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Introduction/Aim: The development of safe and effective vaccines is crucial to conquering the COVID-19 pandemic. Recombinant proteins represent the best understood and reliable approach to pandemic vaccine delivery with well-established safety;however, they face challenges in design, structural characterisation, manufacture, potency testing and ensuring adequate immunogenicity. Method(s): Our team used in silico structural modelling to design a vaccine based on a stabilised spike protein extracellular domain (ECD). The insect cell expressed recombinant spike ECD was formulated with Vaxine's proprietary Advax-CpG55.2 adjuvant. Result(s): The vaccine known as Covax-19 or SpikoGen induced high titers of antibody and memory T-cells which translated to protection against SARS-CoV-2 infection in hamsters, ferrets, and aged monkeys. Despite numerous challenges along the journey, clinical trials in Iran during a major wave of delta variant infection confirmed SpikoGen vaccine was 78% effective in reducing risk of severe disease and with no evidence of vaccine-associated thrombosis, myocarditis, or sudden death, receiving marketing approval under emergency use authorisation in Iran on 6 October 2021. This made it the first recombinant spike-protein vaccine in the world to be approved, and the first Australian-developed human vaccine to receive marketing approval in four decades. Since approval millions of doses have been administered and additional trials in Australia and Iran have confirmed its effectiveness as a booster to prevent waning immunity, as well as its safety and effectiveness in children from the age of 5 years. The ongoing Australian and overseas clinical trial program is focussed on gaining better understanding the effect of dosing intervals on vaccine immunogenicity, gathering additional data on use as a booster, and development of new variant formulations. Conclusion(s): Covax-19/Spikogen is safe and effective adjuvanted recombinant protein vaccine.
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Purpose of Study: Residents have experienced changes in educational structure, format, content, and patient experience due to the COVID-19 pandemic. Resident physicians across the country have reported changes in workload including a decrease in well child checks and immunizations resulting in limited clinical exposure. This study aimed to assess the confidence of first year pediatric residents (interns) in conducting routine preventive screening for children and to identify potential gaps in knowledge among this cohort. Methods Used: We conducted a cross-sectional observation study that included 13 categorical first year pediatric residents. A voluntary, anonymous online survey was administered in September 2022. The survey assessed confidence levels, and perceived comfort regarding common preventive pediatric encounters and screening tools. The survey included 7-questions based on the 4th Edition Bright Future's Guidelines and respondents rated their answers on a 5-point Likert scale. The surveys were distributed anonymously via e-mail using Survey Monkey, a web-based software platform that provided an intuitive interface for validated data capture. Participants were given 2 weeks to complete the survey and reminders were sent via email. Summary of Results: Eight of 13 interns participated for a response rate of 62%. Sixty-three percent of the residents had completed a subinternship in pediatrics. Of our respondents, 75% reported feeling "not at all confident" in executing well child check-ups for children <12months old and 63% reported feeling "very confident" in examining children> 13months old. Regarding the ability to perform a genitourinary examination in children >12years of age, 63% of respondents stated that they were "slightly" or "not at all confident". We asked interns to rate their confidence in providing anticipatory guidance to their patients. Interns perceived being somewhat confident regarding guidance about safe sex, tobacco use, and healthy lifestyles but less confident regarding newborn care, breast feeding and infant nutrition. Nearly 40% reported comfort in recommending and advising parents about the risks and benefits of age appropriate immunizations. We asked residents to report their ability in administering and interpreting screening tools (ASQ, MCAT, EPDS). Interns reported that were able to interpret results but lacked confidence in providing guidance. Conclusion(s): Our study identifies opportunities to bridge experiential knowledge gaps and confidence among pediatric interns who may have had limited clinical exposure to pediatrics following the COVID-19 pandemic. Graduate medical education programs should consider developing tailored educational interventions specifically geared for identified learning gaps to mitigate the challenges posed by the pandemic.
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Background: Hand washing, also known as hand hygiene, is a simple procedure used for cleaning and cleansing hands for eliminating soil, dirt, and germs including microorganisms such are bacterial or viral particles. In the absence of water and soap, cinder can be used as an alternative method for cleaning hands. Hand hygiene is an essential part that needs to be carefully fol-lowed in the infection control protocols. With the expanding loads of Health-Care Associated Infections (HCAIs) and the increasing levels of both treatment complexity and severity of illness synchronized by multi-drug resistant (MDR) pathogen infections, health care practitioners are fo-cusing on the basic and most essential facts of disease prevention by implementing the basic and simple cleaning measures including hand hygiene measures. According to healthcare facilities, many scientific evidences support the observation that hand hygiene or handwashing if properly im-plemented, can decrease and eliminate the risk factors of cross-transmission infections. Method(s): The data was collected using a self-administrated survey, which included 10 questions, constructed using the monkey survey website. The survey was sent by email and collected from 100 participants of different ages. Result(s): Our results indicated that the majority of our population under study is considered healthy, representing good educational levels. Conclusion(s): The majority revealed advanced knowledge and understanding about the key aspects for hand washing procedures.Copyright © 2021 Bentham Science Publishers.
