Monitoring real-time junior doctor sentiment from comments on a public social media platform: a retrospective observational study.

OBJECTIVES: To investigate whether sentiment analysis and topic modelling can be used to monitor the sentiment and opinions of junior doctors. DESIGN: Retrospective observational study based on comments on a social media website. SETTING: Every publicly available comment in r/JuniorDoctorsUK on Reddit from 1 January 2018 to 31 December 2021. PARTICIPANTS: 7707 Reddit users who commented in the r/JuniorDoctorsUK subreddit. MAIN OUTCOME MEASURE: Sentiment (scored -1 to +1) of comments compared with results of surveys conducted by the General Medical Council. RESULTS: Average comment sentiment was positive but varied significantly during the study period. Fourteen topics of discussion were identified, each associated with a different pattern of sentiment. The topic with the highest proportion of negative comments was the role of a doctor (38%), and the topic with the most positive sentiment was hospital reviews (72%). CONCLUSION: Some topics discussed in social media are comparable to those queried in traditional questionnaires, whereas other topics are distinctive and offer insight into what themes junior doctors care about. Events during the coronavirus pandemic may explain the sentiment trends in the junior doctor community. Natural language processing shows significant potential in generating insights into junior doctors' opinions and sentiment.

Monitoring real-time junior doctor sentiment from comments on a public social media platform: a retrospective observational study.

OBJECTIVES: To investigate whether sentiment analysis and topic modelling can be used to monitor the sentiment and opinions of junior doctors. DESIGN: Retrospective observational study based on comments on a social media website. SETTING: Every publicly available comment in r/JuniorDoctorsUK on Reddit from 1 January 2018 to 31 December 2021. PARTICIPANTS: 7707 Reddit users who commented in the r/JuniorDoctorsUK subreddit. MAIN OUTCOME MEASURE: Sentiment (scored -1 to +1) of comments compared with results of surveys conducted by the General Medical Council. RESULTS: Average comment sentiment was positive but varied significantly during the study period. Fourteen topics of discussion were identified, each associated with a different pattern of sentiment. The topic with the highest proportion of negative comments was the role of a doctor (38%), and the topic with the most positive sentiment was hospital reviews (72%). CONCLUSION: Some topics discussed in social media are comparable to those queried in traditional questionnaires, whereas other topics are distinctive and offer insight into what themes junior doctors care about. Events during the coronavirus pandemic may explain the sentiment trends in the junior doctor community. Natural language processing shows significant potential in generating insights into junior doctors' opinions and sentiment.

Use of social media platforms by migrant and ethnic minority populations during the COVID-19 pandemic: a systematic review.

OBJECTIVE: Migrants and ethnic minority groups have been disproportionately impacted by COVID-19 and have lower levels of vaccine uptake in some contexts. We aimed to determine the extent and nature of social media use in migrant and ethnic minority communities for COVID-19 information, and implications for preventative health measures including vaccination intent and uptake. DESIGN: A systematic review of published and grey literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched databases including Embase, Web of Science, PubMed NIH, CINAHL, facilitated through the WHO Global Research on COVID-19 database from 31 December 2019 to 9 June 2021. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Research reporting the use of social media by migrants and/or ethnic minority groups in relation to COVID-19. DATA EXTRACTION: We extracted data on key outcomes, study design, country, population under study and sample size. RESULTS: 1849 unique records were screened, and 21 data sources were included, including populations in the UK, USA, China, Jordan, Qatar and Turkey. We found evidence of consistent use of a range of social media platforms for COVID-19 information in some migrant and ethnic minority populations (including WeChat, Facebook, WhatsApp, Instagram, Twitter, YouTube), which may stem from difficulty in accessing COVID-19 information in their native languages or from trusted sources. Some evidence suggested circulating misinformation and social media use may be associated with lower participation in preventative health measures, including vaccine intent and uptake, findings which are likely relevant to multiple population groups. CONCLUSIONS: Social media platforms are an important source of information about COVID-19 for some migrant and ethnic minority populations. Urgent actions and further research are now needed to better understand effective approaches to tackling circulating misinformation, and to seize on opportunities to better use social media platforms to support public health communication and improve vaccine uptake. REGISTRATION: This study has been registered with PROSPERO (CRD42021259190).

