Avatar and distance simulation as a learning tool - virtual simulation technology as a facilitator or barrier? A questionnaire-based study on behalf of Netzwerk Kindersimulation e.V.

Background: Virtual simulation modalities have been implemented widely since the onset of the severe acute respiratory syndrome coronavirus 2 pandemic restrictions in March 2020, as educators face persistent restrictions to face-to-face education of medical students and healthcare professionals.There is paucity of published data regarding the benefits and barriers of distance and avatar simulation training modalities. Methods: Following a 2-day virtual pediatric simulation competition facilitated by Netzwerk Kindersimulation e.V., using remote human avatars and distance simulation, we conducted a multicenter survey to explore the advantages and challenges of avatar and distance simulation among participants. We used a modified Delphi approach to draft and develop the 32-item online questionnaire with 7-point Likert-like scales (7 being the highest rating). Results: Twenty participants answered our questionnaire. Respondents indicated both a high overall satisfaction (median of 5.0 [Q25-Q75: 4.0-6.0] ) for avatar and distance simulation 6.0 (5.0-6.0), respectively, as well as a high achieved psychological safety with both simulation types (5.0 [4.0-6.0] vs. 5.0 [4.0-6.0]). The most frequently reported profits of avatar and distance simulation included the elimination of travel distances, associated lower costs, less time spent attending the education activity, and effective communication and leadership training, especially with avatar simulation. Most often named challenges were technical problems, limited reception of non-verbal cues and a spatial distance from the team/educator. Discussion: Based on the results of this pilot study, avatar and distance simulation can be employed successfully and appear to be good supplements to face-to-face simulation. Other studies are warranted to further explore the effectiveness of various types of virtual simulation compared to conventional presential simulation. We suggest using avatar-based simulation for targeted communication and leadership skills training and the application of distance simulation to bring simulation experts virtually to remote places where educator resources are lacking.

COVID-19-Related Trajectories of Psychological Health of Acute Care Healthcare Professionals: A 12-Month Longitudinal Observational Study.

The COVID-19 pandemic hit healthcare professionals (HCPs) hard, potentially leading to mental health deterioration. This longitudinal study investigated the 1-year evolution of psychological health of acute care HCPs during the COVID-19 pandemic and explored possible differences between high and low resilient HCPs. From April 2020 to April 2021, a convenience sample of 520 multinational HCPs completed an online survey every 3 months, up to five times. We used mixed linear models to examine the association between resilience and the variation of COVID-19-related anxiety, depressiveness, perceived vulnerability, and psychological trauma symptomatology. We demonstrated "u-shaped" trajectories for all mental health symptoms. We also explored differences in the abovementioned variables between front-line and second-line acute care HCPs. In contrast to HCP.s with lower levels of resilience (-1SD), those with higher levels of resilience (+1SD) showed increased COVID-19 anxiety and perceived vulnerability over time. Front-line and second-line HCPs differed in their depressiveness and psychological trauma variation during the 1-year analysis. High and average resilient second-line HCPs showed steeper depressiveness increases with time than high and average resilient front-line HCPs. Acute care HCPs reported their most elevated clinical symptoms of depressiveness (5-7%) and psychological trauma symptomatology (26-46%) in April 2020. During the first year of the COVID-19 pandemic, second-line HCPs with more resilience showed a steeper worsening of their depressiveness than more resilient front-line HCPs. HCPs with low resilience may benefit from interventions at the beginning of a pandemic, whereas HCPs with high resilience might benefit from resilience-enhancing interventions at later phases. Trial Registration: The study protocol was pre-registered with the International Standard Randomised Controlled Trial Number (ISRCTN13694948) published (Fuchs et al., 2020).

Health-Promoting Quality of Life at Work during the COVID-19 Pandemic: A 12-Month Longitudinal Study on the Work-Related Sense of Coherence in Acute Care Healthcare Professionals.