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Introduction: There are no contraindications to COVID-19 vaccination for people with inherited bleeding disorders. The COVID vaccine trials demonstrating efficacy have only been performed using an intramuscular (IM) route of administration. Subcutaneous administration, which is an option for other types of vaccines for people in people with bleeding disorders (1) is not recommended. There is little data on the safety of intramuscular (IM) injections in children with bleeding disorders (2) Expert consensus guidelines from theWFH and other major medical & patient organisations advised to use the smallest gauge needle available, apply pressure to the site for at least 10 min. Children with severe or moderate haemophilia should receive prophylactic replacement therapy prior to IM vaccination if available. For those on Emicizumab tranexamic acid to be considered. For children with VWD, depending onVWFactivity levels therapies such asDDAVP or tranexamic acid can be considered in consultation with the clinicians. Haemostatic support for patients with rare bleeding disorders should depend on the severity of the disorder and be decided in consultation with their treatment centre. Method(s): The haemostatic advice given at Birmingham Children's Hospital (BCH), was in line with these published guidelines. We designed a short retrospective survey and asked parents to complete the survey after their child received COVID-19 vaccination in order to assess if patients were experiencing bleeding complications. The survey link (survey monkey) was distributed via text to patients registered at our haemophilia centre. The survey was registered and approved as an audit at BCH. Result(s): We received 24 responses. 50% had received 2 vaccinations. 23/24 (95.8%) reported no bleeding complications. Although the uptake of the survey was poor, no child attended the haemophilia unit or the emergency department for management of any post-vaccination bleeding problem. Discussion/Conclusion: We conclude that COVID-19 IM vaccination can be safely administered in children with bleeding disorders, following guidelines. (Figure Presented) .
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Background: COVID-19 vaccines are safe & effective, though patients with rheumatic diseases like idiopathic inflammatory myositis (IIMs), and those with multiple comorbidities continue to be hesitant. Adverse events after vaccination are not extensively studied in those with multiple coexisting autoimmune diseases. Patients with IIM often have multiple autoimmune rheumatic and autoimmune non-rheumatic comorbidities (IIM-AIDs), with potentially increased risk of AEs. The COVAD study aimed to assess COVID-19 vaccination-related AEs till 7 days post-vaccination in IIM-AIDs compared to IIMs and healthy controls (HCs) group. Method(s): T he C OVAD s tudy g roup c omprised > 110 c ollaborators across 94 countries. The study was conducted from March-December 2021. A survey monkey platform-based self-reported online survey captured data related to COVID-19 vaccination-related AEs in IIMs, AIDs, and HCs. We compared COVID-19 vaccination-related AEs among IIM-AID patients and IIM alone and HCs, adjusting for age, gender, ethnicity, vaccine type, immunosuppression, and numbers of AIDs, using binary logistic regression. Statistically significant results following multivariate regression are reported. Result(s): Among 6099 participants, 1387 (22.7%) IIM, 4712 (77.2%) HC, 66.3% females, were included from 18 882 respondents: 573 (41.0%) people with IIM-AIDs;814 (59.0%) with IIM without other AIDs;and 4712 HCs. People with IIM were older [median 54 (45-66) IIM-AIDs, 64 (50-73) IIM, 34 (26-47) HC years, P < 0.001]. BNT162b2 (Pfizer) (37.5%) and ChAdOx1nCoV-19 (Oxford) (11.1%) were the most common vaccines. When compared to IIM alone, IIM-AID patients reported higher overall AEs [OR 1.5 (1.1-2.1)], minor AE [OR 1.5 (1.1-2.1)] &major AE [OR 3 (1.5-5.8)]. IIM-AIDs patients also reported higher body ache, nausea, headache, & fatigue (OR ranging 1.3-2.3). After adjusting for the number of AIDs, the major AEs equalized but overall AEs, & minor AEs, such as fatigue remained higher. When compared to HCs, IIM-AIDs patients reported similar overall AEs, minor AEs but higher major AEs [OR 2 (1.2-3.3)] nausea/ vomiting [OR 1.4 (1.01-2)], headache [OR 1.2 (1.01-1.6)], and fatigue [OR 1.3 (1.03-1.6)]. Dermatomyositis with AIDs (n = 183) reported higher major AEs [OR 4.3 (1.5-12)] compared to DM alone (n = 293). Active IIM with AIDs (n = 482) reported higher overall AEs [OR 1.5 (1.1-2.2)], minor AEs [OR 1.5 (1.1-2.2)] and major AEs [OR 2.6 (1.2-5.2)] compared to active IIM alone (n = 643). Conclusion(s): COVID-19 vaccination is safe with minimal to no risks of short-term AEs in patients with IIM without other concomitant autoimmune diseases. The presence of autoimmune multimorbidity conferred higher self-reported short-term risks of overall, major, and minor COVID-19 vaccination-related AEs 7 days post-vaccination, particularly in those with active IIM.