Automated digital counselling with social network support as a novel intervention for patients with heart failure: protocol for randomised controlled trial.

INTRODUCTION: Heart failure (HF) symptoms improve through self-care, for which adherence remains low among patients despite the provision of education for these behaviours by clinical teams. Open Access Digital Community Promoting Self-Care, Peer Support and Health Literacy (ODYSSEE-vCHAT) combines automated digital counselling with social network support to improve mortality and morbidity, engagement with self-care materials, and health-related quality of life. METHODS AND ANALYSIS: Use of ODYSSEE-vCHAT via Internet-connected personal computer by 162 HF patients will be compared with a control condition over 22 months. The primary outcome is a composite index score of all-cause mortality, all-cause emergency department visits, and HF-related hospitalisation at trial completion. Secondary outcomes include individual components of the composite index, engagement with self-care materials, and patient-reported measures of physical and psychosocial well-being, disease management, health literacy, and substance use. Patients are recruited from tertiary care hospitals in Toronto, Canada and randomised on a 1:1 ratio to both arms of the trial. Online assessments occur at baseline (t=0), months 4, 8 and 12, and trial completion. Ordinal logistic regression analyses and generalised linear models will evaluate primary and secondary outcomes. ETHICS AND DISSEMINATION: The trial has been approved by the research ethics boards at the University Health Network (20-5960), Sunnybrook Hospital (5117), and Mount Sinai Hospital (21-022-E). Informed consent of eligible patients occurs in person or online. Findings will be shared with key stakeholders and the public. Results will allow for the preparation of a Canada-wide phase III trial to evaluate the efficacy of ODYSSEE-vCHAT in improving clinical outcomes and raising the standard of outpatient care. TRIAL REGISTRATION NUMBER: NCT04966104.

Effectiveness of a web-based virtual journal club to promote medical education (Web-Ed): protocol of a multicentre pragmatic randomised trial.

INTRODUCTION: A journal club (JC) is a commonly used medical educational tool. Videoconferencing technology can facilitate the delivery of JCs, however, there remains no evidence on the role of web-based virtual JCs in promoting the acquisition and retention of medical knowledge. The Web-Ed trial aims to evaluate the educational benefits, feasibility and acceptability of web-based virtual JCs compared with traditional face-to-face ones. METHODS AND ANALYSIS: Web-Ed is a multicentre pragmatic parallel-group randomised trial across teaching hospitals within the UK National Health Service (NHS). We will enrol qualified doctors or medical students who are >18 years old, proficient in English and able to use online videoconferencing software. Block randomisation will be used to allocate participants in 1:1 ratio to either intervention group. Both groups will be presented with the same educational material and follow a standardised JC structure hosted by nominated moderators and medical faculty members.The primary outcome is the difference in participants' knowledge acquisition and retention 7 days after the JCs evaluated using standardised multiple-choice questions. We will report secondarily on the feasibility and acceptability of the JCs using Likert scale questionnaires. Assuming a 30% drop-out rate, we aim to enrol 75 participants to detect a 20% improvement in knowledge acquisition at 80% power and 5% significance. We will report using mean difference or risk ratio with 95% CIs and assess significance using parametric/non-parametric testing. Where relevant, we will adjust for predetermined characteristics (age, grade of training and session duration) using multivariate regression analyses. ETHICS AND DISSEMINATION: Web-Ed was designed by doctors in training to address their learning needs and evaluate the preferred mode of learning. The trial results will be published in peer-reviewed journals and presented at relevant scientific conferences. The trial has been approved by the NHS Health Regulation Authority (21/HRA/3361). TRIAL REGISTRATION NUMBER: ISRCTN18036769.

