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1.
J Ayurveda Integr Med ; 13(1): 100476, 2022.
Article in English | MEDLINE | ID: covidwho-1838960

ABSTRACT

The COVID-19 pandemic is ravaging the world, leaving the mainstream medical system handicapped with no proven treatment at one end and the ambiguities regarding the efficacies of vaccines at the other. The elderly population is at greater risk in terms of complications and death. The use of complementary and alternative medicine (CAM) against COVID-19 has already been documented in countries like China with a national participation rate of 90%. In this regard, the practice of CAM especially Ayurveda is relevant in India. The current report is a case series of 64 elderly COVID-19 patients managed through a Non-Linear multi-modal Ayurveda Intervention (NLMAI) via online consultation. NLMAI is a combination of herbal and herbo-mineral drug interventions, lifestyle modifications, and psychological support done in 2 phases. The post-management analysis revealed a mean duration of 11 symptoms of COVID-19 assessed through survival function as 0.577 days [SE=0.39] with a CI of 95% [0.500-0.653] which was considerably low when compared to global statistics. Moreover, none of the cases advanced to complications or death. Hence, novel approaches like NLMAI can be utilized to counter the gravity of the COVID-19 after scientific validation.

2.
Iatreia ; 35(2):165-174, 2022.
Article in Spanish | EMBASE | ID: covidwho-1822650

ABSTRACT

Introduction: The Covid-19 pandemic changed medical education, with strategies supported by virtual platforms and non-conventional scenarios. An example of this is the morbidity and mortality meetings (M&M). The objective of this study is to find the characteristics of virtual M&M meetings in different institutions focused on general surgery resident´s students in Colombia, and how medical residents and professors feel about them compared to the traditional face-to-face meetings. Methodology: This is an observational, and descriptive study in 21 hospital practice institutions of 17 General Surgery programs in Colombia, where virtual M&M operate. Information was obtained on their objectives, operational characteristics and scope. Additionally, in self-completion surveys, the participants’ perception about the usefulness and operation was investigated, this, because of the shift to virtuality. There was participation of 82 residents and 65 professors from different postgraduate programs in General Surgery in the country. Results: Virtual M&Ms continue in 53 % of the practice sites, with a predominance in private institutions. There are differences in their organization, although the traditional M&M model persists: objectives, structure, and scope. There is a longer duration of meetings, unconventional schedules and the perception of a reduced academic level. There is an improvement in the hostile environment, within the virtuality. Conclusion: M&Ms have a place in a virtual scenario. Its operation is like face-to-face meetings, and its execution offers opportunities for improvement in terms of form and content.

3.
Chinese Journal of Disease Control and Prevention ; 26(2):188-192 and 217, 2022.
Article in Chinese | EMBASE | ID: covidwho-1822638

ABSTRACT

Objective To describe the social support, anxiety, and sleep quality of residents in the District of Shanghai during the COVID-19 and to analyze the to correlation of these factors. Methods A structured questionnaire was used to investigate residents' social support, anxiety, and sleep quality. The questionnaire consisted of social support rate scale, the self-rating anxiety scale (SAS) and Pittsburgh sleep quality index (PSQI), investigated the social support, anxiety, and sleep quality of residents in the District of Shanghai under the COVID-19 epidemic and analyzed their potential influencing factors. Structural equation model was constructed to understand the relationship among these factors. Results A total of 258 questionnaires were collected, with 237 being eligible for analyzing. The results showed that there were statistically significant differences in sleep quality (P =0.004) and social support (P =0.009) among residents with different highest education levels. The structural equation model-fitting indices were CFI =0.929, NFI =0.891, IFI =0.930, NNFI =0.907, RMSEA =0.082, χ 2/df =2.599. It indicated that the fitting degree was good. The results showed that the social support of residents could affect their anxiety degree to some extent (r=-0.15). The higher the social support, the lower the anxiety degree they had. Moreover, the degree of anxiety could affect the sleep quality (r =0.72), and the higher the degree of anxiety, the worse the sleep quality they had. Conclusion During the epidemic of COVID-19, residents' social support is related to their anxiety level, and the anxiety level is related to their sleep quality. By improving residents' support, their degree of anxiety could be reduced to improve their sleep quality.