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Introduction At the onset of the Covid-19 pandemic, hospital educational activities were halted in order to focus on healthcare delivery and maintain social distancing. As a response to this disruption, BSPGHAN trainees set up the BSPGHAN Education Series, a twice- weekly virtual learning programme. The core objective of this programme was to deliver high quality paediatric gastroenterology, hepatology and nutrition (PGHAN) teaching during the pandemic. In this study, we analysed the attendances and feedback received from the education series, in order to guide future directions. Methods We reviewed the Zoom meeting attendance logs and Survey Monkey feedback forms for the BSPGHAN Education Series from April 2020 to December 2020. Results In nine months, a total of 55 talks were delivered by 43 speakers. 23 (41.8%) sessions were gastroenterologythemed, 25 (45.4%) were hepatology-themed and 7 (12.7%) were nutrition-themed. Thirteen paediatrics gastroenterology units (12 in the UK and 1 in the United States) and all 3 UK tertiary paediatric liver centres contributed to the talks. The highest contributing centres were Birmingham Children's Hospital (20 sessions), followed by King's College Hospital (9 sessions) and Leeds Children's Hospital (7 sessions). Attendance logs and feedback forms were available for 53 sessions. A total of 2369 attendances were logged, with a median of 41 attendees per session (IQR 31-54). Attendees from 22 countries have participated in these sessions. A total of 810 survey feedback forms were received, with a median of 14 forms received per session (IQR 10-18). 32% were filled in by PGHAN Grid trainees, 23% by consultants, 15% by clinical fellows. Allied Health Professionals (AHPs) comprised 6% of feedback returns. 54% of survey feedback respondents accessed the teaching sessions from home. An average of 98% (95% CI 96.3-99.2) survey respondents strongly agreed/agreed that the sessions were relevant to their learning. 97% (95% CI 96-98.7) of survey respondents strongly agreed/agreed that the sessions delivered were of high quality. Discussion The BSPGHAN series has been a positive initiative arising from the pandemic, providing access to high quality PGHAN education when local availability was paused, and giving a platform for the society internationally. Our report shows that the BSPGHAN Education Series has been wellreceived by attendees. The virtual sessions are more accessible compared to in-person teaching sessions, as evidenced by the high percentage of feedback respondents accessing the sessions from home. Looking ahead, the BSPGHAN Education Group, set up in October 2020, will play a vital role in the further development of the Education Series. Sessions are recorded and made available to BSPGHAN members on the BSPGHAN websitefurther work may include creating online learning modules centred around these recordings. AHP involvement is an area for development- for 2021, we hope to include more topics that will be relevant to their interests.
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The Covid-19 pandemic has caused a fresh shift in the global population today, requiring people to adjust their typical routines and lifestyles. In the last five years, electronic books (e-books) have become a popular reading and reference alternative, particularly for fiction (Jandri, P., et al). (2020). In the academic realm, however, e-books have not had the same level of success in terms of use and acceptability. It will take further research to determine why this is happening among academic users. Because the usage of e-books is new, it has an impact on library services. Because it is new, there is a need to improve library service quality. There are challenges in influencing user behavior in accessing e-content materials. The methodology and procedures used describe the different types of research paradigms and justify the reasons for using each in this study. Therefore, this paper discusses the influence of challenges in influencing user behavior in accessing e-content materials in terms of services in digital libraries in selected universities using questionnaires as a research tool to collect data through Survey Monkey application and Google forms. Structural Equation Model (SEM) - SmartPLS will be used in this study. The quantitative approach is used to measure factors influencing user behavior in accessing and using e-content among trainee students in Teachers' Training Institutes in Malaysia. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Methods: A survey was designed using Survey Monkey to query faculty regarding measures of stress and burnout related to both remote teaching and on campus teaching. A fivepoint Likert scale was used to garner respondents' reactions to 21 closed ended questions. The anonymous, confidential survey link was sent by email to faculty at three chiropractic programs. Respondents were instructed to reflect on March 2020 to March 2021 when completing the survey. Results: The survey request yielded 36 respondents. The majority of respondents, 66%, worked partially at home and partially on campus, while 26% worked entirely from home and 8% entirely on campus. In addition to work responsibilities, 31% of respondents were educating children at home. Nearly 2/3 of respondents (61%), indicated that they did not stop working at the end of the workday and 47% indicated that they felt stressed at work. However, 72% of respondents indicated that they were able to create a productive learning environment for students. While only 17% of respondents agreed that working with students remotely was energizing, most (70%) did not feel students blamed them for issues experienced during remote learning. Background: The purpose of this study was to examine the effect of moving to emergency remote teaching due to the COVID-19 pandemic on chiropractic college faculty. The job of a faculty member has always included demands. Stress can lead to occupational burnout, defined by the World Health Organization (WHO) in 2019 as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” Conclusion: Chiropractic faculty variably experienced stress during the height of the COVID-19 pandemic. This may be due to working remotely and an absence of separation of home and work life. Despite the stressors felt surrounding teaching and work, faculty created a positive learning environment for students.
