A NEW MODEL FOR SCHOOL NURSING?: THE JOURNAL OF THE HEALTH VISITORS' ASSOCIATION

During the pandemic, many school nurses brilliantly flexed their service to ensure they continued to support students. Here, Scott discusses the practices that have continued.

Nurse's Contributions to Collaborative Problem Solving, Entrepreneurship and Innovation at virtual MIT Hackathons During the Covid-19 Pandemic

Background: The COVID-19 pandemic propelled the use of online collaborative platforms to bring diverse individuals together to drive rapid innovation in healthcare. Massachusetts Institute of Technology (MIT) Hacking Medicine hackathons served as an ideal space for collaborative problem-solving, entrepreneurship, and innovation. We aimed to assess the impact of nurses within MIT-led hackathons, which may provide insight into the value nurses bring to other challenges in healthcare. Methods: An anonymous 25-item Google forms survey was disseminated to the MIT COVID-19 Challenge participants through the SLACK online platform for six MIT-led hackathons in 2020. Results: Out of 65 responses, 48 met the inclusion criteria. Nurses' contributions were considered "very” or "extremely” valuable in helping to identify and break down the problem (85%), and in helping to brainstorm and iterate the solution (88%). The participants were "very” and "extremely” satisfied with the nurses' abilities to be an asset to the team and valuable contributors (88%), knowledgeable (94%), and effective communicators (90%). They recognized the nurses as a source of high-quality information outside the clinical context (92%), indicated an interest in seeking expertise from nurses (90%), seek nurses as a mentor (83%) and as team members (79%). Conclusions: Nurses can make important contributions to teams working on innovative healthcare solutions across the globe via online platforms. Involving them in problem-solving teams should be encouraged.

The Physician Leader's Guide to Thriving in Dyads, Triads, and Other Multidisciplinary Team-Based Management Models

[...]the dyad leadership model was pioneered by the Mayo Clinic in 1908.34 However, several more recent trends and developments have prompted healdicare organizations to adopt team-based management models. Hospital and health system combinations have increased significantly in the past decade, and experts predict a surge in healdicare M&A activity as the COVID-19 pandemic winds down.6 Following a merger or acquisition, the hard work of organizational integration is typically led by an array of multidisciplinary teams composed of clinical leaders, executives, and administrative managers. The quality movement in healthcare. Since the 1999 publication of To Err is Human,7 the healdicare industry's focus on quality and patient safety has deepened significantly. Benefits include more effective change management, greater transparency in decision-making, reduced variability in patient care, and increased physician engagement.10 In addition, team-based leadership models lead to improved patient outcomes, which may result in better performance under value-based payment models for improved quality and reduced cost of medical care.11 However, team-based management models also present challenges.

Evaluation of changes to work patterns in multidisciplinary cancer team meetings due to the COVID-19 pandemic: A national mixed-method survey study.

BACKGROUND: It is not well understood the overall changes that multidisciplinary teams (MDTs) have had to make in response to the COVID-19 pandemic, nor the impact that such changes, in addition to the other challenges faced by MDTs, have had on decision-making, communication, or participation in the context of MDT meetings specifically. METHODS: This was a mixed method, prospective cross-sectional survey study taking place in the United Kingdom between September 2020 and August 2021. RESULTS: The participants were 423 MDT members. Qualitative findings revealed hybrid working and possibility of virtual attendance as the change introduced because of COVID-19 that MDTs would like to maintain. However, IT-related issues, slower meetings, longer lists and delays were identified as common with improving of the IT infrastructure necessary going forward. In contrast, virtual meetings and increased attendance/availability of clinicians were highlighted as the positive outcomes resulting from the change. Quantitative findings showed significant improvement from before COVID-19 for MDT meeting organisation and logistics (M = 45, SD = 20) compared to the access (M = 50, SD = 12, t(390) = 5.028, p = 0.001), case discussions (M = 50, SD = 14, t(373) = -5.104, p = 0.001), and patient representation (M = 50, SD = 12, t(382) = -4.537, p = 0.001) at MDT meetings. DISCUSSION: Our study explored the perception of change since COVID-19 among cancer MDTs using mixed methods. While hybrid working was preferred, challenges exist. Significant improvements in the meeting organisation and logistics were reported. Although we found no significant perceived worsening across the four domains investigated, there was an indication in this direction for the case discussions warranting further 'live' assessments of MDT meetings.

Gang intervention during COVID-19: A qualitative study of multidisciplinary teams and street outreach in Denver.