4.
Current Orthopaedic Practice ; 2022.
Article in English | EMBASE | ID: covidwho-1821984

ABSTRACT

Background: The COVID-19 pandemic has forced many medical education institutions to switch from in-person to online learning environments. There is an existing gap in knowledge about the effectiveness of virtual learning for medical students. Objective: The purpose of the study was to determine if virtual orthopaedic surgery away rotations (VOSAR) benefit medical students and programs. Methods: Virtual rotations were created at two large residency programs for fourth-year medical students. From October 12, 2020 through December 28, 2020, satisfaction and quality were assessed using a 22-question survey, residency interview, rank, and match data. Forty-two fourth-year medical students participated, 38 of whom responded to the survey. Results: Most students stated course objectives were clear and consistent with coursework. Most were pleased with the variety of cases and presentations and were able to meaningfully interact with faculty and residents. Most stated they would participate again and suggest the rotation to others. Twenty-five of 42 participants were ranked by at least one program;39 were accepted into residency positions, 21 of which were in orthopaedic surgery. Conclusions: The results indicate that the VOSAR benefits students and programs. Based on the success of the VOSAR, both programs continued to offer the curriculum for 2021. Level of Evidence: Level IV.

5.
Nursing Clinics of North America ; 2022.
Article in English | ScienceDirect | ID: covidwho-1819458
6.
International Journal of Environmental Research and Public Health ; 19(9), 2022.
Article in English | EMBASE | ID: covidwho-1818131

ABSTRACT

U.S. non-citizen residents are burdened by inequitable access to socioeconomic resources, potentially placing them at heightened risk of COVID-19-related disparities. However, COVID-19 impacts on non-citizens are not well understood. Accordingly, the current study investigated COVID-19 mortality disparities within New York (NYC) and Los Angeles (LAC) to test our hypothesis that areas with large proportions of non-citizens will have disproportionately high COVID-19 mortality rates. We examined ecological associations between March 2020–January 2021 COVID-19 mortality rates (per 100,000 residents) and percent non-citizens (using ZIP Code Tabulation Areas (ZCTA) for NYC and City/Community units of analysis for LAC) while controlling for sociodemographic factors. Multiple linear regression analyses revealed significant positive associations between the percentage of non-citizen residents and COVID-19 mortality rates in NYC (95% CI 0.309, 5.181) and LAC (95% CI 0.498, 8.720). Despite NYC and LAC policies intended to provide sanctuary and improve healthcare access for non-citizen residents, communities with larger proportions of non-citizens appear to endure higher COVID-19 mortality rates. The challenges that non-citizens endure—e.g., inequitable access to public benefits—may discourage help-seeking behaviors. Thus, improved health surveillance, public health messaging, and sanctuary policies will be essential for reducing COVID-19 mortality disparities in communities with large shares of non-citizens.

7.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816941

ABSTRACT

Purpose: Determine the role of social determinants of health (SDOH), including socioeconomic status (SES) (education, income in predicting intent to vaccinate for COVID-19 among a diverse community-based population, over sampled for cancer survivors in Connecticut (CT). Background: Race, ethnicity, and the SDOH (e.g., food insecurity, housing instability, trouble paying utilities bills) have a known impact on COVID-19 incidence, morbidity, and mortality. Although the impact on cancer survivors is not as well understood, this population may also face disproportionately severe outcomes. To our knowledge, there are no published studies that address intention to vaccinate in community based populations that are predominantly African American/Black (AA) or Hispanic/Latinx (H/L), nor in the cancer survivors who live in these communities. Prior studies have suggested that some vulnerable populations have lowered willingness to vaccinate (e.g., for influenza) than other groups. This study will explore the role of the high burden of SDOH barriers and selected socio-cultural factors such as perceived risk, medical mistrust, and source of health information. Methods: Data for this study are from 252 CT residents, collected from August - December, 2020 using Qualtrics, an online survey platform. Using an extensive network of community partners, we recruited through list serves and social media, targeting communities known to be most impacted by the pandemic. The intent was to enroll a population that was similar to the racial/ethnic sociodemographic profile of the city of New Haven, while oversampling cancer survivors. Using SAS 9.4, we conducted descriptive and multivariate analyses to identify the role of SDOH in willingness to vaccinate. Results: The study population was disproportionately African American/Black (23.5%) and Hispanic/Latinx (17.5%) and included 83 (32.9%) cancer survivors. In this high-risk population, 38.9% of the sample were unwilling or uncertain whether they would vaccinate against Covid-19 in the future. In multivariate adjusted model, individuals reporting at least one SDOH barrier (food insecurity, trouble paying utilities bills, or housing instability) were significantly less likely to vaccinate (odds ratio=2.26;95% Confidence Interval 1.17-4.36). Other significant predicators included low perceived risk and lacking confidence in information provided through the health care system. Conclusion: Social determinants of health play a critical role in predicting intent to vaccinate for COVID-19. Special efforts are needed to ensure that vulnerable populations understand their individual risk, the benefits and risks of getting the COVID-19 vaccine, with interventions aimed at enlisting trusted entities that may not be recognized as traditional sources of health information.