(1) Background: During a pandemic, the wellbeing of healthcare professionals is crucial. We investigated the long-term association of the Work-related Sense of Coherence (Work-SoC) and the evolution of psychological health symptoms of acute care healthcare professionals during the first year of the COVID-19 pandemic. (2) Methods: This longitudinal observational study enrolled 520 multinational healthcare professionals, who completed an online survey every three months from April 2020 to April 2021. Mixed linear models examined the associations between Work-SOC and COVID-19-related anxiety, perceived vulnerability, depressiveness, and psychological trauma symptomatology. (3) Results: Healthcare professionals with a higher Work-SoC reported lower levels of COVID-19-related anxiety, perceived vulnerability, depressiveness, and psychological trauma symptomatology in April 2020 than healthcare professionals with an average or lower Work-SoC, but the levels increased to higher values in April 2021. Healthcare professionals with a lower Work-SoC reported higher levels of depressiveness and psychological trauma symptomatology in April 2020 but lower levels in April 2021. (4) Conclusions: Healthcare professionals with higher levels of Work-related Sense of Coherence might be protected against variations in psychological symptoms for about three months, but this protection seems to decrease as the pandemic continues, resulting in mental health deterioration. In contrast, healthcare professionals with a lower Work-SoC might be protected at later stages of the pandemic.

Correction: Scientific quality of COVID-19 and SARS CoV-2 publications in the highest impact medical journals during the early phase of the pandemic: A case control study.

[This corrects the article DOI: 10.1371/journal.pone.0241826.].

Anxiety among front-line health-care workers supporting patients with COVID-19: A global survey.

OBJECTIVE: We aimed to explore anxiety status across a broad range of HCWs supporting patients with COVID-19 in different global regions. METHOD: This was an international online survey in which participation was on voluntary basis and data were submitted via Google Drive, across a two-week period starting from March 18, 2020. The Beck Anxiety Inventory was used to quantify the level of anxiety. RESULTS: 1416 HCWs (70.8% medical doctors, 26.2% nurses) responded to the survey from 75 countries. The distribution of anxiety levels was: normal/minimal (n = 503, 35.5%), low (n = 390, 27.5%); moderate (n = 287, 20.3%), and severe (n = 236, 16.7%). According to multiple generalized linear model, female gender (p = 0.001), occupation (ie, being a nurse dealing directly with patients with COVID-19 [p = 0.017]), being younger (p = 0.001), reporting inadequate knowledge on COVID-19 (p = 0.005), having insufficient personal protective equipment (p = 0.001) and poor access to hand sanitizers or liquid soaps (p = 0.008), coexisting chronic disorders (p = 0.001) and existing mental health problems (p = 0.001), and higher income of countries where HCWs lived (p = 0.048) were significantly associated with increased anxiety. CONCLUSIONS: Front-line HCWs, regardless of the levels of COVID-19 transmission in their country, are anxious when they do not feel protected. Our findings suggest that anxiety could be mitigated ensuring sufficient levels of protective personal equipment alongside greater education and information.

Scientific quality of COVID-19 and SARS CoV-2 publications in the highest impact medical journals during the early phase of the pandemic: A case control study.

BACKGROUND: A debate about the scientific quality of COVID-19 themed research has emerged. We explored whether the quality of evidence of COVID-19 publications is lower when compared to nonCOVID-19 publications in the three highest ranked scientific medical journals. METHODS: We searched the PubMed Database from March 12 to April 12, 2020 and identified 559 publications in the New England Journal of Medicine, the Journal of the American Medical Association, and The Lancet which were divided into COVID-19 (cases, n = 204) and nonCOVID-19 (controls, n = 355) associated content. After exclusion of secondary, unauthored, response letters and non-matching article types, 155 COVID-19 publications (including 13 original articles) and 130 nonCOVID-19 publications (including 52 original articles) were included in the comparative analysis. The hierarchical level of evidence was determined for each publication included and compared between cases and controls as the main outcome. A quantitative scoring of quality was carried out for the subgroup of original articles. The numbers of authors and citation rates were also compared between groups. RESULTS: The 130 nonCOVID-19 publications were associated with higher levels of evidence on the level of evidence pyramid, with a strong association measure (Cramer's V: 0.452, P <0.001). The 155 COVID-19 publications were 186-fold more likely to be of lower evidence (95% confidence interval [CI] for odds ratio, 7.0-47; P <0.001). The quantitative quality score (maximum possible score, 28) was significantly different in favor of nonCOVID-19 (mean difference, 11.1; 95% CI, 8.5-13.7; P <0.001). There was a significant difference in the early citation rate of the original articles that favored the COVID-19 original articles (median [interquartile range], 45 [30-244] vs. 2 [1-4] citations; P <0.001). CONCLUSIONS: We conclude that the quality of COVID-19 publications in the three highest ranked scientific medical journals is below the quality average of these journals. These findings need to be verified at a later stage of the pandemic.

