Real Workload-Situated Training in COVID-19 Prevention of General Practice Residents in China: A Situated Cognition Study.

Objective: The participation of general practice (GP) residents in COVID-19 prevention and control tasks touched workload participation in public health and disease prevention and control and was also a rare, valuable training experience for the residents and research material for medical education. This experience contributed to the understanding of three key points: First, was the content of the COVID-19 prevention task suited to them, or did it overload them in the present? Second, their competence in the COVID-19 prevention task reflected whether the early medical school training was sufficient or not. Third, what can be drawn from this study to promote public health training in the future? This study aimed to explore these issues by conducting a real epidemic situated training (REST) program. Methods: A situated cognition study was designed that included situational context design, legitimate peripheral participation, and the construction of a community of practice. The Task Cognitive Load Scale (NASA-TLX Scale) and self-developed questionnaires were adopted to conduct a questionnaire survey of resident doctors in a GP training program from West China Hospital of Sichuan University, and 183 questionnaires were collected. SPSS 23.0 statistical software was used for the statistical analysis of data. Results: The NASA scale showed that the intensity of field epidemic prevention and control (training) was tolerable. In particular, there was statistical difference in the cognitive load intensity of training before and after the epidemic occurred at different time points (P < 0.05). This shows that they were early trained and well-prepared before sudden outbreak of the COVID-19. Before the outbreak of the epidemic, the public health knowledge and training received came from undergraduate education (83.16%), early residents program training (69.47%), online self-study (49.16%), and continuing education (20.53%). Conclusion: Former medical school education and training at the regulatory training stage have a good effect and enable residents to master the skills required for epidemic prevention and control and to physically and mentally prepare for the task. After this stage, epidemic prevention and control training in real situations will make important contributions to the self-assessment and performance improvement of public health training.

Real Workload-Situated Training in COVID-19 Prevention of General Practice Residents in China: A Situated Cognition Study (preprint)

Objective: The participation of general practice (GP) residents in COVID-19 prevention and control tasks touched workload participation in public health and disease prevention and control and was also a rare, valuable training experience for the residents and research material for medical education . This experience contributed to the understanding of three key points: First, was the content of the COVID-19 prevention task suited to them, or did it overload them in the present? Second, their competence in the COVID-19 prevention task reflected whether the early medical school training was sufficient or not .Third, what can be drawn from this study to promote public health training in the future? This study aimed to explore these issues by conducting a real epidemic situated training (REST) program. Methods: A situated cognition study was designed that included situational context design, legitimate peripheral participation, and the construction of a community of practice. The Task Cognitive Load Scale (NASA-TLX Scale) and self-developed questionnaires were adopted to conduct a questionnaire survey of resident doctors in a GP training program from West China Hospital of Sichuan University, and 183 questionnaires were collected. SPSS 23.0 statistical software was used for the statistical analysis of data. Results: The NASA scale showed that the intensity of field epidemic prevention and control (training) was tolerable. In particular, there was no statistical difference in the cognitive load intensity of training before and after the epidemic occurred at different time points (P<0.05). This shows that they were early trained and well prepared before sudden outbreak of the COVID-19.Before the outbreak of the epidemic, the public health knowledge and training received came from undergraduate education (83.16%), early residents program training (69.47%), online self-study (49.16%), and continuing education (20.53%). Conclusion: Former medical school education and training at the regulatory training stage have a good effect and enable residents to master the skills required for epidemic prevention and control and to physically and mentally prepare for the task. After this stage, epidemic prevention and control training in real situations will make important contributions to the self-assessment and performance improvement of public health training,and make participants more competent to face the epidemic task.

Online Study: Understanding the Laws of Self-Regulated Study (preprint)

Background: The sudden COVID-19 outbreak has posed challenges to the normal development of continuing education for general practitioners. Consequently, an online medical training program for family doctors has emerged. Online study helps us better understand the laws of self-regulated learning because we can track the process and outcome of family physicians and compare it to that of face-to-face training programs. The study track the GPCC online program to reveal this principle. Results: By recording learners’ study behaviors and explore the law of learning progress and analyse the impact of latent variables on learning through structural equation models,the study find that the the impact of teacher support and supervision and of internal motivation on learning input and the influence of teacher support and supervision on internal motivation can be researched through online study. Conclusions: Online study helps us better understand the laws of self-regulated learning. It helps to better understand the impact of teacher support, supervision, and internal motivation on learning input , as well as the influence of teacher support and supervision on internal motivation. Examining online study can also help in making effective use of the self-education characteristics of internal motivation and cultivate the ability of independent thinking and learning self-discipline .