8.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816910

ABSTRACT

INTRODUCTION: COVID-19 has been declared as a pandemic by the World Health Organisation (WHO)in December 2019, as it spread globally and confirmed cases approach 5,000 000 patients and will exceed 365000 deaths on the 25 May 2020 across over 160 countries. Cancer patients are one of the most vulnerable groups in the current (COVID-19) pandemic. To date, the clinical characteristics of COVID-19-infected cancer patients remain widely not well understood. Patients and methods A retrospective study was conducted in Royal Wolverhampton NHS Trust for COVID-19 Cancer patients. Hospitalised cancer patients diagnosed with COVID-19 infection were identified between 30th March 2020 to 30th June 2020. Patients already have been diagnosed with cancer and had a laboratory-confirmed SARS-CoV-2 infection were enrolled. Clinical retrospective data were collected from hospital medical records, including demographic features, clinical features, laboratory findings, and chest radiograph and chest computed tomography (CT) images. Statistical analysis was done to assess the risk factors associated with severe events which required admission to an intensive care unit, the use of mechanical ventilation, or death Results Forty Cancer patients with Covid 19 infection during the period from 30th March 2020 to 30th June 2020 were enrolled. (52.6%) 22 of patients were females. Median age was 65 years .All patients were local residents of Wolverhampton. Among the cancer patients, Breast cancer was the most frequent type of cancer (n= 9;21.1%), followed by Gl cancers (n= 8;21%) and lymphoma (n = 6;15.8%).Twenty two patients (52.6%) were diagnosed with stage I-III cancer.18 patients (47.4%) were on active chemotherapy, 3 patients were on target therapy and 3 patients(7.9%) were on active immunotherapy. In addition to cancer, 31 (81.6%) patients had at least one or more coexisting chronic diseases. The most common clinical features on admission were fever (92.1%), dry cough (86.8%), and fatigue (92%);29 (76.3%) patients developed dyspnoea along with lymphopaenia (n = 32, 84.2%), high level C-reactive protein (n = 40, 100%), anaemia (n = 22, 57.9 %), and hypoproteinaemia (n = 21, 55.3%). The common chest computed tomography (CT) findings were ground-glass opacity (n = 13) and patchy consolidation (n= 4) .It is important to note that CT chest not done in 17 patients. A total of 19 patients had severe events and the mortality rate was (44.7%) .Median days of hospital admission was (12.5).It is noted that all patients with active immunotherapy had recovered despite disease progression. Conclusions: Cancer patients have deteriorating conditions and worse outcomes from the COVID-19 infection. It is recommended that cancer patients receiving antitumour therapies should have regular screening for COVID-19 infection and should avoid treatments causing immunosuppression or have dose reduction during COVID-19 Pandemic in second wave .Covid 19 has different response with patients on active immunotherapy need to be highlighted.