Novel 3D printable powered air purifying respirator for emergency use during PPE shortage of the COVID-19 pandemic: a study protocol and device safety analysis

ObjectivesTo design a low-cost 3D printable powered air-purifying respirator (PAPR) that meets National Institute for Occupational Safety and Health (NIOSH) standard for flow rate and Occupational Safety and Health Administration (OSHA) standard for particle filtration for loose-fitting PAPRs and that can be made with a 3D printer and widely available materials.DesignDetailed description of components, assembly instructions and testing of a novel PAPR design in an academic laboratory following respective protocols. The assembled PAPR must meet NIOSH standards of flow rate, 170 L/min;OSHA fit factor for particle filtration, ≥250 and maintain positive pressure during regular and deep breathing.Main outcome measuresThe PAPR design was run through a series of tests: air flow (L/min), particle filtration (quantitative and qualitative) and positive pressure measured inside the helmet (mm Hg).ResultsFlow rate was 443.32 L/min (NIOSH standard: minimum 170 L/min) and overall fit factor for particle filtration was 1362 (OSHA pass level: ≥500), n=1. The device passed qualitative particle filtration, n=2, and measured peak pressure of 6mm Hg (>0 mm Hg indicates positive pressure) in the helmet, n=1.ConclusionsThe Hygieia PAPR is a low-cost, easily accessible, just-in-time 3D printable PAPR design that meets minimum NIOSH and OSHA standards for flow-rate and particle filtration for loose-fitting PAPR devices to be made and used when industry-made designs are unavailable.

Technology-based group exercise interventions for people living with dementia or mild cognitive impairment: a scoping review protocol.

INTRODUCTION: More than 50 million people worldwide are living with dementia in 2020, and this number is expected to double every 20 years. Physical exercise is a growing field in non-pharmacological interventions for dementia care. Due to public health measures during the COVID-19 pandemic, more people have considered adapting to technology-based exercise via digital devices. This scoping review will explore evidence relating to the use of technology-based group exercise by people with dementia or mild cognitive impairment. METHODS AND ANALYSIS: This review will follow the Joanna Briggs Institute scoping review methodology to review literature published between June and December 2021. This review is designed to identify existing types of technology-based group exercise interventions for people with dementia. The review will provide a synthesis of current evidence on the outcome and impacts of technology-based group exercise. The context of this review will include homes, assisted living facilities and memory care services but exclude hospitals. The review will include a three-step search strategy: (a) identify keywords from MEDLINE and Embase, (b) search using the identified keywords in databases (MEDLINE/PubMed, CINAHL, Web of Science, Embase, Cochrane Library, PsychInfo and Google) and (c) review references from included studies to identify additional studies. Only studies in English will be included. Four researchers will independently assess titles and abstracts and then review the full text of the selected articles, applying the inclusion criteria. The extracted data will be presented in tables and summarised narratively. ETHICS AND DISSEMINATION: Scoping review data will be collected from publicly available articles; research ethics approval is not required. The findings will be disseminated to healthcare practitioners and the public through a peer-reviewed publication and conference presentations.

Differential impact of physical distancing strategies on social contacts relevant for the spread of SARS-CoV-2: evidence from a cross-national online survey, March-April 2020.

OBJECTIVES: We investigate changes in social contact patterns following the gradual introduction of non-pharmaceutical interventions and their implications for infection transmission in the early phase of the pandemic. DESIGN, SETTING AND PARTICIPANTS: We conducted an online survey based on targeted Facebook advertising campaigns across eight countries (Belgium, France, Germany, Italy, the Netherlands, Spain, UK and USA), achieving a sample of 51 233 questionnaires in the period 13 March-12 April 2020. Poststratification weights based on census information were produced to correct for selection bias. OUTCOME MEASURES: Participants provided data on social contact numbers, adoption of protective behaviours and perceived level of threat. These data were combined to derive a weekly index of infection transmission, the net reproduction number [Formula: see text] . RESULTS: Evidence from the USA and UK showed that the number of daily contacts mainly decreased after governments issued the first physical distancing guidelines. In mid-April, daily social contact numbers had decreased between 61% in Germany and 87% in Italy with respect to pre-COVID-19 levels, mostly due to a contraction in contacts outside the home. Such reductions, which were uniform across age groups, were compatible with an [Formula: see text] equal or smaller than one in all countries, except Germany. This indicates lower levels of infection transmission, especially in a period of gradual increase in the adoption rate of the face mask outside the home. CONCLUSIONS: We provided a comparable set of statistics on social contact patterns during the COVID-19 pandemic for eight high-income countries, disaggregated by week and other demographic factors, which could be leveraged by the scientific community for developing more realistic epidemic models of COVID-19.

