Establishment of infection prevention and control strategy in nursing managements during surgical operations in COVID-19 patients based on Delphi method.

AIM: The aim of this study was to establish an infection prevention and control strategy for nursing managements during surgical operations in coronavirus disease 2019 (COVID-19) patients. DESIGN: A Delphi method. METHODS: Between November 2021 and March 2022, we first formulated a preliminary infection prevention and control strategy based on the literature review and institutional experience. Then, we applied Delphi method and performed expert surveys to reach a final strategy for nursing managements during surgical operations in COVID-19 patients. RESULTS: The strategy included seven dimensions with 34 items. The positive coefficients of Delphi experts in both surveys were 100%, indicating a high coordination among experts. The degree of authority and expert coordination coefficient were 0.91 and 0.097-0.213. After the second expert survey, value assignments for importance of each dimension and item were 4.21-5.00 and 4.21-4.76 points, respectively. The coefficients of variation for dimension and item were 0.09-0.19 and 0.05-0.19, respectively. PATIENT OR PUBLIC CONTRIBUTION: Except the medical experts and research personnel, there was no other patient or public contribution involved in the study.

Using a latent Hawkes process for epidemiological modelling.

Understanding the spread of COVID-19 has been the subject of numerous studies, highlighting the significance of reliable epidemic models. Here, we introduce a novel epidemic model using a latent Hawkes process with temporal covariates for modelling the infections. Unlike other models, we model the reported cases via a probability distribution driven by the underlying Hawkes process. Modelling the infections via a Hawkes process allows us to estimate by whom an infected individual was infected. We propose a Kernel Density Particle Filter (KDPF) for inference of both latent cases and reproduction number and for predicting the new cases in the near future. The computational effort is proportional to the number of infections making it possible to use particle filter type algorithms, such as the KDPF. We demonstrate the performance of the proposed algorithm on synthetic data sets and COVID-19 reported cases in various local authorities in the UK, and benchmark our model to alternative approaches.

The effects of online Team-Based Learning on undergraduate nursing students' performance, attitudes and accountability during COVID-19 pandemic.

BACKGROUND AND AIM: The COVID-19 pandemic forced many institutions to move Team-Based Learning to an online format. The primary aim of this study is to examine the performance of undergraduate nursing students on tRAT and iRAT during online TBL. The secondary aims are to evaluate the students' attitudes and their accountability, preferences and satisfaction with online TBL. METHODS: The study employed a one-group pretest-posttest quasi-experimental design. The primary outcome was evaluated by comparing the students' average scores in the tRAT versus the iRAT in each online TBL session. The secondary outcomes were evaluated through the questionnaire designed by Parmelee et al. (2009) and the Team-Based Learning Student Assessment Instrument (TBL-SAI) (Mennenga, 2012). RESULTS: A statistically significant improvement was identified between tRAT and iRAT performances in all online TBL sessions (p<0.001). Students' satisfaction with team experience showed a statistically significant increase (p=0.003). Participants considered the peer evaluation to be fair (p<0.001), although it didn't encourage them to study more (p=0.028). Finally, students felt they were able to make the right decisions (p<0.001). The mean scores for accountability (m=30±3.7) and preferences for TBL (m=51.8±6.3) were higher than their neutral values (n=24; n=48). Students' satisfaction was neutral (m=27.8±5, n=27). CONCLUSIONS: In online TBL, teamwork has improved individual performances and has been appreciated by the participants. The online TBL had a positive effect on the accountability of students who preferred it to frontal lectures.

The effectiveness of online team-based learning in introduction to medical ethics education for medical students at a medical college of Nepal: a pilot study.