9.
Clinical Neurosurgery ; 67(SUPPL 1):62, 2020.
Article in English | EMBASE | ID: covidwho-1816188

ABSTRACT

INTRODUCTION: Neurosurgery is one of the youngest and rapidly evolving surgical disciplines. After adequate training, residents graduate with the capability to practice across different settings such as academic centers, community hospitals, and others. We present the effect of COVID 19 pandemic on the surgical case volume in a US training program. METHODS: We retrospectively reviewed operative case volume at our program for the year 2019 and January-mid April 2020.We chose to include the mid-March to mid-April period as it corresponded to the time when our institution started deferring elective cases. We categorized cases as an elective cranial, elective spine, and emergency (trauma and other non-elective cases). We then summarized and compared the number of cases during this period. RESULTS: The average number of cases in 2019 was 99 cases per month (37 elective cranial, 42 elective spine, and 20 emergent). In 2020, The total case number in January, February, March, and mid-March to mid-April was 97, 86, 71, and 41cases respectively. In comparison to January 2020, February, March, mid-March to mid-April showed a 12%, 27%, and 58% reduction in the number of cases. The absolute number of emergent cases was comparable in January through mid-April 2020 (17,11,15, and 16) but in mid-March to mid-April emergent cases constituted 39% of the total case number. CONCLUSION: Neurosurgical residency is an eighty-four months of rigorous training with a minimum of 800 cases is required to prepare residents for a successful career in neurosurgery. The significant decline in the number of cases due to COVID 19 might affect the quality of training, especially for senior residents.

10.
Clinical Neurosurgery ; 67(SUPPL 1):57, 2020.
Article in English | EMBASE | ID: covidwho-1816186

ABSTRACT

INTRODUCTION: During this unprecedent time, standard residency didactic conferences have been put on hold. Here we present our preliminary experience from a pilot program devised to optimize online resident education. METHODS: We moved our residency didactic conferences to an online format. In order to create a streamlined process for didactics, a curriculum website was created to house the conference schedule, learning objectives, presentations, reading assignments, and assessments. Assigned reading topics, including any relevant publications were posted in advance of weekly didactics conference. It is known that spaced repetition improves recall. Therefore, quizzes are posted at the 1 week, and 3 week intervals after the lecture to prime recall and enhance retention of content. The lectures themselves were optimized for learning with active learning techniques such as case-based discussion, polling and games. RESULTS: Residents prepare by reading the relevant material in advance of the lecture, and complete an Individual Readiness Assurance Test (iRAT). This new program was reviewed well by both faculty and residents participating in conferences. CONCLUSION: With residency programs continuing to evolve, the challenges of educating trainees in a vast and ever-growing fund of knowledge are not unique. Our experience offers an outline for using a web based platform as part of a rigorous system for residency didactics, while taking advantage of online teaching tools to create an engaging learning environment.

11.
Journal of Neurological Surgery, Part B Skull Base ; 83(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1815663

ABSTRACT

Introduction: To be adequately prepared for the technical surgical demands and interprofessional teamwork required of the operating room, cadaveric laboratory training is essential.1 A recent survey of neurosurgical residency programs in the United States bore this out: 95.4% of respondents view laboratory dissection as an integral to training and an additional 89.2% would support a national “suggested” dissection curriculum and manual.2 To address this demand, the OHSU Neurosurgery residency program in partnership with OHSU Simulation, the OHSU Body Donation Program, and industry stakeholders have developed, over the past 6 years, an annual three-part cadaveric surgical simulation course series that has provided training in skull base procedures. Methods: Resident surgical education aims to (1) Develop decision-making, complication management and technical surgical abilities in a low-risk environment, (2) review anatomy, and (3) refine interprofessional teamwork typical to the operating room between otolaryngology (ENT) and neurosurgery disciplines. Successful resident education in simulation is dependent on collaboration between neurosurgical faculty, educational support staff, and industry experts. We describe a manuscript for successfully implementing a cadaveric surgical simulation course to meet the educational objectives above. This comprehensive overview details (1) equipment and instrumentation, (2) course maps and photos ([Figs. 1] and [2]), (3) curriculum development, (4) tissue procurement and preparation, (5) communications between major stakeholders, (6) scheduling and logistics, (7) evaluation of resident proficiency, and (8) COVID-19-specific modifications to course curriculum. Results: Course evaluations from 337 OHSU neurosurgery and otolaryngology residents over the past 6 years were collected and analyzed. Means and SDs of Likert's scale questions were calculated and indicated uniformly positive responses ([Table 1]). Free-text responses were analyzed via sentiment analysis. This resultant heat map ([Fig. 3]) indicated positive attitudes, with the lowest value being +0.41 (on a scale of -1.0 to 1.0). Conclusion: We hope this manuscript can serve as a guide for other institutes to develop their own residency educational curriculum in cadaveric skull base procedures. (Figure Presented).