Online information on face masks: analysis of websites in Italian and English returned by different search engines.

OBJECTIVE: Countries have major differences in the acceptance of face mask use for the prevention of COVID-19. This work aims at studying the information online in different countries in terms of information quality and content. DESIGN: Content analysis. METHOD: We analysed 450 webpages returned by searching the string 'are face masks dangerous' in Italy, the UK and the USA using three search engines (Bing, Duckduckgo and Google) in August 2020. The type of website and the stance about masks were assessed by two raters for each language and inter-rater agreement reported as Cohen's kappa. The text of the webpages was collected from the web using WebBootCaT and analysed using a corpus analysis software to identify issues mentioned. RESULTS: Most pages were news outlets, and few (2%-6%) from public health agencies. Webpages with a negative stance on masks were more frequent in Italian (28%) than English (19%). Google returned the highest number of mask-positive pages and Duckduckgo the lowest. Google also returned the lowest number of pages mentioning conspiracy theories and Duckduckgo the highest. Webpages in Italian scored lower than those in English in transparency (reporting authors, their credentials and backing the information with references). When issues about the use of face masks were analysed, mask effectiveness was the most discussed followed by hypercapnia (accumulation of carbon dioxide), contraindication in respiratory disease and hypoxia, with issues related to their contraindications in mental health conditions and disability mentioned by very few pages. CONCLUSIONS: This study suggests that: (1) public health agencies should increase their web presence in providing correct information on face masks; (2) search engines should improve the information quality criteria in their ranking; (3) the public should be more informed on issues related to the use of masks and disabilities, mental health and stigma arising for those people who cannot wear masks.

How do Canadian public health agencies respond to the COVID-19 emergency using social media: a protocol for a case study using content and sentiment analysis.

INTRODUCTION: Keeping Canadians safe requires a robust public health (PH) system. This is especially true when there is a PH emergency, like the COVID-19 pandemic. Social media, like Twitter and Facebook, is an important information channel because most people use the internet for their health information. The PH sector can use social media during emergency events for (1) PH messaging, (2) monitoring misinformation, and (3) responding to questions and concerns raised by the public. In this study, we ask: what is the Canadian PH risk communication response to the COVID-19 pandemic in the context of social media? METHODS AND ANALYSIS: We will conduct a case study using content and sentiment analysis to examine how provinces and provincial PH leaders, and the Public Health Agency of Canada and national public heath leaders, engage with the public using social media during the first wave of the pandemic (1 January-3 September 2020). We will focus specifically on Twitter and Facebook. We will compare findings to a gold standard during the emergency with respect to message content. ETHICS AND DISSEMINATION: Western University's research ethics boards confirmed that this study does not require research ethics board review as we are using social media data in the public domain. Using our study findings, we will work with PH stakeholders to collaboratively develop Canadian social media emergency response guideline recommendations for PH and other health system organisations. Findings will also be disseminated through peer-reviewed journal articles and conference presentations.

Evaluating the motivation of Red Cross Health volunteers in the COVID-19 pandemic: a mixed-methods study protocol.