Gang and violence intervention programs have become a staple in American cities. These programs often find themselves navigating turbulent political environments, a challenge that can be exacerbated during times of societal upheaval, such as the COVID-19 pandemic. The current study examines how the pandemic impacted the forms and functions of the Gang Reduction Initiative of Denver (GRID). While GRID coordinates many strategies and collaborates with government and community groups across Denver, its centerpiece intervention entails multidisciplinary teams and street outreach, the focus of this qualitative study. We draw on 197  hours of field-based observation and 19 semi-structured interviews gathered as part of an evaluation of this intervention-initiated prior to the pandemic-to arrive at three key conclusions on the impact of COVID-19. First, upper-level administrative support can be a critical factor in agency efficacy and morale. City government's tenuous familiarity and ties with GRID was consequential to non-essential classification at the early stage of the pandemic. Second, agency leaders are crucial advocates for their agency, as GRID navigated many challenges without stable leadership and suffered as a result. Finally, interagency collaboration and relationships are slow to develop and easy to lose, made even more fragile in times of crisis. We discuss these findings in the context of large-scale federal investment in community violence intervention.

Adaptation of a Study Design to the COVID-19 Pandemic Regulations - Evaluation of a Voice-Controlled Robotic Kitchen Assistance System for the Support of Older Adults in Need of Care

Background. The COVID-19 pandemic had and still has a major impact on the design and realization of studies with volunteers due to the associated restrictions in face-to-face research. In connection with vulnerable target groups in particular, alternative study designs have to be considered. In the AuRorA project, a voice-controlled robotic kitchen assistance system was developed for supporting older adults in need of care. We will present how we planned and conducted the evaluation of the system despite pandemic restrictions. Methods. We carried out an iterative risk management based on ISO 12100:2010 with a multidisciplinary team before starting the study. In addition to the consideration of personnel safety in human-robot interaction, additional focus was placed on subject safety with respect to the COVID-19 pandemic. Results. The risk management revealed that the study cannot be conducted via face-to-face with the target group. As a result, the study was performed via an online survey. We evaluated the robotic system using questionnaires. We simulated and filmed an exemplary cooking process and implemented the video into the survey. The target group was reached via mail. Discussion. Other research groups also struggeled to adapt their studies to the pandemic situation. However, no best practice example exist yet. With our risk management, we were able to adapt our study design. However, only part of the target group could be reached. In addition, it can be questioned wether the ISO, which adresses machine safety, was an efficient application of risk management in this area. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Applying a Collaborative Online International Learning Experience (COIL) during two Undergraduate Environmental Engineering Courses in the US and Mexico

The ability to communicate effectively and to work in multidisciplinary teams with individuals from diverse international backgrounds are some of the student outcomes that need to be met by academic programs seeking accreditation by independent organizations such as ABET. International course collaborations able to fulfill these goals are challenging under regular conditions, but the COVID-19 pandemic and the migration to virtual learning in both Mexico and the United States presented an opportunity to test multinational collaboration during a regular course context. In the Fall 2021, we piloted a month-long collaboration between two engineering courses at Rice University (US) and Tecnológico de Monterrey (Mexico). This collaboration was designed to meet the two student outcomes stated above in the context of UN Sustainable Development Goal 6 using COIL. A series of activities were designed to promote student reflection on topics such as the cultural, social, and technical factors related to the design of a rainwater collection system. Examples of these activities include discussion sessions prompting the exchange of ideas by students from both institutions, and mutual evaluation of their rainwater harvesting designs. At the end of the collaboration, the students completed a survey reporting their understanding of the current global water crisis, the challenges to provide sustainable solutions, and their perception of the collaboration. Due to differences in both courses, such as accessibility and quality of internet access, the personal goals of the students and the language barrier, the authors obtained mixed reactions from the students to this collaboration. Most students reported that this experience was positive, provided new knowledge and an opportunity to develop their international collaboration skills;only a few students reported no positive outcomes. Although this first collaboration proved to be satisfactory for both students and instructors, it also provided several learning opportunities, such as forming smaller work groups to allow the students to connect at a more individual level, providing TAs to be present in every discussion room to encourage participation of all students, and emphasizing the need for more cultural awareness, such as the fact that some participants are not having these discussions in their native language. © American Society for Engineering Education, 2022.