12.
Beni Suef Univ J Basic Appl Sci ; 10(1): 47, 2021.
Article in English | MEDLINE | ID: covidwho-1817312

ABSTRACT

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of ongoing global pandemic of coronavirus disease 2019 (COVID-19), has infected millions of people around the world, especially the elderly and immunocompromised individuals. The infection transmission rate is considered more rapid than other deadly pandemics and severe epidemics encountered earlier, such as Ebola, Zika, Influenza, Marburg, SARS, and MERS. The public health situation therefore is really at a challenging crossroads. MAIN BODY: The internal and external and resident microbiota community is crucial in human health and is essential for immune responses. This community tends to be altered due to pathogenic infections which would lead to severity of the disease as it progresses. Few of these resident microflora become negatively active during infectious diseases leading to coinfection, especially the opportunistic pathogens. Once such a condition sets in, it is difficult to diagnose, treat, and manage COVID-19 in a patient. CONCLUSION: This review highlights the various reported possible coinfections that arise in COVID-19 patients vis-à-vis other serious pathological conditions. The local immunity in lungs, nasal passages, oral cavity, and salivary glands are involved with different aspects of COVID-19 transmission and pathology. Also, the role of adaptive immune system is discussed at the site of infection to control the infection along with the proinflammatory cytokine therapy.

13.
Journal of Clinical and Translational Science ; 2022.
Article in English | EMBASE | ID: covidwho-1815387

ABSTRACT

The COVID-19 pandemic led to an increased need to conduct research and community engagement using digital methods. Unfortunately, the shift away from in-person research activities can make it difficult to engage and recruit participants from under-resourced communities that lack adequate digital infrastructure. At the beginning of the pandemic our team recognized that imminent lockdowns would significantly disrupt ongoing engagement with lowincome housing resident community partners and that we would ultimately bear responsibility if that occurred. This manuscript outlines the development of methods designed to create capacity for virtual engagement with a community advisory board that were subsequently applied to a longitudinal mixed-methods study. We describe how our experience engaging low-income housing residents during the height of the pandemic influenced the approach and offer guidelines useful for engaging under-resourced communities regardless of setting. Of these, a strong commitment to providing technology, unlimited data connectivity, and basic digital literacy training/technical support is most important. While each of these is essential and failure in any one area will reduce overall effectiveness of the effort, providing adequate technical support while maintaining ongoing relationships with community members is the most important and resource intensive.

14.
JAMA Network Open ; 5(3):E223887, 2022.
Article in English | EMBASE | ID: covidwho-1800409
15.
Urology ; 2022.
Article in English | ScienceDirect | ID: covidwho-1799680

ABSTRACT

Objective To assess the impact of the Urology Collaborative Online Video Didactic (COViD) lecture series series on resident knowledge as a supplement to resident education during the COVID-19 pandemic. Methods One hundred thirty-nine urology residents were voluntarily recruited from 8 institutions. A 20-question test, based on 5 COViD lectures, was administered before and after watching the lectures. Pre- and post-test scores (percent correct) and score changes (post-test minus pre-test score) were assessed considering demographic data and number of lectures watched. Multiple linear regression determined predictors of improved scores. Results Of residents recruited, 95 and 71 took the pre- and post-tests. Median number of lectures watched was 3. There was an overall increase in correct scores from pre-test to post-test (45% vs. 57%, p<0.01). Watching any lectures vs. none led to higher post-test scores (60% vs. 44%, p<0.01) and score changes (+16% vs. +1%, p<0.01). There was an increase in baseline pre-test scores by post-graduate year (PGY) (p<0.01);however there were no significant differences in post-test or score changes by PGY. When accounting for lectures watched, PGY, and time between lecture and post-test, being a PGY6 (p=0.01) and watching 3-5 lectures (p<0.01) had higher overall correct post-test scores. Watching 3-5 lectures led to greater score changes (p<0.001-0.04). Over 65% of residents stated the COViD lectures had a large or very large impact on their education. Conclusions COViD lectures improved overall correct post-test scores and increased knowledge base for all resident levels. Furthermore, lectures largely impacted resident education during the COVID-19 pandemic.

