ABSTRACT
The COVID19 pandemic resulted in lock-downs and reduction of social interactions to reduce the risks of disease transmission. Routine medical services were affected and telemedicine was rapidly adopted for the diagnosis, monitoring, and treatment of many chronic diseases including hypertension. We look at the considerations for the design and set-up of telemedicine for the management of hypertension. Many aspects need attention in order to ensure a safe, reliable, and effective program. Many regulatory agencies developed guidelines, advisories, regulations, and legislation to manage telemedicine. We examine some of these guidelines and their differences in South East Asian countries. Often, the professional clinical service standards in telemedicine are maintained by the state medical boards or councils. Additional training or certification and licensure is needed prior to providing telemedicine services. In-person visits are required when remote consultations cannot meet the professional clinical standards. Because telemedicine can traverse national boundaries, different regulators differ in their approach to the provision of telemedicine services to overseas patients. Nonetheless, the doctor must meet the same standard of care for overseas patients. Also, practice insurance will need to explicitly cover the practice of telemedicine especially for overseas patients. Besides the professional clinical standards, telemedicine differs by technology platforms, communication devices, software, and blood pressure monitoring devices. These varied devices and software require further evaluation of technical standards for safety, reliability, data privacy, storage, transmission, and licensure. Some of the guidelines also cover the need for quality improvements and technology upgrades. Regardless, there have been many studies of telemedicine in hypertension covering many aspects of care. Some can be simpler telemonitoring of blood pressure to highly sophisticated ones with devices linked to personal communicators (usually cellphone) with feedback to healthcare professionals (doctors, nurses, dietitians, pharmacists) and tagged to clinical interventions to improve the control of hypertension. Reviews of these studies show that hypertension telemedicine programs are effective but the evidence may be available in different practice settings and patient types, thus, complicating the design and recommendations. Therefore, it is important to review the type of practice and patients, determine which aspects are lacking to be targeted, and designing a good program. A good program will lead to better clinical outcomes, patient satisfaction, lower cost, reduced manpower for delivery of care, and convenience all round. Clinical practice guidelines and undergraduate and postgraduate medical training need to encompass telemedicine for the future.
ABSTRACT
Objectives: Early investments in new diagnostic technologies that allow for rapid and decentralized testing were critical in reducing SARS-CoV-2's detrimental health and economic effects. This study evaluates public knowledge about, acceptance of and willingness to use COVID-19 self-testing kits. Methods: An online descriptive cross-sectional questionnaire was used in this study. The final study population included all contacted national and resident adults, age 18 and over, who were willing to engage in the study. The survey was divided according to participants' demographic information and 11 questions assessed the respondents' understanding of and willingness to use COVID-19 self-testing kits. The statistical analysis was carried out using SPSS version 24. Multivariate linear regression models were used to identify the factors influencing respondents' knowledge of and attitudes toward the acceptability of self-testing kits for COVID-19 and their willingness to use these kits. Key findings: A total of 876 respondents participated in the study and completed the whole questionnaire. The average knowledge score on the acceptability of and willingness to use self-testing kits for COVID-19 was 70.2%, with a 95% confidence interval (CI) [69.1%, 71.4%]. Participants who were postgraduate, female and vaccinated against COVID-19, as well as employees and older participants, were jointly highly associated with higher levels of knowledge about, acceptance of and willingness to use self-testing kits for COVID-19. Moreover, participants who had been infected with COVID-19, were vaccinated against COVID-19 or were female, employees, older, Western or Arabic were jointly highly associated with positive attitudes about the acceptability of and willingness to use self-testing kits for COVID-19. Conclusions: The majority of the respondents have acceptable levels of knowledge about, acceptance of and willingness to use self-testing kits for COVID-19. Nonetheless, future studies should consider the issues of pre- and post-test counselling, false negative results and the sale of unregulated testing kits. Additional information should be communicated so that people can make informed decisions and be protected from possible abuse of COVID-19 self-testing kits when they become available in pharmacies.
ABSTRACT
Background Online learning can play a vital role in the process of teaching and learning during Corona Virus Disease 2019 (COVID-19) pandemic. However, learners' satisfaction is extremely important in effective implementation of the online learning, especially at institutions where it is newly adopted. Objective To assess satisfaction towards online learning and its predictors among students at Chitwan Medical College, Bharatpur. Method A web-based cross-sectional survey was undertaken among 434 undergraduate and postgraduate students from various academic programs who had participated in the online classes started during this COVID-19 pandemic. A structured questionnaire consisting of 31 items (5-point Likert scale) covering four major student satisfaction domains (learners' dimensions, technological characteristics, instructors' characteristics and course management and coordination) was distributed to the students using Google Form. Result More than half (53.5%) of the students were satisfied with the online learning, while 29.7% gave neutral views. Bivariate analyses found that all four domains scores were positively correlated with each other as well as with the students' overall satisfaction towards learning. In multivariate analysis, female gender [aOR: 2.72, p = 0.013], WiFi as internet modality for learning [aOR: 3.36, p = 0.001) and learners' dimension score [aOR: 1.27, p<0.001] were the significant predictors of students' satisfaction. Conclusion Although recently adopted, the satisfaction of the students towards online classes appears good, and prioritizing the identified predictors and working on the weak links could assist in enhancing students' satisfaction and better outcomes. Copyright © 2020, Kathmandu University. All rights reserved.