Experiential Entrepreneurship in Food Engineering: Student Perspectives on Three Student-Initiated Ventures

This paper presents exemplary cases of learning entrepreneurial mindset from an institution that provides faculty, graduate students, and undergraduate students separate theory-driven trainings in entrepreneurship and subsequent opportunities to practice experiential learning of entrepreneurship together. A sequence of project-based learning courses in engineering brings together faculty and students to work in multi-disciplinary teams. Students gain experience solving practical, open-ended engineering problems and developing professional skills throughout their studies. Opportunity identification, feasibility analysis, product development, professional communication, leadership, and teamwork are emphasized. Both faculty mentors and students build foundations in the entrepreneurial mindset via training certificates and funding programs offered by the institution through a dedicated center in innovation and entrepreneurship. By leveraging support from these programs, student-initiated ventures become viable. Research project-based courses, accessible laboratories, and trained faculty provide an enabling environment for students to accelerate their entrepreneurial experiences. Herein, a snapshot of three concurrent student-initiated ventures into food engineering is captured via case reports. The student leaders of these ventures offer different approaches to ideation and venture initiation, especially representing three successive cohorts of students - a third-year, a fourth-year, and a newly graduated engineering student. Their backgrounds and visions vary, and the changing world, including last year's COVID-19 pandemic and research lab shutdown, impacts them in different ways. Yet, these students share a drive to innovate and make the most of available opportunities. The perspectives of these students on the engineering entrepreneurship education they receive through this institution will help to develop future projects and entrepreneurship programs. © American Society for Engineering Education, 2022

Poor team training is a PETT hate for many: paediatric emergency team training: a virtual course to enhance real life team work

AimsMultidisciplinary teams work together, under significant stress, towards time critical common goals of stabilising critically ill children. These teams often assemble only when needed which may contribute to ineffective teamwork, and therefore error. For example, a paediatrician in a district general hospital may only interact with an operating department practitioner when a child is critically unwell;a team of experts does not necessarily ensure an expert team. However, efficient communication and teamwork is crucial for teams to function effectively. Team training has long been used in military and aviation sectors to enhance team working skills. More recently, courses have been developed in healthcare to enhance team working skills. Due to the Covid-19 pandemic, it was not possible to deliver these courses in the same way and our previous course, SPARTACUS (Simulated Paediatric and Anaesthetic Response to Assist Children’s Urgent Stabilisation) did not suit the online environment. We designed a denovo course, Paediatric Emergency Team Training (PETT) course with the aims of improving teamworking skills and increasing participant confidence in their role in the team.MethodsThe PETT course, delivered on Microsoft Teams, is modelled on the TeamSTEPPS model of effective teamwork. This incorporates 4 domains;communication, leadership, mutual support and situation monitoring. Small groups (maximum 8 participants with 3 faculty) allowed a more intimate environment to be created. The medical participants were all experienced, middle grade or above to focus the learning on teamworking skills rather than medical knowledge. Ground rules were established, including having cameras on whenever possible. Varied pedagogical modalities were used to enhance the learning experience, including gamification with breakout room games to highlight communication and team strategy. Interactive workshops were used to discuss contributing factors and the dynamics of effective teamwork, barriers to effective teamwork, and strategies to enhance teamwork using pre-recorded video scenarios of acutely unwell children to debrief with the online participants. The course was evaluated via surveys before, immediately after and 8 weeks after the course.ResultsPETT has been delivered so far to 20 participants, with one pilot and two full courses. Participants have come from paediatric backgrounds (paediatric registrars), anaesthetic backgrounds (consultants and registrars), nursing backgrounds and operating department practitioners. In pre-course surveys, 41% of participants (5/12) agreed with the statement ‘when teamwork within a multidisciplinary team, or across specialties is challenging, I have tools to help.’ After the course, 91% (10/11) agreed with this statement. Before PETT, 41% of participants (5/12) agreed that ‘communication skills can be taught effectively online’, whereas after the course 91% (10/11) agreed with this statement. Before PETT, 66% of participants (8/23) felt confident in ‘communicating with other members of the multidisciplinary team, and with other specialties’ whereas afterwards, 91% (10/11) felt confident in doing this.ConclusionWe have demonstrated that PETT course, as an online course for the multidisciplinary team (aiming at senior level), has met our aims of a course to improve teamwork and team confidence. Going forward, we intend to deliver this biannually in addition to our previous face-to-face courses such as SPARTACUS.