BACKGROUND: The effectiveness of online classes is always a concern, and it can be overcome by opting for active learning strategies like team-based learning (TBL). This study was conducted to find out the effectiveness of online TBL as an active learning strategy. We also aimed to explore the satisfaction and perception of students toward TBL. METHODS: This is a mixed-method study conducted among 29 third-year Bachelor of Medicine and Bachelor of Surgery (MBBS) students of Gandaki Medical College using purposive sampling method in the duration of January to September 2021. Three two hours online TBL sessions were used for teaching introduction to medical ethics. The individual readiness assurance test (IRAT) scores were compared to the group readiness assurance test (GRAT) scores to evaluate the effect of TBL through cooperative learning. Learner reactions and satisfaction of students towards TBL were assessed using a validated questionnaire comprising of a five-point Likert scale. An open-ended question asking the participants to describe their overall experience of the TBL sessions was also included to explore their perceptions towards TBL. The data were collected using Google form and exported to Microsoft Excel and the quantitative data were then analyzed using Statistical Package for Social Sciences (SPSS) version 16.0. To check the normal distribution of the data, Kolmogorov Smirnov and Shapiro-Wilk test were used. Non-parametric tests were used for the non-normally distributed data. P value of < 0.05 was regarded as significant. Thematic analysis was conducted for the qualitative data. RESULTS: The median GRAT scores were significantly higher (p = 0.006 in TBL 1 and 0.001 in TBL 2) than IRAT scores. Learner reactions toward TBL sessions were positive as shown by the mean scores which were in the range of 3.59 to 4.66. Five themes were generated from the codes: "effective learning method", "positive experience", "gained knowledge", "expression of gratitude" and "the way of conduction of the sessions". CONCLUSION: Online TBL in medical ethics was effective as a teaching learning tool in our setting. The students were satisfied with the learning process and rated the learning strategy positively.

A 75-Year-Old Female Smoker with Advanced Small-Cell Lung Cancer and Eastern Cooperative Oncology Group Performance Status 2 who Responded to Combination Immunochemotherapy with Atezolizumab, Etoposide, and Carboplatin.

BACKGROUND Atezolizumab is an immune checkpoint inhibitor used as first-line treatment with carboplatin and etoposide chemotherapy for advanced small cell lung cancer. Immunochemotherapy treatment decisions can be affected by patients' physical ability. Because of the exclusion of patients with an Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥2 from clinical trials, treatment outcome evidence in this group is limited. CASE REPORT We present the case of a 75-year-old woman with an ECOG PS of 2 admitted with respiratory symptoms and diagnosed with advanced small-cell lung cancer. After managing exacerbation of COPD and decompensated heart failure, atezolizumab with carboplatin and etoposide was administered. After 2 cycles of immunochemotherapy, deterioration of health was observed, including anemia and thrombocytopenia. Because of the good response in imaging tests and restored balance of the patient condition, immunochemotherapy was continued. After 4 cycles of combined treatment, complete regression was achieved. No another adverse effects were observed. The patient was qualified for maintenance therapy with atezolizumab. In follow-up CT scan after 2 cycles of atezolizumab, progression was observed and patient was qualified for second-line treatment. CONCLUSIONS This report presents the case of an older patient with advanced small cell lung cancer and an ECOG status of 2 who responded to combined immunochemotherapy with atezolizumab, etoposide, and carboplatin. Adverse effects observed during immunotherapy were not a reason for discontinuation of the therapy. The assessment of the effectiveness of immunotherapy in patients with ECOG PS ³2 is difficult owing to the insufficient representation of this group in clinical trials.

'I want every minute to be worthwhile now': The views and experiences of people living with dementia and their care partners about returning to in-person group meetings after COVID-19 lockdown restrictions.

COVID-19 and the resulting limitations on freedom of movement has been difficult for many, including individuals living with dementia and those who provide support and care. In the summer of 2021, England's national lockdown measures eased, and regulations were amended to allow indoor social gatherings. With this enabling a return to in-person meetings, this study explored the experiences of people living with dementia and current and former care partners who had previously attended groups at Salford Institute for Dementia (UK). Two phases of research were conducted. In the first phase, during the summer of 2020, telephone interviews were utilised to ask participants (n = 13) about their views of re-engagement and how the in-person groups might be best reintroduced. Phase two began in the summer of 2021, where mood questionnaires (n = 10) were administered and observations conducted to explore how participants experienced the return to in-person meetings. Thematic analysis resulted in the construction of three overarching themes: planning for and the reality of transitioning; safety versus autonomy; and tensions and complexities of life in the 'new normal'. Despite initial concerns about their reintegration into the community, participants all enjoyed resuming in-person meetings. An inclusive and consultative approach to re-engagement allowed all participants to feel valued, safe, and informed about their return to campus. However, individuals living with dementia and care partners experienced the transition to re-engagement in different ways and their perceptions shifted over time. We therefore highlight the complexities of responding to different perceptions of risk and safety, while also promoting engagement and inclusivity after a period of social isolation. In this paper, we consider implications for the re-integration of individuals with dementia and their care partners into in-person social groups and propose further avenues for research.

A Moderated Mediation Model Explaining the Relationship Between Risk-Group Membership, Threat Perception, Knowledge, and Adherence to COVID-19 Behavioral Measures.