INTRODUCTION: Voluntary organisations provide essential support to vulnerable populations and front-line health responders to the COVID-19 pandemic. The French Red Cross (FRC) is prominent among organisations offering health and support services in the current crisis. Comprised primarily of lay volunteers and some trained health workers, FRC volunteers in the Paris (France) region have faced challenges in adapting to pandemic conditions, working with sick and vulnerable populations, managing limited resources and coping with high demand for their services. Existing studies of volunteers focus on individual, social and organisational determinants of motivation, but attend less to contextual ones. Public health incertitude about the COVID-19 pandemic is an important feature of this pandemic. Whether and how uncertainty interacts with volunteer understandings and experiences of their work and organisational relations to contribute to Red Cross worker motivation is the focus of this investigation. METHODS AND ANALYSIS: This mixed-methods study will investigate volunteer motivation using ethnographic methods and social network listening. Semi-structured interviews and observations will illuminate FRC volunteer work relations, experiences and concerns during the pandemic. A questionnaire targeting a sample of Paris region volunteers will allow quantification of motivation. These findings will iteratively shape and be influenced by a social media (Twitter) analysis of biomedical and public health uncertainties and debates around COVID-19. These tweets provide insight into a French lay public's interpretations of these debates. We evaluate whether and how socio-political conditions and discourses concerning COVID-19 interact with volunteer experiences, working conditions and organisational relations to influence volunteer motivation. Data collection began on 15 June 2020 and will continue until 15 April 2021. ETHICS AND DISSEMINATION: The protocol has received ethical approval from the Institut Pasteur Institutional Review Board (no 2020-03). We will disseminate findings through peer-reviewed articles, conference presentations and recommendations to the FRC.

Remote monitoring of marginalised populations affected by COVID-19: a retrospective review.

OBJECTIVES: The COVID-19 outbreak in Singapore has largely centred around migrant worker dormitories, comprising over 90% of all cases in the country. Dormitories are home to a culturally and linguistically distinct, low-income population, without on-site healthcare after-hours. The primary objective of this study was to assess the engagement and utilisation of a simple, low-cost, accessible, mobile health solution for remote self-reporting of vital parameters in dormitory residents with COVID-19. DESIGN: Retrospective review of medical care. SETTING: Two large migrant worker dormitories with a combined population of 31 546. PARTICIPANTS: All COVID-19-affected residents housed in dormitories during the study period. INTERVENTION: All residents were taught to use a chat assistant to self-report their temperature, heart rate and oxygen saturations. Results flowed into a dashboard, which alerted clinicians of abnormal results. OUTCOMES: The primary outcome measure was engagement rate. This was derived from the total number of residents who registered on the platform over the total number of COVID-19-affected residents in the dormitories during the study period. Secondary outcome measures included outcomes of the alerts and subsequent escalations of care. RESULTS: 800 of the 931 COVID-19-affected residents (85.9%) engaged with the platform to log a total of 12 511 discrete episodes of vital signs. Among 372 abnormal readings, 96 teleconsultations were initiated, of which 7 (1.8%) were escalated to emergency services and 18 (4.9%) were triaged to earlier physical medical review on-site. CONCLUSIONS: A chat-assistant-based self-reporting platform is an effective and safe community-based intervention to monitor marginalised populations with distinct cultural and linguistic backgrounds, living communally and affected by COVID-19. Lessons learnt from this approach may be applied to develop safe and cost-effective telemedicine solutions across similar settings.

How accurate are digital symptom assessment apps for suggesting conditions and urgency advice? A clinical vignettes comparison to GPs.