The Knowledge, Attitudes and Current practices of Malaysian Physiotherapists in Preventing and Managing Type 2 Diabetes

Background and Objectives: Diabetes Mellitus (DM) is a lifestyle disease that affects 463 million of adults worldwide. In Malaysia, DM especially Type 2 DM (T2DM) has an alarming increasing trend. Physiotherapy has been demonstrated to be effective in preventing and managing T2DM. Hence, a Knowledge, Attitude and Practices (KAP) survey is conducted to determine the knowledge, attitudes, and current practices of Malaysian physiotherapists in preventing and managing Type 2 diabetes mellitus. Methods: Malaysian physiotherapists were recruited to answer a KAP survey. The survey contained 44 items in four domains: demographics and education, attitudes and beliefs, current practices, and knowledge of diabetes. A descriptive analysis was completed for all the response variables from the survey. Results: 297 practicing physiotherapists in Malaysia predominantly from Kuala Lumpur and Selangor were recruited. The participants generally had a moderate knowledge in T2DM care, in which a lack of hypoglycaemia management knowledge was noticed. A great proportion of respondents was not confident in key aspects T2DM care. Even though 76.73% of respondents agreed that T2DM fall under physiotherapy scope of practice, only 55.22% provided counselling on T2DM prevention and management. A lack in practice of blood glucose testing and monitoring was also noticed in most of the respondents. A discrepancy between respondents' self-efficacy and knowledge was observed, in which a proportion of respondents were confident in providing T2DM care but lacked the relevant knowledge. Conclusion: This study identified gaps in knowledge, attitude and practice on T2DM care by Malaysian Physiotherapists. Measures to close the gaps are therefore recommended.

Growing interest of Augmented Reality in retail: A Literature Review

The experience of purchasing a good is highly influenced by various technologies that have not only impacted the shopping experience but have also significantly changed the way brands work on their digital presence. Augmented reality, a technology that delivers multisensory experiences that merge the real world with the digital, discussed in this article, is gaining presence in retail. The multidisciplinary teams of companies in this field, often through their branders and brand managers, have proposed creating and promoting distinctive technological experiences that put the user/customer at the centre. This trend has taken hold in physical retail and increasingly in online retail, which has experienced an unpredictable surge prior to the pandemic associated with COVID19. This paper aims to provide a literature review to understand better the state of the art of Augmented Reality (AR) in the retail space and its evolution in recent years and to identify the brands that have invested the most in this technology. Using SCOPUS and Web of Science as a research base, the work presented here shows that although research in this area already exists, it is perhaps still in an introductory phase in this field and is still looking for greater maturity in the use of AR in the consumer experience. © 2022 IEEE Computer Society. All rights reserved.

The Power of Engagement With Multidisciplinary Societies

Kirkland-Kyhn discusses the power of engagement with multidisciplinary societies. Societies promote collaboration and new ideas. Engagement in societies for practice, research, education, leadership, and advocacy can be a platform for building unlimited connections for professional development. One should focus on engaging with a society or societies with the goal of an eventual chair or co-chair position on the advisory board. Many societies are urging people to join and engage because so many people changed jobs and priorities during the COVID-19 pandemic.

Impact of the COVID-19 Pandemic on Adherence to Exercise Prescription: The case of Cardiac Rehabilitation Programs

Cardiac Rehabilitation Programs (CRPs) are an important tool of secondary prevention and their implementation within health services, despite the uneven geographical distribution, has been receiving attention from decision-makers in recent years. Adherence to the CRPs is one of the great challenges faced by the multidisciplinary team, and there are several strategies to maintain adherence, particularly in CRP-Phase III, which occurs outside the hospital environment. One of the strategies followed is the use of remote performance monitoring and recording of possible alert symptoms. With the pandemic due to COVID-19, these challenges have become even more evident as Phase II programs have been suspended, thus increasing the importance of the home-based CRPs. In this work, the results of a study aiming to understand the impact of the pandemic on adherence to the prescription of exercise and the perception of patients regarding the effects of physical activity on health conditions are shown. The results indicate that the pandemic did not have a major effect on the adherence to home-based exercises, in particular, in patients undergoing programs using a telemonitoring system. Moreover, the perception of the importance of physical activity for health and well-being was reinforced in the context of the pandemic. © 2022 Croatian Society MIPRO.

