (OR 1.87. IC 1.04-3.34, P = 0.034). The variable associated with the presence of satiety during recovery from the disease is the presence of anorexia (OR 6.65, CI 3.75-11.79, P <0.001). The presence of epigastric pain after COVID 19 infection is associated with diarrhea (OR 3.32, IC 1.42-7.79, P = 0.006), arthralgia (OR 3.15, IC 3.15-1.16-8.55, P = 0.026), treatment with azithromycin ( OR 2.29, IC 1.13-4.64, P = 0.021), chlorine dioxide treatment (OR 11.35, IC 2.69-47.9, P = 0.001).Conclusions: The presence of dyspepsia after infection by COVID 19 is frequent, some of the associated variables are similar to those reported in other cases of post-infectious dyspep-sia, the use of medications has an important relationship with the presence of epigastric pain.

INCIDENCE OF “NEW-ONSET” CONSTIPATION AND ASSOCIATED FACTORS DURING LOCKDOWN DUE TO THE CORONAVIRUS-19 PANDEMIC

Background: A minimum of physical activity and low liquid intake are factors that havebeen associated with constipation. The health emergency brought on by the COVID-19pandemic has resulted in adopting behavior, such as sheltering-in-place (less mobility) anddietary changes, creating a scenario we believe to be an adequate model for examining theappearance of symptoms of constipation and its associated factors. At present, there are no reports in the literature that establish a relation between a change in bowel movement habitand being under the current lockdown. Thus, the aim of our study was to evaluate theincidence of symptoms of constipation and associated factors during the lockdown implementedto contain the spread of COVID-19 in Mexico.Methods: A cross-sectional and descriptive study was conducted on an open population,applying an electronic survey (4 weeks after lockdown due to COVID-19 in Mexico) toevaluate: demographic characteristics, physical activity, water and fiber intake, appearanceof constipation symptoms (including stool consistency), and quality of life. Incidence (newcases) of constipation after the lockdown (“new-onset” constipation) was calculated and the95% CI was reported. A comparative analysis of the categorical variables and continuousvariables was carried out between the participants with “new-onset” constipation and thosewith no constipation during the lockdown, utilizing the Student’s t test, the Mann-WhitneyU test, the chi-square test, or the Wilcoxon test, as appropriate. Statistical significance wasset a p < 0.05.Results: Out of 678 subjects evaluated, 170 (25%, 95% CI 21.7-28.4) developed symptomsof “new-onset” constipation, with a significant decrease in the number of daily bowelmovements (p<0.05) and stool consistency (p<0.05) during lockdown (Figure 1). Furthermore,in the “new-onset” constipation population, there was a higher proportion of subjects(48%) who stopped exercising during the pandemic compared to the subjects who did notdevelop constipation symptoms (29%, p=0.0005, OR 2.23, CI 95% 1.4-3.48, Figure 2).The multivariate analysis (logistic regression) showed that female sex (p=0.001), water intake(p=0.039), and physical activity (p=0.012) were associated with “new-onset” constipation.Conclusions: In conclusion, in our study we found that one-fourth of the population thatreduced their physical activity and drank less water due to mobility restrictions imposedfor epidemiologic reasons, in the face of the COVID-19 pandemic, developed “new-onset”constipation symptoms. Given those results, appropriate physical activity and adequateliquid intake during prolonged periods of lockdown should be recommended to preventsaid symptoms.(Image Presented)Number of bowel movements, days of physical activity and stool consistency before and after the lockdown(Image Presented)Percentage of subjects who stop physical activity during the pandemic among groups.

Applications used and recommendations provided by university professors for self-regulation of learning in the context of covid-19 pandemic

The strategic use of digital applications in higher education acquired special relevance in times of COVID-19 pandemic. This exploratory study inquires which digital applications are used and recommended by Chilean higher education lecturers in order to promote self-regulated learning on the virtual education context. The methodology was qualitative, with a phenomenographic approach, based on three focus groups, with an intentional sample of 17 lecturers. The data were analyzed through Content Analysis technique. 27 relevant digital applications were identified to facilitate self-regulation of learning, 16 useful for the preparation phase, 19 for the execution phase, 11 for the self-reflection phase, and 8 for the three phases of the Zimmerman cyclical model. WhatsApp and Google Calendar are the most recommended applications for self-regulation processes, specifically for the disposition of learning. Taking benefit of the reciprocal influence of knowledge on self-regulation of learning and ICT skills emerges as a shared challenge to promote a strategic use of digital applications and to foster inclusive and quality learning in the university, in the context of emergency online education. © 2021 North Caucasian Institute of Mining and Metallurgy, State Technological University. All rights reserved.

Design, Validity and Effect of an Intra-Curricular Program for Facilitating Self-Regulation of Learning Competences in University Students with the Support of the 4Planning App

Background: Smartphone applications have the potential to support university students for the benefit of learning in higher education. Objective: To design and evaluate the effect of an intra-curricular program using a mobile application on self-regulated learning strategies in university students. Method: The 4Planning mobile application was designed following a systematic literature review, expert judgement and application. The instrument to assess the effect of the intervention was the SRL Readiness Practices Scale, with a one-factor structure (CFI = 0.98;TLI = 0.97;RMSEA = 0.05) with reliability of alpha = 0.89. The design was quasi-experimental with pre- and post-test measures and experimental and control groups. The sample consisted of 473 first-year university students (37.02% male) from seven Chilean universities with a mean age of 19.35 (SD = 2.49). Statistical analysis was an ANOVA performed in R software version 4.0.3. Results: Statistically significant differences were identified in the levels of self-regulated learning between the experimental group compared to the control group. Conclusion: The development of the 4Planning app proved to be effective in promoting the development of self-regulated learning strategies in university students.

Psychosocial Characterization and Mental Health in Families of Chilean Students during Physical Isolation by Covid-19

The research objectives were to examine psychosocial and academic variables in families of primary and secondary schoolchildren in southern Chile in physical isolation and to analyze the mental health of parents. A descriptive cross-sectional design was used. Two stages were considered. In the first stage, an ad-hoc survey was applied to 8,102 families. In the second stage, the DASS-21 instrument was applied to a sample of 59. The results of the first stage showed that 40% of the participant families had a member without paid work, an income of less than $ 440, and the majority did not have computer at home. The schoolchildren have felt anxiety, night fears, bad mood or aggressiveness, several of them have not completed schoolwork and reported motivational difficulties. Most of surveyed students have not dedicated enough time to schoolwork and their main activity has been to watch TV series. The second stage showed that the 57.6% of parents presented severe anxiety, 50.8% stress and 83% depression. It is concluded that families lack the resources for the effective development of online education. Specialized actions are required to "mitigate" the impact of physical isolation by Covid-19 on socio-academic and mental health variables in schoolchildren and their families.