Background: COVID-19 is a threat to individual and global health, thus, reducing the disease's spread is of significant importance. However, adherence to behavioral measures against the spread of COVID-19 is not universal, even within vulnerable populations who are at higher risk of exposure to the virus or severe COVID-19 infection. Therefore, this study investigates how risk-group membership relates to adherence to COVID-19 behavioral measures, whether perceived threat of COVID-19 is a mechanism explaining this relationship, and whether knowledge about COVID-19 moderates these effects. Methods: We conducted a web-based survey (N = 4,096) representative of the adult population in Germany with regard to gender, age (18 to 74), and province. Therein, we assessed risk group membership with two indicators (risk of exposure to COVID-19 and risk of severe COVID-19 infection), perceived COVID-19 threat with the Perceived Coronavirus Threat Questionnaire, knowledge about COVID-19 with a knowledge test; and adherence to six behavioral measures to protect against the spread of COVID-19 (e.g., keeping distance, using mouth-nose protection, and following contact restrictions). We used moderated mediation models to test whether perceived threat mediates the relationship between risk-group membership and adherence and whether knowledge about COVID-19 moderates this relationship. Results: We found that risk group members had more perceived COVID-19 threat and that knowledge about COVID-19 increased perceived threat. Moreover, risk group membership had a positive direct effect on adherence to most behavioral measures and risk group members with less knowledge about COVID-19 violated measures more frequently. Risk-group membership also had positive indirect effects on adherence via perceived COVID-19 threat. The moderated indirect effects of threat indicate that threat led to more adherence when knowledge was low, but lost relevance as knowledge increased. Conclusion: The results may help to evaluate disease-regulation measures and to combat the pandemic more effectively. For example, increasing COVID-19 knowledge in the general population could increase adherence to COVID-19 behavioral measures. However, policy makers should be mindful that this could also have negative mental health implications as knowledge increases perceived COVID-19 threat.

Relational incentives theory.

Our life is built around coordinating efforts with others. This usually involves incentivizing others to do things and sustaining our relationship with them. Using the wrong incentives backfires: it lowers effort and tarnishes our relationships. But what constitutes a "wrong" incentive? And can incentives be used to shape relationships in a desired manner? To address these and other questions, we introduce relational incentives theory, which distinguishes between two aspects of incentives: schemes (how the incentive is used) and means (what is used as an incentive). Prior research has focused on means (e.g., monetary vs. nonmonetary incentives). Our theory highlights the importance of schemes, with a focus on how they interact with social relationships. It posits that the efficacy of incentives depends largely on whether the scheme fits the relational structure of the persons involved in the activity: participation incentive schemes for communal sharing relations, hierarchy for authority ranking relations, balancing for equality matching relations, and proportional incentive schemes for market pricing relations. We show that these four schemes encompass some of the most prevalent variants of incentives. We then discuss the antecedents and consequences of the use of congruent and incongruent incentive schemes. We argue that congruent incentives can reinforce the relationship. Incongruent incentives disrupt relational motives, which undermines the coordinating relationship and reduces effort. But, importantly, incongruent incentives can also be used intentionally to shift to a new relational model. The theory thus contributes to research on relational models by showing how people constitute and modulate relationships. It adds to the incentives and contracting literatures by offering a framework for analyzing the structural congruence between incentives and relationships, yielding predictions about the effects of incentives across different organizational and individual-level contexts. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Effects of experimental situation on group cooperation and individual performance: Comparing laboratory and online experiments.

With the spread of online behavioral experiments, estimating the effects of experimental situations and sample heterogeneity is increasing in discussions of the generalizability of data. In this study, we examined how the experimental situations (laboratory/online) affected group cooperation and individual performances. The participants were Japanese university students, randomly assigned to laboratory or online experiments. For the group cooperation task, they were asked to perform the public goods game with or without punishment, but no effect of the experimental situation was found both for cooperative and punitive behaviors. For the individual tasks, participants were asked to perform tasks including a creative task and a dull task. We manipulated the presence or absence of an external incentive. As a result, there was no significant difference between the experimental situations with one exception: only in the laboratory situation was the performance of the difficult creative task lower in the presence of an external incentive. Furthermore, we conducted as an additional experiment using the same treatments for a Japanese online-worker sample. This sample was less cooperative in the public goods game than the student sample, both with and without punishment. In addition, the presence of external incentives facilitated performance of the online-worker sample only for the dull task. We discuss the similarities and differences with previous studies that examined the effects of experimental situations and sample heterogeneity, and the implications for remote work in the real world.