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Background: E-learning forms a core component of training programmes for healthcare professionals. However, institutions utilize e-learning in different formats with varying degrees of development and validation, and for different purposes. There is limited published data on the use and the effectiveness of e-learning for transfusion medicine. Aims: This survey aims at collecting information on the scope and content of existing transfusion e-learning modules in different blood establishments and transfusion services worldwide. Methods: A survey was designed using the Survey Monkey tool by the ISBT Clinical Transfusion Working Party, with participation of experts in transfusion education and e-learning. The ISBT central office distributed the survey to all ISBT members. Descriptive statistics were utilized to summarize the results. Results: A total of 177 respondents participated, 68 of which had elearning modules in their institutions. Of the 68 respondents with e-learning modules, 56% worked in academic/ university-affiliated institutions. The insitutions included hospital-based transfusion services/blood banks (n = 16, 23.5%), regional blood services/blood centers (n = 11, 16.2%) and hospitalbased blood services (n = 9, 13.2%). These institutions were from different World Health Organization Regions, namely;Europe (n = 27, 39.7%), Americas (n = 12, 17.6%), South East Asia (n = 10, 14.7%), Western Pacific (n = 9, 13.2%), Eastern Mediterranean region (n = 5, 7.4%) and Africa (n = 5, 7.4%). More than half of the e-learning modules were developed inhouse (66%), and 63.2% are available to learners from outside the institutions. In a third of institutions, these modules were established during the COVID-19 pandemic, while 14.7% used e-learning modules for more than 10 years. The modules target different audiences and topics ranging from blood donation to administration and hemovigilance (see Table). The commonest audiences were physicians (n = 48, 71%), laboratory scientists/ technologists (n = 47, 69.1%), transfusion practitioners (n = 43, 63.2%) and medical students (n = 41, 60.3%). More than half of the respondents had modules on transfusion reactions targeting physicians (63%) and transfusion practitioners (57%). E-learning modules on laboratory practice is in use in 63% of the institutions for laboratory scientists/technologists. Formal assessment of learning outcomes is used in 70% of the e-learning programs. Summary/Conclusions: The survey demonstrates the widespread use of e-learning modules in transfusion education, with a substantial proportion being developed during the COVID-19 pandemic. There is considerable variability in the content of e-learning modules. More data are required to understand the effectiveness of this method of education on learning outcomes.
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OBJECTIVE: To assess Telehealth services offered by Society for Assisted Reproductive Technology (SART) member clinics and provider experiences with incorporating Telehealth into reproductive endocrinology and infertility practices. MATERIALS AND METHODS: A 16-question web-based survey on use of Telehealth was distributed to SART member reproductive endocrinology and infertility clinics. Clinic demographic data, Telehealth descriptive data and provider satisfaction with use of Telehealth were assessed. Results were collected via Survey Monkey. RESULTS: A total of 330 SART clinics were reached via email. 38 clinics responded (11.5%), representing 17 unique states, with California, NewYork, and Illinois most commonly represented. 22 clinics (59.5%) were private, 12 (32.4%) were university-affiliated and 3 (8.11%) were health system-based. 25 clinics (67.6%) were described as suburban and 12 (32.4%) were urban. All 38 clinics surveyed offer Telehealth visits. The most common Telehealth platform was Zoom (58.6%), followed by use of telephone or landline (41.4%), and Telehealth service through electronic medical platform (31%). New patient consultations and return visits were offered by 36 (94.7%) and 35 (92.1%) of clinics, respectively. The most common types of consultations offered were related to fertility (100%), reproductive endocrinology (94.7%) and reproductive surgery (73.7%). Only 13 clinics (34.2%) offered Telehealth services before the COVID-19 pandemic;most of these clinics estimated that 25-50% of visits were done via Telehealth before the pandemic. Half of the clinics estimated that>75% of visits were done via Telehealth during the pandemic. The majority of clinics (89.5%) anticipate they will offer Telehealth visits after the COVID-19 pandemic. 63.2% of clinics anticipate fewer Telehealth visits after the pandemic because of logistics (28.6%) and patient preference (25.7%). Most providers (73.7%) stated that they are ''very satisfied'' with Telehealth overall. CONCLUSIONS: Telehealth enabled safe patient-provider interactions throughout the COVID-19 pandemic for all clinics that responded to this survey, most commonly performed via Zoom. While only few clinics offered Telehealth services before COVID-19, the majority of clinics anticipate that they will continue to offer Telehealth after the pandemic. There is ongoing research assessing patient satisfaction with Telehealth, and future research can focus on ways to overcome logistical issues to widen use of a service that is considered satisfactory for providers and patients alike. IMPACT STATEMENT: Telehealth is a method of care delivery that reduces risk of cross-contamination caused by close contact (1), critical during pandemics and convenient under other routine circumstances as well. All clinics surveyed used Telehealth during the COVID-19 pandemic. Most providers express great satisfaction with Telehealth and anticipate they will offer Telehealth services henceforth.