Parents' perception of auditory hypersensitivity in children with clinical signs of risk for Autism Spectrum Disorder 1

Conclusion: Auditory hypersensitivity was observed, especially related to irritability, which suggests a relationship with the limbic system and, therefore, may refer to misophonia. [...]it is important for the multidisciplinary team to pay attention to the occurrence and characteristics of hypersensitivity in this population, in order to maximize favorable conditions for rehabilitation. Specifically in relation to auditory sensory alterations, previous studies showed wide variability in prevalence, with results from 15% to 100% (Khalfa et al., 2004;Gomes et al., 2008;Bhatara et al., 2013;Danesh et al., 2015). [...]auditory hypersensitivity is configured as an abnormal perception of sound, which can impact different everyday situations, such as social and leisure activities (Aazh et al., 2016). [...]data is important to understand how this change occurs, as well as to provide parents and caregivers with intervention strategies and better quality of life. [...]having as references studies that showed changes in the limbic system, related to emotions, in children with ASD (Haznedar et al., 2000;Stigler et al., 2011), the hypothesis listed is that parents perceive behaviors of Misophonia-type auditory hypersensitivity, with irritability to specific sounds and consequent impact on daily life situations. Additionally, we hypothesized that, during the period of social isolation resulting from the COVID-19 pandemic, such behaviors could be minimized, since children possibly stayed longer in controlled environments and had less exposure to outdoor environments. [...]considering that hearing is one of the sensory inputs of the human body, essential for the development of oral language, this study aimed to investigate the occurrence and type of auditory hypersensitivity in children with clinical signs of ASD through the report of the parents in the context of the COVID-19 pandemic.

USING VIDEO TELEMEDICINE FOR INPATIENT WORKING: A NOVEL APPROACH TO REMOTE WORKING DURING THE COVID-19 PANDEMIC

Background Orthogeriatrics inpatient ward. Introduction The COVID-19 pandemic changed working patterns for many trainees. Remote telephone or video outpatient consultations became established practice, with clinically vulnerable staff able to support this provision. We adapted the use of telemedicine to provide remote clinical working for inpatient care and continued speciality training opportunities. Method Microsoft Teams video conferencing facilitated interaction between the specialist registrar working remotely and the on-site multidisciplinary team (MDT). Daily activities included virtual handover attendance, inpatient ward round consultations and MDT discussions. A portable computer enabled the clinician to see and interact with inpatients remotely. Access to electronic patient records facilitated timely decision making and enactment of management plans. Anonymous MDT feedback was collected via online questionnaires. This project conformed to service evaluation guidelines and ethical approval was not required. Results Fourteen staff members completed the feedback survey. Results were overwhelmingly positive, with 78.6% of respondents strongly agreeing that the senior doctor working remotely supported the MDT, facilitated complex clinical decision making and was beneficial to patient care. Feedback noted that some patients praised the ‘clever’ and ‘innovative’ method. Limitations included technical difficulties due to Wi-Fi connection, which contributed to communication not being as fluid as face-to-face consultations and increased ward round duration. Patient factors, namely hearing and cognitive impairment, limited the interaction that patients were able to have with the clinician via video link. Conclusion Video inpatient ward round consultations offer an effective opportunity for physicians to continue clinical patient-facing roles whilst working remotely. Furthermore, this minimises the impact of COVID-19 on specialty trainees, by providing continued training and assessment opportunities for individuals required to shield. This novel method affords a framework transferrable to clinicians from other hospital specialties who may be required to work remotely. Future reviews of patient and relative satisfaction with this process are required.

Highlights from this issue

This is an important topic and an interesting paper to work through. Serum ammonia is important for the diagnosis and management of urea cycle disorders and acute liver failure. Based on the premise that serum ammonia levels are unreliable for the diagnosis of hepatic encephalopathy (HE) and not associated with the severity of HE in individuals with cirrhosis Aby and colleagues looked at serum ammonia ordering in adult patients presenting to a large mid-western healthcare system – 20 338 tests (8536 patients) over 5 years. 53% of the cohort had chronic liver disease, 8 patients had a Urea Cycle Disorder, 69 patients had Acute Liver Failure and 148 were on Sodium Valproate. Of the 20 338 tests, 1138 (6.5%) were ordered for a definitive, appropriate indication, while the remainder were felt to have been ordered inappropriately. There was no change in the proportions over time. This data has significant financial implications with hence the title – serum ammonia use: unnecessary, frequent and costly with the need to educate clinicians regarding appropriate ammonia testing - in essence when to do and when not to do – we don’t, for example, want to miss a urea cycle disorder. There is an excellent accompanying commentary Testing for ammonia: do as I say, not as we do which includes a nice table on when to test in the hospital setting (See page 275).