Group singing for health and wellbeing in the Republic of Ireland: the first national map.

AIMS: (1) To catalogue and map all singing for health and wellbeing groups in the Republic of Ireland (ROI); (2) determine how they prioritise health outcomes; (3) understand what they consider success; and (4) identify gaps in provision. METHODS: A novel mixed-methods survey was distributed electronically through SING Ireland (the Choir Association of Ireland), artsandhealth.ie, and to 2736 potential stakeholders with links to singing for health and wellbeing and singing on social prescription (SSP) from October 2020 to April 2021. Thematic analysis was used to analyse four open-ended survey questions. RESULTS: A total of 185 singing for health and wellbeing groups were identified, with varied representation in each of the ROI's 26 counties. 35 groups were noted to have links to SSP. Gaps in provision for clinical and individual populations and for SSP were identified. Six themes related to the success of group singing for health and wellbeing programmes were determined: fostering and funding social and community connections; the people and the approach; enjoyment and atmosphere; musical and personal growth, programmatic structure and musical content; and the impact of Covid. CONCLUSION: The first-ever national mapping of group singing for health and wellbeing in the ROI, and one of few internationally, this study may serve as a roadmap for gathering information about existing singing for health and wellbeing provision and identifying geographical and clinical gaps internationally. Recommendations are included for future research to address gaps in provision, explore the feasibility of integrating SSP more widely and for further public health investment.

The effect of online and in-person team-based learning (TBL) on undergraduate endocrinology teaching during COVID-19 pandemic.

BACKGROUND: Team-based learning (TBL) combines active and collaborative learning, while incorporating aspects of the flipped classroom approach and problem-based learning. The COVID-19 pandemic presented certain challenges in the delivery of TBL in class. In this study, we investigated the impact of TBL on the academic performance of final year Biomedical Sciences' undergraduate students in the context of an "Endocrine Disorders" study block. We did so by comparing the classical in-person approach and online delivery due to the COVID-19 pandemic. METHODS: A non-compulsory TBL session was introduced to the curriculum of this block, which followed the traditional 2-h lecture delivery. Comparative analysis was performed for the exam and coursework performance of students who attended the TBL sessions (online and in-person) and those that did not. RESULTS: Both cohorts of students who attended either in-person (n = 66) or online TBL sessions (n = 109) performed significantly better in their exams (p < 0.05) and a related coursework (p < 0.001 and p < 0.05, respectively) when compared to those that did not attend. For both these cohorts the exam mark distribution was much narrower compared to those that did not attend the TBL sessions where the majority of fails and "no shows" were recorded. CONCLUSIONS: Online and in-person TBL, can successfully supplement traditional lecture-based teaching and enhance the learning/performance, for complex medical subjects/topics. Our findings demonstrate that it is possible to deliver these sessions online with demonstrable benefit for students suggesting that there is greater flexibility in the use of TBL in higher education.

Interdisciplinary groups perform better than intradisciplinary groups in online group discussion activities.

Online classes have been provided for health-care pre-licensure learners during the novel coronavirus disease 2019 pandemic. The purpose of this study was to evaluate the utility of online group work in interprofessional education. A total of 209 students were assigned to 50 groups (18 medical student groups, 13 nursing student groups, and 19 mixed medical/nursing student groups). Learners performed group work during the orientation for the course, which was hosted using an online video conferencing system. The learners first performed the activity individually (10 min) and then engaged in a group discussion to reach consensus on their answers (30 min). We calculated the scores before and after the group discussion and shared the results with the students. Scores were improved after the group discussion (mean ± SEM, 23.7 ± 0.9) compared with before (37.3 ± 1.3) (P < .0001). Lower scores after the group discussion, which indicated the effect of the group discussion on making better decisions, were observed most in the mixed medical/nursing student groups, followed by the nursing student and medical student groups. We noted only 3 groups in which the group discussion showed a negative effect on decision-making: all 3 of these groups were mixed (3 of 19 groups; 16%). These data demonstrated the power of group discussion for solving tasks when the participants' professional fields were mixed. However, the small size of the interdisciplinary groups might have resulted in less effective discussion, which might be due in part to psychological barriers arising from professional differences. Online group work is effective for facilitating discussion and building consensus about decisions in interprofessional education for medical and nursing students. Potential psychological barriers may exist in about 16% of mixed group students at the start, which should be kept in mind by instructors. Abbreviations: COVID-19: coronavirus disease 2019; IPE: Interprofessional Education; NASA: National Aeronautics and Space Administration; SD: standard deviation; WHO: World Health Organization.