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Aims: In response to the covid-19 pandemic remote training for healthcare professionals (HCPs) to maintain and expand the availability of, and access to DAFNE courses for people living with type 1 diabetes, has been developed. It consists of both Open University hosted online modules, and a national DAFNE trainer assessed workshop. The effectiveness of the pilot training and the fully developed remote training and assessment of the Remote DAFNE Educator Programme (RDEP) has been evaluated. Methods: Review of pilot training survey monkey feedback and the numbers of HCPs taking part in training, and their assessment results between July 2020 and October 2021. Results: Pilot trainees (n = 20) confidence scores (out of 10) both for insulin adjustment and carbohydrate counting skills improved from 7.2 and 8.1, to 8.7 and 9.1 respectively, p < 0.005. 85% reported the level of challenge about right. The virtual workshop increased confidence scores in facilitation skills from 6.5 to 8.4, p < 0.0001. The majority, 88%, rated the workshop as excellent, and the pass rate was 92%. Subsequent to the pilot the RDEP insulin adjustment unit and the carbohydrate counting unit has been accessed by over 300 HCPs, with 94% completing the assessments. The pass rate was 93% for the insulin adjustment unit and 100% for the carbohydrate counting unit. Summary: RDEP training has been successfully completed by over 90% of trainees. Confidence scores in all areas of learning increased significantly showing that this blended remote training format has proven to be both acceptable and effective to hundreds of HCPs.
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Aims: Gestational diabetes group education was delivered face to face prior to the covid-19 pandemic. An online workshop was set up in September 2020 to deliver remote group training on diet and lifestyle for blood glucose management in pregnancy. This created a safe, supportive environment to deliver education to patients and allowed efficient use of staffing during the pandemic response. Methods: An Eventbrite page for gestational diabetes workshop was set up and a presentation with additional resources created. A midwife referral system was created from two hospital sites and participants recruited weekly. Sessions were delivered online via Microsoft Teams and emails with resources sent to patients after the workshop. Data was collected on Excel regarding attendance and a follow up questionnaire via Survey Monkey. Results: Twenty six online workshops over eight months (November 2020-June 2021) had a total of 166 patient bookings. There was equal distribution across the two sites and an attendance rate of 59%. Forty patients completed the Survey Monkey questionnaire where it was found that 100% enjoyed and would recommend the session;47.5% strongly agree and 52.5% agree that they have a good understanding of Gestational Diabetes and how to manage it and 40% strongly agree, 57.5% agree and 2.5% neither agree/disagree with being confident to manage Gestational diabetes with diet and exercise. Conclusion: Virtual group workshops are an effective way to educate gestational diabetes patients on their diet and lifestyle to manage their blood glucose.
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Background/Aims Since the last UK wide survey of undergraduate (UG) education in rheumatology in 2000 (1), the landscape of both university teaching and clinical services has altered significantly. There has been an increase in the number of medical schools (26 to 37), rise in student numbers, curricula expansions, plus the impact of Covid-19. This survey evaluates the current status of rheumatology teaching in the UK and highlights areas for the Rheumatology community to consider when planning future training. Methods In early 2021, a 'Survey Monkey' was emailed to named MSK leads representing all 37 UK schools. This included open and closed questions and explored themes from previous published surveys. Reminders were sent after 2 and 4 weeks. Results Responses were received from 34/37 (92%) schools. There is wide variation in what, when and how teaching is delivered, but the vast majority deliver rheumatology specific teaching spread across years 1- 5. Overall length of clinical rheumatology exposure varied from 3 days to 7 weeks, delivered either as separate days (e.g. in integrated placements or PBL), as formal blocks (often with orthopaedics) or within a student selected component. Approximately 25% of teaching is delivered in primary care. Most is delivered in Year 4. Most schools have a designated rheumatology lead: a clinical academic or clinician. Teaching is acknowledged in most job plans with educational roles discussed at appraisals. Small group teaching remains the most common method of delivering formal teaching, followed by on-line learning and lectures. The majority of teaching is delivered by consultants, trainees and research fellows. A wide range of barriers were noted including competing pressures from clinical work, lack of physical space for teaching and the volume of medical students. Due to COVID-19, 50% of medical schools suspended placements at some point during the pandemic. 70% of schools reported a 50-75% reduction in patient contact time for students reflecting the national data re: 20% of rheumatology departments functioning at less than 50% during the pandemic (2). Many schools reported designing new innovative (often online) resources to support learning during the pandemic. Available resources such as the Versus Arthritis patient examination videos (available on YouTube) and flipbook were noted to be particularly useful learning resources. Conclusion Over the past 20 years, rheumatology UG teaching has remained strong but time for dedicated rheumatology training has reduced in some centres. Remote learning has become more common, which coupled with Covid, has raised concerns amongst teachers that students are not getting sufficient clinical exposure. There is interest for a rheumatology UG community to create and share online resources and act as a source of support.