16.
Open Access Macedonian Journal of Medical Sciences ; 10:511-515, 2022.
Article in English | EMBASE | ID: covidwho-1798870

ABSTRACT

BACKGROUND: Community involvement in community organization is as Muhammadiyah in handling Coronavirus Disease 2019 (COVID-19) that is essential. Since the beginning of the emergence COVID-19 in Indonesia, Muhammadiyah had shown concern in tackling COVID-19. AIM: This research analyzed the relationship between the knowledge, attitude, and behavior of Muhammadiyah members’ compliance based on regulation on preventing the spread of COVID-19. METHODS: This research used a cross-sectional design with 100 respondents from Muhammadiyah members in Surabaya. The respondents were selected through purposive sampling. The researchers distributed the questionnaires with Google form. The descriptive analysis determined each variable and the non-parametric Rank Spearman or Kendall’s tau-b statistical SPSS test that analyzed the correlation between respondents’ behavior and compliance. RESULTS: The majority of Muhammadiyah residents in Surabaya have good knowledge, attitudes, practices, and obedience. CONCLUSION: Community involvement in relation to handling COVID-19 that was very important, especially Muhammadiyah through its various instruments to carry out campaigns and efforts to prevent the spread of COVID-19 in the community.

17.
Open Access Macedonian Journal of Medical Sciences ; 10:498-505, 2022.
Article in English | EMBASE | ID: covidwho-1798869

ABSTRACT

BACKGROUND: Low availability of medical care and low level of comfort living in rural areas, underdeveloped infrastructure, and difficult working conditions lead to the deterioration of health of rural residents. Rural areas are characterized by less comfortable living conditions than in the city, which can affect health-related quality of life. AIM: The purpose of this study was to assess the satisfaction of the population with the quality of life in rural areas as well as to study the quality of life of the rural population of the Republic of Kazakhstan related to health. METHODS: This study was a one-stage cross-sectional study. Online questionnaire was asked by 411 local residents, of which only 302 were suitable for processing. RESULTS: The results showed that almost a third of the respondents are unemployed (27.2%). In the course of the survey, respondents could subjectively assess their own health, for example, almost a third of respondents (35.76%) assess their health as “poor” and “below average.” At the same time, 18.21% of respondents are not satisfied with the quality of medical services provided in rural areas. The coefficients of correlation between the desire to move to the city and age, income level, family composition, marital status, and type of housing were established. The universal social functioning-36 index was 0.6 (±0.02) for women and 0.55 (±0.033) for men CONCLUSIONS: We can say that the quality of life of the rural population remains quite low. This is evidenced by low income, high unemployment, and the problem of drinking water. Quarantine measures related to COVID-19 also had an impact on the increase in unemployment, however, during the quarantine, there is a deterioration in mental health indicators among men compared to women. The results of the study confirmed that the issue of accessibility of medical services remains very urgent for rural residents.

18.
Journal of Clinical and Diagnostic Research ; 16(SUPPL 1):5-6, 2022.
Article in English | EMBASE | ID: covidwho-1798698