Remote clinical training practice in the neurology internship during the COVID-19 pandemic.

Background: During the current COVID-19 pandemic, offline clinical education was mandated to suspend at the neurology department of many teaching hospitals globally, yet there is insufficient evidence regarding the preferred practice and methods for online neurology intern training course.Objective: The investigation aimed to examine whether the online neurology training course based on Small Private Online Course (SPOC) and blending learning mode can achieve a good effect and cater for interns from different medical programs and whether the learning group size affects the teaching effect.Design: The subjects were 92 students enrolled in the neurology internship at the Second Xiangya Hospital of China from 9 March to 9 August 2020. After completing the online course, the final scores and evaluation results were compared among different groups of interns, and their preference to distinct contents of the course was analyzed. Statistical analysis was performed using the SPSS program (version 22.0).Results: Our online course received consistent positive recognition from the interns. Ninety-nine percent of the interns recommended incorporating the online course into the conventional offline training program after the pandemic. There was no significant difference between interns from different programs concerning the final scores and course evaluation. A smaller learning group size (<15 students) could achieve a better teaching effect than a larger group size (p < 0.05). The interns preferred interactive discussions, and course contents that they can get practice and feedback from, rather than video watching and didactic lectures.Conclusions: The online neurology intern training course based on SPOC and blending learning mode is worthy of popularization in a large student base. The teaching effect of an online intern training program may be improved by limiting the group size to less than 15 students and encouraging more interactive discussion, more practice and feedback.

Online team based learning in teaching Biochemistry for first year MBBS students during COVID-19 pandemic.

The emergence of Corona Virus Disease-2019 (COVID-19) pandemic had unprecedented effects on medical education worldwide. Sustaining student engagement in virtual learning is an arduous task. Team based learning (TBL) is a learner-centered approach that can facilitate better student engagement. Adapting TBL to online platform may address the challenges faced in virtual learning. This study was conducted to implement and evaluate online TBL among first year MBBS students in Biochemistry. After obtaining informed consent, three online TBL sessions were planned. The Individual Readiness Assessment Test, Group Readiness Assessment Test, and team application were assigned in Google classroom. The students used online platforms for their team interactions. After submitting their assignments, they joined online discussion with facilitator. Peer evaluation was done via Google forms. At the end of all the sessions, the students' perceptions on the process were collected using a structured anonymous feedback with open comments. Analysis of their feedback showed that the students found the process useful and it helped in fostering their team skills. Five major themes emerged on content analysis of the open comments; 'Enriched team skills', 'Gain in knowledge', 'Impact on attitude', 'Interaction during pandemic', and 'Emotional responses'. Students perceived that the online TBL is effective in improving their engagement, learning, and team skills.

Learning in peer teaching of patient relations and communication skills at the "Anamnesegruppen" Munich - proof-of-concept and lessons learned.

Background: Due to the ban on classroom teaching during the pandemic, the Munich "Anamnesegruppen" had to be switched to e-learning at short notice. There were no established concepts for this, which is why digitalization was piloted and evaluated for feasibility. Student "Anamnesegruppen": "Anamnesegruppen" have existed for over 50 years and are organized as independent student peer teaching. In small groups of medical and psychology students, interviews with patients are conducted once a week during the semester. This is followed by a feedback and discussion round, in which ethical and professional questions are discussed in addition to the patient's medical history. The goal is to train the participants' ability to communicate and reflect. Adaptation to digital methods: The anamnesis seminars have been moved to a virtual group room using video conference. Patients were mainly recruited from the participants' circle of acquaintances. The group size was set at eight people each in four groups and supervised by a pair of student tutors. Confidentiality and data protection declarations were obtained in writing. Results: By switching to digital anamnesis groups, all four groups were successfully completed. Both the final supervision of the tutors and the electronic evaluation of the participants yielded positive feedback. Compared to the two previous evaluations of the semesters in classroom sessions, there were no significant differences in the evaluation. Discussion: The continuously good evaluation results, which did not differ between the digital format and the classroom course of the previous semesters, show that an ad hoc conversion to digital teaching is possible. We want to stress the fact that elements reflecting the doctor-patient relationship were successfully preserved. For the similarly structured Balint groups, virtual sessions may also be considered. Further research, especially prospective, is desirable in order to better understand the possibilities of digital teaching in this area.