ABSTRACT
Introduction/Background: The Paediatric Rheumatology Clinical Nurse Specialist often has to manage a large caseload of children and young people. Paediatric Rheumatology is an umbrella term of over 80 conditions, most of which are long-term chronic illnesses which can be challenging for families to manage. The Clinical Nurse Specialist is therefore the first point of contact for families who want answers and guidance in caring for their child/young person. The UK and Ireland Paediatric Rheumatology Nurses Group, in turn, provides peer support to these nurses. This will present the growth of this network, particularly over the last two years. Description/Method: Over two decades ago, a UK Paediatric Rheumatology Nurses group was established. Since the group's formation, membership has grown from 20 to over 100 nurses, and has expanded into the Republic of Ireland. All nurses work in paediatrics and most are working solely in Rheumatology as Clinical Nurse Specialists (various titles exist). However, the group also contains nurses who may not solely focus on Rheumatology, but who also manage a number of specialities (one being Rheumatology), and those who have developed their own specialist interest in Rheumatology, often derived from providing clinical support to weekly Rheumatology clinics. The group's Lead Nurse has also encouraged Clinical Research Nurses supporting Paediatric Rheumatology studies to join, as the shared learning is useful to support their clinical practice too. Currently we only have one Paediatric Rheumatology Senior Clinical Research Nurse, but we do have some nurses who manage Paediatric Rheumatology studies as part of their wider clinical roles. Members are located across 37 different centres in the UK and Ireland. Four of these centres have joined in the last month, with nurses hearing about the group and approaching the steering committee about their participation. The centres range from district general hospitals through to specialist regional Children's hospitals. The seniority of our members ranges from band 5 through to band 8b, with three members managing Rheumatology services in a matron capacity. In fifteen of these centres, there is only one Paediatric Rheumatology Nurse within that centre, which can be isolating. The UK and Ireland group is accessible through email and WhatsApp and is always available for a quick question or check in. Keeping membership up to date, particularly with some nurses only joining for short periods of time to cover maternity leave, can be challenging. Tomorrow the numbers may have changed again! Discussion/Results: The growth of this group, particularly over the last two years, could be for a number of reasons: 1. Regular virtual meetings have been advertised on social media channels, especially via the British Society of Rheumatology (BSR). These don't have to be sighted by Rheumatology nurses themselves but may have been noticed from other Rheumatology multidisciplinary team members, who then encouraged their nurses to make contact. 2. Having regular virtual meetings ensures that all of the Paediatric Rheumatology Nurses are invited and can take turns in attending and sharing best practice, so it is in a team's best interest to encourage more hesitant nurses to ask to join. 3. The development of the WhatsApp group has provided quick and instantaneous responses and has clearly proven beneficial according to member feedback. 4. During the Covid-19 pandemic, working patterns changed with nurses being allowed to work from home. This change contributed to nurses feeling isolated from their peers, and also not having the wider multi-disciplinary team easily on hand and therefore asked the group their clinical questions. 5. Some members of the group have taken on additional roles, either within BSR or the Royal College of Nursing and this offers wider communication channels and increased visibility of the group through advertising. 6. Membership growth appears to mirror the growth seen in Rheumatology services, for example some centres have appointed veitis Clinical Nurse Specialist posts to work in conjunction with the Rheumatology Nursing Team. 7. The change in societal ways of working, with more work and meetings occurring virtually, and outside of the 9-5 office hours, means that nurses can attend meetings easier than having to expend time and finances to travel to face-to-face meetings. 8. New members joining naturally increases word of mouth and the wider reach of the group. Key learning points/Conclusion: Raising and maintaining the profile of this group is important. We know that there is no similar group for adult Rheumatology Nurse Specialists in the UK. Also, there is no other similar European Paediatric Rheumatology Nurses group. Paediatric Rheumatology is a huge speciality with nurses needing to be able to support families in their management of conditions outside of hospital appointments to prevent hospital admissions. The scope of the Rheumatology nurse is also always increasing, with pressure on nurses to undertake postgraduate studies, become nurse prescribers, carry out joint examinations, deliver nurse-led clinics and manage patients on immunomodulatory therapies in the community. The Paediatric Rheumatology Nurse also requires knowledge and skills in best practices for young people transitioning into adult services and be an expert in child development stages and the implications of these, whilst managing the needs and expectations of the child's main carer and wider family. For these reasons alone, it is vital that we protect the Paediatric Rheumatology Nurse Specialist and ensure that they are supported, developed and valued, and therefore, stay in Rheumatology. The ask of the wider multidisciplinary team is to allow Paediatric Rheumatology Nurses time to attend group meetings, encourage them to ask questions of the wider nursing group and to promote the group to new nurses or those who may not be aware of the group, to reach out and seek expert peer support.