OBJECTIVES: To compare breadth of condition coverage, accuracy of suggested conditions and appropriateness of urgency advice of eight popular symptom assessment apps. DESIGN: Vignettes study. SETTING: 200 primary care vignettes. INTERVENTION/COMPARATOR: For eight apps and seven general practitioners (GPs): breadth of coverage and condition-suggestion and urgency advice accuracy measured against the vignettes' gold-standard. PRIMARY OUTCOME MEASURES: (1) Proportion of conditions 'covered' by an app, that is, not excluded because the user was too young/old or pregnant, or not modelled; (2) proportion of vignettes with the correct primary diagnosis among the top 3 conditions suggested; (3) proportion of 'safe' urgency advice (ie, at gold standard level, more conservative, or no more than one level less conservative). RESULTS: Condition-suggestion coverage was highly variable, with some apps not offering a suggestion for many users: in alphabetical order, Ada: 99.0%; Babylon: 51.5%; Buoy: 88.5%; K Health: 74.5%; Mediktor: 80.5%; Symptomate: 61.5%; Your.MD: 64.5%; WebMD: 93.0%. Top-3 suggestion accuracy was GPs (average): 82.1%±5.2%; Ada: 70.5%; Babylon: 32.0%; Buoy: 43.0%; K Health: 36.0%; Mediktor: 36.0%; Symptomate: 27.5%; WebMD: 35.5%; Your.MD: 23.5%. Some apps excluded certain user demographics or conditions and their performance was generally greater with the exclusion of corresponding vignettes. For safe urgency advice, tested GPs had an average of 97.0%±2.5%. For the vignettes with advice provided, only three apps had safety performance within 1 SD of the GPs-Ada: 97.0%; Babylon: 95.1%; Symptomate: 97.8%. One app had a safety performance within 2 SDs of GPs-Your.MD: 92.6%. Three apps had a safety performance outside 2 SDs of GPs-Buoy: 80.0% (p<0.001); K Health: 81.3% (p<0.001); Mediktor: 87.3% (p=1.3×10-3). CONCLUSIONS: The utility of digital symptom assessment apps relies on coverage, accuracy and safety. While no digital tool outperformed GPs, some came close, and the nature of iterative improvements to software offers scalable improvements to care.

Perceptions of medical students towards online teaching during the COVID-19 pandemic: a national cross-sectional survey of 2721 UK medical students.

OBJECTIVES: To investigate perceptions of medical students on the role of online teaching in facilitating medical education during the COVID-19 pandemic. DESIGN: Cross-sectional, online national survey. SETTING: Responses collected online from 4th May 2020 to 11th May 2020 across 40 UK medical schools. PARTICIPANTS: Medical students across all years from UK-registered medical schools. MAIN OUTCOME MEASURES: The uses, experiences, perceived benefits and barriers of online teaching during the COVID-19 pandemic. RESULTS: 2721 medical students across 39 medical schools responded. Medical schools adapted to the pandemic in different ways. The changes included the development of new distance-learning platforms on which content was released, remote delivery of lectures using platforms and the use of question banks and other online active recall resources. A significant difference was found between time spent on online platforms before and during COVID-19, with 7.35% students before versus 23.56% students during the pandemic spending >15 hours per week (p<0.05). The greatest perceived benefits of online teaching platforms included their flexibility. Whereas the commonly perceived barriers to using online teaching platforms included family distraction (26.76%) and poor internet connection (21.53%). CONCLUSIONS: Online teaching has enabled the continuation of medical education during these unprecedented times. Moving forward from this pandemic, in order to maximise the benefits of both face-to-face and online teaching and to improve the efficacy of medical education in the future, we suggest medical schools resort to teaching formats such as team-based/problem-based learning. This uses online teaching platforms allowing students to digest information in their own time but also allows students to then constructively discuss this material with peers. It has also been shown to be effective in terms of achieving learning outcomes. Beyond COVID-19, we anticipate further incorporation of online teaching methods within traditional medical education. This may accompany the observed shift in medical practice towards virtual consultations.

'Learning from home': role of e-learning methodologies and tools during novel coronavirus pandemic outbreak.

BACKGROUND: During the crucial time of coronavirus pandemic, education is being remodelled: opening the doors of electronic learning (e-learning). The review emphasises on the various e-learning methods that can be used in the current scenario. METHODS: The review was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on databases, namely, PubMed, Google Scholar and Cochrane. Out of 1524 identified articles, after the process of screening and based on the eligibility criteria, 45 full-text articles were reviewed. RESULTS: Though there are many caveats on the path of successful implementation this is the right time that we step towards e-learning. The article discusses the methods and tools in e-learning that can modify the traditional ways of content delivery, record maintenance, assessment and feedback. CONCLUSION: During the period of 'planet arrest', when the whole world is locked down with the motive of social distancing, let us stay connected with e-learning.