Distress and resilience of healthcare professionals during the COVID-19 pandemic (DARVID): study protocol for a mixed-methods research project.

INTRODUCTION: The unprecedented COVID-19 pandemic has exposed healthcare professionals (HCPs) to exceptional situations that can lead to increased anxiety (ie, infection anxiety and perceived vulnerability), traumatic stress and depression. We will investigate the development of these psychological disturbances in HCPs at the treatment front line and second line during the COVID-19 pandemic over a 12-month period in different countries. Additionally, we will explore whether personal resilience factors and a work-related sense of coherence influence the development of mental health problems in HCPs. METHODS AND ANALYSIS: We plan to carry out a sequential qualitative-quantitative mixed-methods design study. The quantitative phase consists of a longitudinal online survey based on six validated questionnaires, to be completed at three points in time. A qualitative analysis will follow at the end of the pandemic to comprise at least nine semistructured interviews. The a priori sample size for the survey will be a minimum of 160 participants, which we will extend to 400, to compensate for dropout. Recruitment into the study will be through personal invitations and the 'snowballing' sampling technique. Hierarchical linear regression combined with qualitative data analysis, will facilitate greater understanding of any associations between resilience and mental health issues in HCPs during pandemics. ETHICS AND DISSEMINATION: The study participants will provide electronic informed consent. All recorded data will be stored on a secured research server at the study site, which will only be accessible to the investigators. The Bern Cantonal Ethics Committee has waiv ed the need for ethical approval (Req-2020-00355, 1 April 2020). There are no ethical, legal or security issues regarding the data collection, processing, storage and dissemination in this project. TRIAL REGISTRATION NUMBER: ISRCTN13694948.

Antibiotic use in patients with COVID-19: a 'snapshot' Infectious Diseases International Research Initiative (ID-IRI) survey.

BACKGROUND: Antibiotics may be indicated in patients with COVID-19 due to suspected or confirmed bacterial superinfection. OBJECTIVES: To investigate antibiotic prescribing practices in patients with COVID-19. METHODS: We performed an international web-based survey and investigated the pattern of antibiotic use as reported by physicians involved in treatment of COVID-19. SPSS Statistics version 25 was used for data analysis. RESULTS: The survey was completed by 166 participants from 23 countries and 82 different hospitals. Local guidelines for antibiotic use in COVID-19 patients were reported by 61.8% (n = 102) of participants and for 82.9% (n = 136) they did not differ from local community-acquired pneumonia guidelines. Clinical presentation was recognized as the most important reason for the start of antibiotics (mean score = 4.07 and SD = 1.095 on grading scale from 1 to 5). When antibiotics were started, most respondents rated as the highest the need for coverage of atypical pathogens (mean score = 2.8 and SD = 0.99), followed by Staphylococcus aureus (mean score = 2.67 and SD = 1.05 on bi-modal scale, with values 1 and 2 for disagreement and values 3 and 4 for agreement). In the patients on the ward, 29.1% of respondents chose not to prescribe any antibiotic. Combination of ß-lactams and macrolides or fluoroquinolones was reported by 52.4% (n = 87) of respondents. In patients in the ICU, piperacillin/tazobactam was the most commonly prescribed antibiotic. The mean reported duration of antibiotic treatment was 7.12 (SD = 2.44) days. CONCLUSIONS: The study revealed widespread broad-spectrum antibiotic use in patients with COVID-19. Implementation of antimicrobial stewardship principles is warranted to mitigate the negative consequences of antibiotic therapy.