Pilot Trial of High-dose vitamin C in critically ill COVID-19 patients (preprint)

Background: No specific medication has been proven effective for the treatment of patients with severe coronavirus disease 2019 (COVID-19). Here, we tested whether high-dose vitamin C infusion was effective for severe COVID-19.Methods: This randomized, controlled, clinical trial was performed at 3 hospitals in Hubei, China. Patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the ICU were randomly assigned in as 1:1 ratio to either the high-dose intravenous vitamin C (HDIVC) or the placebo. HDIVC group received 12 g of vitamin C/50 ml every 12 hours for 7 days at a rate of 12 ml/hour, and the placebo group received bacteriostatic water for injection in the same way. The primary outcome was invasive mechanical ventilation-free days in 28 days(IMVFD28). Secondary outcomes were 28-day mortality, organ failure, and inflammation progression.Results: Only fifty-six critical COVID-19 patients were ultimately recruited due to the early control of the outbreak. There was no difference in IMVFD28 between two groups. During the 7-day treatment period, patients in the HDIVC group had a steady rise in the PaO2/FiO2 (day 7: 229 vs. 151 mmHg, 95% CI 33 to 122, P=0.01). Patients with SOFA scores ≥3 in the HDIVC group exhibited a trend of reduction in 28-day mortality (P=0.06) in univariate survival analysis. IL-6 in the HDIVC) group was lower than that in the placebo group (19.42 vs. 158.00; 95% CI -301.72 to -29.79; P=0.04) on day 7. Conclusion: This pilot trial showed that HDIVC might show a potential signal of benefit for critically ill patients with COVID-19, improving oxygenation even though it failed to improve IMVFD28. Clinicaltrial.gov identifer and date: NCT04264533. Registered February 14 2020.

Clinical Features and Outcome Analysis of Patients Infected with Severe and Critical COVID-19 Associated Pneumonia (preprint)

Background Until now, information on the clinical characteristics of severe and critical patients with COVID-19 is extremely limited.The aim of the present study was to analyse the clinical features of these patients and influencing factors of clinical outcome, and explore treatment effects of prone position on COVID-19 patients with severe ARDS. Methods A retrospective analysis was performed on 55 COVID-19 patients in the ICU of Zhongnan Hospital of Wuhan University from January 6 to February 15, 2020 in Wuhan, China. Case data from each patient were collected and related clinical outcomes on day 14 of ICU admission were recorded. The follow-up deadline was February 29, 2020. Results Of the 55 patients included, 35 were male (63.6%), with an average age of 63.0 (SD 15.2) years, and 80.0% were patients over 50 years old. The first three symptoms were fever (36 cases, 65.5%), fatigue (13 cases, 23.6%), and cough (11 cases, 20.0%). The rate of invasive mechanical ventilation was 52.7% (29 cases); on the 14th day of ICU admission, 31 patients(56.4%) were improved, and 19 (34.5%) were worsened.  On the 14th day after entering the ICU, a comparative analysis showed that peripheral blood CD4, CD8, and NK cell counts in deteriorated patients were significantly lower than those in improved patients (P<0.05). Meanwhile, concentrations of IL-10, IL-4, IL-6 and TNF-α in deteriorated patients were higher than those in improved patients (P <0.05). Among  a total of 27 prone position sessions, the oxygenation index (PaO2 / FiO2 ) of 9 prone position sessions(33.3%) improved, and the PaCO2 in arterial blood gas analysis of 5 sessions(18.5%) improved. Conclusion The majority of patients with severe and critical COVID-19 in the ICU were over 50 years old and male. 52.7% need invasive mechanical ventilation. On the 14th day of admission, 56.4% of the patients improved, 34.5% of the patients deteriorated. The rate of deaths during hospitalization was 21.8%. The worsening of COVID-19 patients might be related to excessive inflammatory and immune responses. In addition, prone ventilation may improve oxygenation in some COVID-19 patients with severe ARDS, but a significant mortality benefit with proning was uncertain.