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The primary motive of this study was to examine advantages of allometry scaling strategies for correct prediction of pharmacokinetics of Baricitinib in human from preclinical species. Baricitinib is basically Janus kinase (JAK) inhibitor used for the treatment of rheumatoid arthritis. Currently approved by FDA in combination with remdesivir for treatment of COVID-19 hospitalized patient. The literature published pharmacokinetic parameters (Cl and Vd) of preclinical species (Rat, Dog and monkey) were utilized for the allometry scaling of Baricitinib. The connection among the primary pharmacokinetic parameters [Volume of distribution (Vd) and clearance (Cl)] and body weight (BW) were studied across three preclinical species, we used the double logarithmic plots for prediction of the human pharmacokinetic parameters i.e. Cl and Vd with use of simple allometry and with additional correction factors for better prediction. The dose extrapolation of baricitinib was carried out by FDA guidelines. By application of the allometric scaling methods and principles correlation was found to be satisfactory for the prediction of intravenous human Cl and Vd for baricitinib. The volume of distribution (Vd) predicted by simple allometry (65.3 L) was found to be in agreement with the reported value (75.5 L);clearance (Cl) prediction by simple allometry was found to be at least 1.06 -closer to the reported value (245 mL/min);CF were used to predict the clearance. Both brain weight (B.W) and maximum life span potential (MLP) predicted the Cl with 0.52- and 0.61 -fold difference. The application of monkey liver blood flow predicted Cl with 0.81 fold which was also in close agreement with reported value. The Cl prediction was also extrapolated using LBF (Liver blood flow) method and observed that the higher species (Dog and Monkey) have predicted Cl with better accuracy than rat. Overall, the simple allometry (SA), monkey liver blood flow (MLBF) and application of liver blood flow (LBF) methods showed excellent correlation with human. The time vs. plasma concentration simulated graph also showed the similar closeness with human profile. The inclusion of plasma protein binding factor didn't improve the prediction accuracy. The FIH dose extrapolation were showed that PK guided approach and exponent for BSA based approach was found closer to actual human dose of 4.0 mg/Kg. Oriental Scientific Publishing Company
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In March 2020 with the onset of the Covid-19 pandemic, Acquired Brain Injury Ireland as a specialist community rehabilitation service provider, moved from a face-to-face to a largely tele-rehabilitation model of service in the community. Our services are inter-disciplinary led with highly trained Rehabilitation Assistants working on a one-to-one basis with the client to implement the Individualised Rehabilitation Plan. Due to successive national lockdowns, social distancing measures and the health and safety risk posed by the pandemic, this model of service, largely provided in the person's home was on longer possible. Therefore, we quickly adapted to provide our range of interventions using a variety of online platforms and methods of engagement. Almost a year into the pandemic we conducted a survey of our clients which aims to provide a snapshot of how they are experiencing their usage of technology during the COVID-19 pandemic. The survey was administered using Survey Monkey software in February 2021 during our third National Level 5 lockdown. A total of nine questions were asked, eight multiple choice, one open-ended where respondents were invited to submit their ideas for the future use of technology in their rehabilitation. There were 134 respondents in total, all ABI Ireland clients currently using our services. Overall, clients' use of technology during the pandemic has been largely positive. In the main, they had access to the necessary equipment and broadband services that they needed to get on-line. Many continue to require on-going support to engage. The respondents provided ratings on how useful or not technology usage was during the pandemic and how easy/difficult they found using technology for rehabilitation, The research explored the advantages and disadvantages of using technology and respondents were asked to rate their future preferences. Finally, the research explores respondents' ideas for the future in relation to using technology. The responses were wide and varied with training in tech for cited, as well as information on the most appropriate apps/ online resources. More creative solutions are required for those with sensory, visual and hearing impairments. It is clear from our findings that, despite the drawbacks, technology has an important role in the future delivery of rehabilitation programs and that clients want to have a combination of in-person and tech responses available to them. Many respondents used the opportunity to point out that nothing takes the place of human contact.
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BACKGROUND: Indonesian Government advised to begin to open the school for offline learning with strict COVID-19 prevention protocol in early September 2021. However, this policy may cause parents to feel anxious and concerned about their children’s health during face-to-face learning. The previous research has focused on parents’ perspectives and readiness toward their children’s digital use in general, leaving their beliefs, attitudes, and readiness concerning offline learning in the COVID-19 pandemic unexplored. AIM: This study aimed to identify knowledge, beliefs, and attitudes toward children’s offline learning among parents during the COVID-19 pandemic in Indonesia. METHODS: A cross-sectional survey was used to collect data using Survey Monkey. The sample in this study was parents who had children aged 6–12-years-old and willing to participate in this study. A linear regression model was employed to find readiness-related factors. RESULTS: A total of 800 (response rate was 80%) participants participated in the study. The average age was 34 (SD = 12.3), 60% were female and 54% worked in the public sector. Participants had an average knowledge score of 10.3 (SD = 3.27, with a range of 0–13), parental attitudes concerning the advantages and disadvantages of offline schooling versus online learning were 3.88 (SD = 0.12), the belief was 3.78 (SD = 0.89), and the readiness score was 3.45 (SD = 0.89). Attitude (β = 3.04 and p = 0.001) and belief (β = 2.89 and p = 0.001) were the factors associated with readiness to offline learning outbreak COVID-19 pandemic. CONCLUSIONS: The results suggested that the implementation of offline learning during the pandemic has been a positive response by families. Individuals may also benefit from targeted health education programs to strengthen COVID-19 knowledge, belief, and preparation for offline learning during pandemic COVID-19.