ABSTRACT

Sir William Osler said, To study the phenomena of disease without books is to sail an unchartered sea, while to study books without patients is not to go to sea at all. This quote is a bleak reminder of the state of clinical teaching after nearly two years of Covid disrupting the implementation of our curriculums across the country given the recent roll out of a Competency-based Curriculum. We cannot allow the undergraduate course to slip into a distant online mode for fear of losses of competences mandated to perform professional roles as physicians of first contact. The focus of this brief lecture is on Undergraduate Teaching-Learning in Clinical Medicine though post-graduate education is not necessarily exempt from these ideas. It will attempt to suggest possibilities given the existing context of the transformation towards the new Competency-based Curriculum and the facts of faculty-student ratios that challenge us. Assumptions must be stated at the beginning that faculty are not only motivated but also enthusiastic and interested in their task to educate their undergraduates to learn and the vice versa exists especially in dealing with students in their clinical phase of studentship. If the patient needs to return to the centre of our education, then moving very moment of teaching to the bedside, Outpatient clinic, Emergency and even Operation Theatre are the needs of the hour. Key elements towards achieving competences and outcomes require us to insist on small groups (usually not more than 15-20 per unit) and formative assessments ongoing throughout phases of teaching clinical medicine. To force multiply we need to include Senior Residents and Postgraduates (even the special Intern) into the pool of 'Faculty' and more importantly use every opportunity to provide experiences in the clinical settings mentioned above not restricted to 'nine to five work hours'. Outpatient (Ambulatory) clinic has great potential to teach small groups of clinical students assigned to shadow faculty and residents/interns working up patients in regular outpatient clinics even participating actively in the actual care and treatment of patients. Since clinical postings occur usually through three semesters leading up to final examinations, judicious involvement in 'work ups' documented in case notes or logbooks as students under supervision of faculty/residents makes fabulous learning. Initial postings begin with history and anthropometric measurements and growth charting leading to physical examination both General and Systems finally even deciding on differentials with investigation plan and writing then counselling regards prescriptions. All this is after it is present to the faculty/resident in the presence of the parents for confirmation or clarifications. Undergraduates enjoys a single patient work up by every student assigned to a faculty/resident is enjoyed by undergraduates simply because it is realistic. Of course, informing the patient or attender of the patient and appropriate allocation even of healthy or follow up patients for this exercise makes this a possibility. It is rare that such an informed patient or attender disallows such an exercise. Depending upon outpatient space, the clinical exercise may occur while sitting opposite the faculty/resident in the same consult room or in a nearby room to return to the faculty/resident's room for presentation in front of the parents. One may hasten the process by focusing on a one patient-one key learning system and various models have been described by John Dent and Ronald Harden classified on Student - Faculty ratios. As an example, in the case of Paediatrics, focusing on growth charting, practical immunisation, nutrition counselling, discussing most likely differentials, investigation approaches, form filling, rational therapeutic choices, optimal prescriptions, education and counselling may be chosen as learning points for different students seeing different patients. Initially, case notes of history and examination are allowed onto outpatient charts followed by assisting by investigation requests, discussing results when relevant and finally actually writing prescriptions to be scrutinised and signed off by faculty/residents. The obvious disadvantage is that it does slow down patient clearance but while students work up their patient's one can continue to clear other patients and every patient does not need to be handed over to students to work up. Their involvement in actual patient care makes great inspiration to learn more. Ambulatory settings also allow one to direct students to the immunisation room or pharmacy to observe and under supervision begin to even administer common vaccines while recognising components of the many prescriptions we dispense. We all know that to do is the best way to strengthen the learning experience. Teaching in the wards at the bedside of patients is also rather fulfilling and motivational for students to understand and want to learn the art and science of medicine. The bedside clinic has been the cornerstone of clinical education only to disintegrate as one 'Bakra' works up and presents the chosen allocated patient to the faculty while the remaining clinical batch of students passively stand by hopefully learning. Allocating patients or beds to individual students or a pair of students, the latter in early postings, with mandatory responsibility of working up and seeing 'their' patients every morning of the clinical posting with details entered in the logbook book is the first step. The faculty assigned for the bedside that day, does not reveal the patient to be discussed but may randomly pick up one of the patients asking the student(s) 'responsible' to present. This mandates that all students posted have to be up to date with history, examination, investigation results and treatment if not daily assessments and care plan. Another successful involving method is to walk up to the batch allocated patients from the parent unit after they have seen their patients for the day and conducting teaching rounds mimicking realistic patient service rounds. Each student or pair of students presents updates of their patients and discussions occur similar to one has on regular rounds. Differentials are argued, Investigation results analysed and Treatment options even choice of antibiotics with doses and duration justified. This clerkship exercise is an early extension of internship and we all know that most learning occurs during Internship at least in our times. Documentation may occur in student logbooks but one may make provisions that patient progress notes be clearly identified as student learning notes and documented as such. The student-doctor then needs to not only interact with patients, practice examining patients, documenting the same, to chase results and cross consults. Common non-medical issues faced in care and treatment are then experienced by students. It is only in the ward that feeding, introducing intravenous cannula, performing phlebotomy, medications administration, infusions, monitoring transfusions, transportation within hospital, changing diapers and even bed making is experienced. It is in the wards that opportunities to participate in procedures like LPs, biopsies, etc. occur making sure that documentation occurs in logbooks. To enable more excitement in learning, the mandating evening duties as observers from 6-8 pm assigned to report to duty residents/postgraduates as they deal with emergencies and regular work documenting what they observe during such duties. Observation in Operation Theatres or in areas where procedures occur only makes good learning if there is a structured system in place, where the teacher briefs the students preparing them for what they are to witness and observe followed by the actual witnessing of the procedure/intervention ending with debriefing of the steps involved and findings. The continuum of learning must continue into the postoperative period to complete the learning by student participation in post-operative rounds. In later postings, the occasional opportunity to scrub up to 'participate' in the intervent on adds to the inspiration to learn. In all these encounters, students must adhere to norms expected of professional behaviour And patient consent by the primary care provider essential. Patients if informed do understand the need and accept reasonable student interaction during their stay in medical college settings. Involving them in providing feedback of students who interviewed and examined them also makes great learning points right from dress code to demonstrating respect. This brief lecture shares ideas to recognise and optimise utilisation of possible teachable moments in clinical medicine thus opening up possibilities of many other ideas from participants.