Senior medical students as assistants in medicine in COVID-19 crisis: a realist evaluation protocol

IntroductionThe assistant in medicine is a new and paid role for final-year medical students that has been established in New South Wales, Australia, as part of the surge workforce management response to the COVID-19 pandemic. Eligibility requires the applicant to be a final-year medical student in an Australian Medical Council-accredited university and registered with the Australian Health Practitioner Regulation Agency. While there are roles with some similarities to the assistant in medicine role, such as assistantships (the UK) and physician assistants adopted internationally, this is completely new in Australia. Little is known about the functionality and success factors of this role within the health practitioner landscape, particularly within the context of the COVID-19 pandemic. Given the complexity of this role, a realist approach to evaluation has been undertaken as described in this protocol, which sets out a study design spanning from August 2020 to June 2021.Methods and analysisThe intention of conducting a realist review is to identify the circumstances and mechanisms that determine the outcomes of the assistant in medicine intervention. We will start by developing an initial programme theory to explore the potential function of the assistant in medicine role through realist syntheses of critically appraised summaries of existing literature using relevant databases and journals. Other data sources such as interviews and surveys with key stakeholders will contribute to the refinements of the programme theory. Using this method, we will develop a set of hypotheses on how and why the Australian assistants in medicine intervention might ‘work’ to achieve a variety of outcomes based on examples of related international interventions. These hypotheses will be tested against the qualitative and quantitative evidence gathered from all relevant stakeholders.Ethics and disseminationEthics approval for the larger study was obtained from the Western Sydney Local Health District (2020/ETH01745). The findings of this review will provide useful information for hospital managers, academics and policymakers, who can apply the findings in their context when deciding how to implement and support the introduction of assistants in medicine into the health system. We will publish our findings in reports to policymakers, peer-reviewed journals and international conferences.

Comparing lung ultrasound: extensive versus short in COVID-19 (CLUES): a multicentre, observational study at the emergency department

BackgroundBedside lung ultrasound (LUS) is an affordable diagnostic tool that could contribute to identifying COVID-19 pneumonia. Different LUS protocols are currently used at the emergency department (ED) and there is a need to know their diagnostic accuracy.DesignA multicentre, prospective, observational study, to compare the diagnostic accuracy of three commonly used LUS protocols in identifying COVID-19 pneumonia at the ED.Setting/patientsAdult patients with suspected COVID-19 at the ED, in whom we prospectively performed 12-zone LUS and SARS-CoV-2 reverse transcription PCR.MeasurementsWe assessed diagnostic accuracy for three different ultrasound protocols using both PCR and final diagnosis as a reference standard.ResultsBetween 19 March 2020 and 4 May 2020, 202 patients were included. Sensitivity, specificity and negative predictive value compared with PCR for 12-zone LUS were 91.4% (95% CI 84.4 to 96.0), 83.5% (95% CI 74.6 to 90.3) and 90.0% (95% CI 82.7 to 94.4). For 8-zone and 6-zone protocols, these results were 79.7 (95% CI 69.9 to 87.6), 69.0% (95% CI 59.6 to 77.4) and 81.3% (95% CI 73.8 to 87.0) versus 89.9% (95% CI 81.7 to 95.3), 57.5% (95% CI 47.9 to 66.8) and 87.8% (95% CI 79.2 to 93.2). Negative likelihood ratios for 12, 8 and 6 zones were 0.1, 0.3 and 0.2, respectively. Compared with the final diagnosis specificity increased to 83.5% (95% CI 74.6 to 90.3), 78.4% (95% CI 68.8 to 86.1) and 65.0% (95% CI 54.6 to 74.4), respectively, while the negative likelihood ratios were 0.1, 0.2 and 0.16.ConclusionIdentifying COVID-19 pneumonia at the ED can be aided by bedside LUS. The more efficient 6-zone protocol is an excellent screening tool, while the 12-zone protocol is more specific and gives a general impression on lung involvement.Trial registration numberNL8497.

Panel on Ethical Constraints on Validation, Verification, and Application of Simulation

Today's challenges must be addressed as socio-technical systems, including insights from the social sciences and humanities to adequately represent the human components. As results of simulations are increasingly driving and justifying political and social decisions, it is important to validate and verify (VV) simulation and data. However, the understanding of what establishes truth and how these views impact validation differ between the social and technical partners. Therefore, we must expand our view of VV. The panel provides various use cases and derives ethical questions related to supporting universities during the COVID-19 pandemic, creating multi-disciplinary teams with diverse viewpoints, challenges of using validated insights without critical evaluation, and lack of broadly accepted scientific measures to connect social models and empirical data. We conclude that the role of VV must be reemphasized, that its social-theoretical implications must be better understood, and that it should be driven by an overarching metaethical framework. © 2021 IEEE.