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Study Objectives: Covid derailed multiple facets of emergency medicine (EM) residency training, including the need to move from in-person to online weekly didactics. While online education has been used within 90% of medical schools, it has not traditionally been used for residency education. Recent studies evaluating post-graduate residents' perception of online education found a receptive audience eager to incorporate the modality. To date, no study has analyzed how EM programs are approaching online education, including content, efficacy, and attendance etiquette. Methods: As part of a process improvement project, an online Survey Monkey questionnaire was sent out to 180 EM residency program directors and coordinators. The survey was open from November 2020 to March 2021. Results: We received 52 responses from program directors and coordinators from all regions of the United States with a majority from academic or university-affiliated programs. Due to COVID-19, over 90% of programs shifted to an online didactic platform with only 10% maintaining in-person didactics. Zoom has been the preferred modality utilized at 89% of programs we surveyed with minimal security and techinical issues. Program consensus was that residents should be on time or no more than 5-minutes late for credit (42% of programs), have video cameras on (52% of programs), and appear attentive (44% of programs). Virtual etiquette was also examined, including screen presence: upright posture (less than 18% of programs reported accountable), background (less than 10%), and lighting (less than 6%). A majority of programs had not set expectations for screen presence. If not presenting, the dress code is generally at the resident’s discretion and was noted to be casual (52%). Sixty percent of programs reported increased faculty attendance since moving to a virtal conference. Programs also reported maintiaing consistency in content (62% of programs), increased utilization of guest speakers (50% of programs), use of national platforms (21% of programs), and maintaing small group sessions (77% of programs). Many residency programs do not record didactics, and only 15% offer credit if lectures are watched at a later date. When safely able, over 65% of programs plan to return to in-person didactics. Conclusion: The online learning platform provides opportunities and proves challenges. Many programs have shifted to online learning and diversified their curriculum. EM residency training requires a strong foundation in core content, which may not entirely be suited for an online platform. This coupled with the loss of face-to-face learning may reflected in the desire for programs to return to in-person learning. The benefits of online learning, which include accessibility, flexibility, and broader reach of topics should not be neglected. Further exploration of the efficacy of knowledge acquisition within online didactics would aid in decisions regarding next steps for return to a potential hybrid teaching model.
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Keywords: Digital, PROMs, Transformation Purpose: Data-driven care, supported by digital technology, is endorsed by the NHS Long Term Plan (2019). Data collection and analysis being vital for evaluation of clinical services, quality improvement and optimal patient care. The COVID-19 pandemic provided an operational barrier to the collection of paper-based patient reported outcome measures (PROMs) at Guy's and St Thomas’ NHS Foundation Trust Integrated Musculoskeletal Physiotherapy department (GSTT iMSK). This accelerated the need for automated, digital systems of data collection. Aim: To implement an automated method of electronic PROM (ePROM) data collection, analysis and reporting. Objectives: • To identify the most suitable condition-specific and/or generic PROMs to employ in GSTT iMSK. • To understand stakeholder preferences regarding PROMs. • To identify a vendor to supply an automated solution for ePROM data collection, analysis and reporting. Methods: The Plan-Do-Study-Act (PDSA) iterative methodology was used with the following sequential steps undertaken: • PLAN: A narrative, scoping review was undertaken to identify the most suitable condition specific and/or generic musculoskeletal PROMs. • DO: Stakeholders (patients, GSTT iMSK and external physiotherapists) were identified and surveyed as to their preferences regarding the use of PROMs. Survey Monkey was used to collect physiotherapist data remotely. Patient data was supplemented with telephone surveys to account for potential selection bias. • STUDY: The review findings were compared against the stakeholder preferences with an aim to optimise completion rate. • ACT: Vendors were vetted against a pre-agreed criteria. Results: PROM suitability: The MSK-HQ was identified as the most suitable generic measure for an MSK service due to;ease of use, anatomical and condition generalisability, and simple scoring system. Stakeholder preferences: All stakeholders felt PROMs were important to deliver data-driven, optimized patient care. Clinicians felt time and method of completion were barriers to PROM use. Patients were prepared to spend 20 minutes completing PROMs if applicable to their pain and care and preferred ePROMs to paper forms. Vendor selection: Many vendors offered digital solutions to automate collection, analysis and reporting of PROMs. However, many were costly and outside the governance/procurement frameworks for GSTT. ‘DrDoctor’, a Trust partner, offered the best solution economically (the system could be built within a current contract at no additional cost) and met all requirements identified during analysis. Conclusion(s): Stakeholders are more likely to engage in PROMs if provided with a user-friendly platform that offers value to the care they will deliver or receive. The MSK-HQ shows excellent validity when used in isolation compared to pathology-specific PROMs and demonstrates that multiple measures are not necessary. Financial restrictions and a focus on value-based care within the NHS make it important to explore existing contracts for digital solutions at no additional cost. Future PDSA cycles will use this automated system via ‘DrDoctor’ to evaluate clinical services and optimise completion rate. Impact: GSTT iMSK is able to use automated systems to evaluate service quality at a population level and undertake regular auditing to ensure acceptable standards are being achieved. A culture of ongoing service evaluation can identify areas of future quality improvement and staff development, whilst redirecting saved administrative resource to different areas. Funding acknowledgements: Unfunded
ABSTRACT