19.
Psychiatria Polska ; 56(1):101-114, 2022.
Article in Polish | EMBASE | ID: covidwho-1798673

ABSTRACT

Aim. The main aim of this study was to assess the effects of social and familial isolation due to COVID-19 on the mental well-being of patients staying in a residential medical care facility and evaluation of the effectiveness of therapeutic measures. Methods. The study was conducted among the patients of a residential medical care facility (58 patients). A short form of the Geriatric Depression Scale (GDS) was used to assess the severity of depressive disorders. The number of medical and psychological interventions during the individual months of isolation was also compared. Results. In February 2020, when there was no isolation, 87.9% of the study group did not suffer from depression compared to 72.4% during the period of full isolation. After introducing controlled methods for contacting loved ones, the number of individuals with no depressive symptoms increased again. A mean of 1.76 medical and 0.23 psychological interventions per one patient were conducted during the period of full isolation. Conclusions. The number of medical and psychological interventions was higher during the period of full isolation compared to months without compulsory isolation due to COVID-19. After the introduction of full isolation, the scores in the GDS were significantly higher, which means that the residents were at a higher risk of depressive disorders than in the months without isolation.

20.
Pharmacy Education ; 22(2):289-291, 2022.
Article in English | EMBASE | ID: covidwho-1798548

ABSTRACT

Background: Over time, cases of COVID-19 have increased significantly;as of June 19, 2020, the total number of patients positive for COVID-19 in Cengkareng District, Indonesia, was 163 as behavioural efforts to prevent COVID-19 have not been carried out optimally by Cengkareng District residents. Objectives: This study aimed to determine the relationship between the level of knowledge and attitude of the community towards COVID-19 prevention behaviour. Methods: This study was observational, prospective, with a cross-sectional design. The sample consisted of the residents of Cengkareng District (n=100) obtained by a purposive sampling technique. The data analysis was univariate and bivariate. Bivariate analysis used the Chi-square test. Results: The univariate analysis revealed that 62% of respondents had good knowledge of COVID-19 prevention, 55% had positive attitudes towards COVID-19 prevention, and 60% had good COVID-19 prevention behaviour. Bivariate analysis showed that men, women, and children were associated with a COVID-19 preventive behaviour (p<0.05). In Cengkareng District, West Jakarta, there was an association between population knowledge and COVID-19 prevention behaviour. To prevent the spread of COVID-19, health workers should promote the importance of COVID-19 prevention behaviours.

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