Association between medical students' prior experiences and perceptions of formal online education developed in response to COVID-19: a cross-sectional study in China.

OBJECTIVES: (1) Understanding the characteristics of online learning experiences of Chinese undergraduate medical students; (2) Investigating students' perceptions of ongoing online education developed in response to COVID-19 and (3) Exploring how prior online learning experiences are associated with students' perceptions. DESIGN: Students' familiarity with online learning modes and corresponding perceived usefulness (PU) according to their previous experiences were investigated using an online survey. The survey also collected data on students' perceptions through their evaluation of and satisfaction with current online learning. SETTING: In response to the educational challenges created by COVID-19, medical schools in China have adopted formal online courses for students. PARTICIPANTS: The questionnaire was sent to 225 329 students, of whom 52.38% (118 080/225 329) replied, with valid data available for 44.18% (99 559/225 329). METHODS: Pearson correlations and t-tests were used to examine the relationship between familiarity and PU. Multiple linear regression and logistic regression analyses were used to determine the impact of prior learning experiences and its interactions with gender, area, learning phase and academic performance on students' perceptions. RESULTS: Students' PU had a significant positive correlation with their familiarity with online learning modes (p<0.01). Students' evaluation of and satisfaction with their current online education were positively associated with their familiarity (ß=0.46, 95% CI 0.45 to 0.48, p<0.01; OR 1.14, 95% CI 1.13 to 1.14, p<0.01) with and PU (ß=3.11, 95% CI 2.92 to 3.30, p<0.01; OR 2.55, 95% CI 2.37 to 2.75, p<0.01) of online learning. Moreover, the higher the students' learning phases, the lower the associations between PU and students' evaluation of and satisfaction with ongoing online education. CONCLUSIONS: Medical students in China have experiences with various online learning modes. Prior learning experiences are positively associated with students' evaluation of and satisfaction with current online education. Higher learning phases, in which clinical practices are crucial, and high academic performance led to lower evaluation and satisfaction scores.

COVID-19 prevention and treatment information on the internet: a systematic analysis and quality assessment.

OBJECTIVE: To evaluate the quality of information regarding the prevention and treatment of COVID-19 available to the general public from all countries. DESIGN: Systematic analysis using the 'Ensuring Quality Information for Patients' (EQIP) Tool (score 0-36), Journal of American Medical Association (JAMA) benchmark (score 0-4) and the DISCERN Tool (score 16-80) to analyse websites containing information targeted at the general public. DATA SOURCES: Twelve popular search terms, including 'Coronavirus', 'COVID-19 19', 'Wuhan virus', 'How to treat coronavirus' and 'COVID-19 19 Prevention' were identified by 'Google AdWords' and 'Google Trends'. Unique links from the first 10 pages for each search term were identified and evaluated on its quality of information. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: All websites written in the English language, and provides information on prevention or treatment of COVID-19 intended for the general public were considered eligible. Any websites intended for professionals, or specific isolated populations, such as students from one particular school, were excluded, as well as websites with only video content, marketing content, daily caseload update or news dashboard pages with no health information. RESULTS: Of the 1275 identified websites, 321 (25%) were eligible for analysis. The overall EQIP, JAMA and DISCERN scores were 17.8, 2.7 and 38.0, respectively. Websites originated from 34 countries, with the majority from the USA (55%). News Services (50%) and Government/Health Departments (27%) were the most common sources of information and their information quality varied significantly. Majority of websites discuss prevention alone despite popular search trends of COVID-19 treatment. Websites discussing both prevention and treatment (n=73, 23%) score significantly higher across all tools (p<0.001). CONCLUSION: This comprehensive assessment of online COVID-19 information using EQIP, JAMA and DISCERN Tools indicate that most websites were inadequate. This necessitates improvements in online resources to facilitate public health measures during the pandemic.