Keywords: Perceptions;Preferences;Virtual consultation Purpose: To determine patients and clinicians perceptions, preferences and expectations of virtual consultations. Our objective was to gather post consultation feedback from patients and clinicians to explore their perceptions of the new model of care delivery and to assess if virtual consultations would be a viable mode of service delivery post Covid 19. Methods: Survey Monkey questionnaires were developed to gain an understanding of the patients’ and clinicians’ perceptions of virtual consultations. Survey Monkey was chosen as the platform for the questionnaire as data was gathered digitally and anonymously. The service evaluation was undertaken in June 2020. All patients who received a virtual consultation (video/telephone) were invited to complete a questionnaire (link was sent via email). Clinicians conducting virtual consultations throughout June 2020 were also invited to complete a questionnaire following each consultation. Patients and Clinicians completed separate questionnaires but both were asked 5 questions around similar themes;expectations, preferences and overall experience. A general feedback section was provided at the end of each questionnaire. Results: Ninety-eight patient responses and 30 Clinician responses were received and evaluated. Patients scored the overall quality of their consultation as 4.7/5, in comparison Clinicians scored it 4/5. When asked how well their queries and concerns were considered and discussed, 75% of patients reported ‘excellent’, 17.5% ‘good’ and 7.5% ‘satisfactory. In contrast when the clinicians were asked how well they could understand patients concerns and queries, 20% reported ‘excellent’, 70% said ‘very good’ and 10% ‘good’. 97% of patients said that their consultation met their expectations. 75% of MCAS clinicians rated the virtual consultation as excellent or very good in aiding clinical decision making and 25% good to fair. When asked what their preference for initial consultation would be, 50% of patients’ first choice would be a face to face, 22% telephone, 19% video (9% failed to answer question fully). Despite this 91% of patients would consider using virtual consultations in the future if available. In contrast, 38% of clinicians would have a preference for face to face consultation, 59% preferred the telephone option and 3% video. Conclusion(s): Overall, both patients and clinicians reported a positive perception of virtual consultations. Patients scored the quality of virtual consultations higher than Clinicians. The perception of virtual consultation was higher in patients than in Advanced Practitioners however the preference for virtual consultation was higher in Clinicians than patients. We suggest repeating this service evaluation now that patients and clinicians are more familiar with virtual consultations to assess if perceptions have changed. We would also suggest capturing the perceptions of patients who did not have access to email to undertake the questionnaire. Impact: The service evaluation has shown a positive perception of virtual consultations and supports their continuation moving forward. We will now endeavour to offer patients a choice of consultation type. It has highlighted that some clinicians are more confident undertaking virtual consultations and will now impact on how we educate and support staff to assess musculoskeletal conditions virtually. Funding acknowledgements: Work was not funded.
ABSTRACT
Keywords: Project ECHO;Telementoring;First contact physiotherapists Purpose: The Chartered Society of Physiotherapy and Health Education England advise that first contact practitioners (FCPs) undertake regular continuous professional development (CPD) to meet the pillars of advanced practice. FCPs in primary care may be at risk of isolation and reduced learning opportunities. Project ECHO has international success using technology for remote learning to increase clinician knowledge and confidence, reduce isolation, and improve patient outcomes. The aim of this project was to ascertain the accessibility and acceptability of Project ECHO methodology in delivering CPD to FCPs remotely within an Integrated Care System (ICS). Methods: Between February 2020 and June 2020 an initial knowledge event and five 90-min ECHO sessions took place via Zoom©. Participants joined sessions from their place of work or residence. Evaluation used mixed methods consisting of attendance monitoring, pre- and post- evaluation of competence and confidence in curriculum topics, a satisfaction survey via Survey Monkey, session evaluations using the polling function on Zoom©, and a 2-person interview via Zoom© following the conclusion of the programme. As the project was a service evaluation, no ethics approval was needed however regulation was governed by the institution's evaluation department. Results: There was a total of 41 individual attendances across the five sessions. Average attendance was 72%. Self-rated knowledge and confidence increased in all areas, 78% of participants felt that they learnt something new and 51% felt they would change their practice due to something they had learnt. The potential miles saved over 6 sessions (knowledge event plus 5 ECHO sessions) from remote learning was 1010.6 miles which equates to £565.94 if paid at the NHS rate of 56p per mile. The average time saved in return travel was 32.8 h (equates to £652.39–£746.53 at bottom–top AfC Band 7). This equates to 336 patient consultations, based on 20 min appointments. Qualitative evaluation from both the post-session evaluation and interviews revealed that participants found the sessions supportive and accessible at a time when all face-to-face training had been halted due to the COVID pandemic. They enjoyed networking with a broader peer group, however recognised that this might also be intimidating to less experienced FCPs. Recommendations made for future programmes included case studies related to the session's topic allowing for consolidation of learning and to split cohorts into entry-level FCPs where topics can be broader and more experienced FCPs where topics and cases can be more specific. Conclusion(s): Project ECHO is an accessible and acceptable median of using technology to provide CPD to FCPs. Participants found the content relevant, enjoyed the peer-support, and most reported taking away new learning. Impact: Utilising Project ECHO for FCP CPD has the potential to reduce the isolation of clinicians working in Primary Care by creating a virtual community of practice, promoting knowledge exchange and improving clinician job satisfaction and patient care. HEE in collaboration with the ICS and the ECHO hub are looking at further ways that Project ECHO can be used to develop FCPs including developing wider regional communities of practice. Funding acknowledgements: This project was funded by Health Education England in partnership with St Luke's Hospice, Sheffield.