Mass online training of health care workers during COVID-19: approach, impact, and outcomes for over 10,000 health care providers.

OBJECTIVES: COVID-19 revealed major shortfalls in healthcare workers (HCWs) trained in acute and critical care worldwide, especially in low-resource settings. We aimed to assess mass online courses' efficacy in preparing HCWs to manage COVID-19 patients and to determine whether rapidly deployed e-learning can enhance their knowledge and confidence during a pandemic. STUDY DESIGN: Retrospective cohort study. METHODS: This international retrospective cohort study, led by a large Academic Medical Centre (AMC), was conducted via YouTube and the AMC's online learning platform. From 2020 to 2021, multidisciplinary experts developed and deployed six online training courses based on the latest evidence-based management guidelines. Participants were selected through a voluntary sample following an electronic campaign. Training outcomes were assessed using pre-and post-test questionnaires, evaluation forms, and post-training assessment surveys. Kirkpatrick's Model guided training evaluation to measure self-reported knowledge, clinical skills, and confidence improvement. We also captured the number and type of COVID-19 patients managed by HCWs after the trainings. RESULTS: Every 22.8 reach/impression and every 1.2 engagements led to a course registration. The 10,425 registrants (56.8% female, 43.1% male) represented 584 medical facilities across 154 cities. The largest segments of participants were students/interns (20.6%) and medical officers (13.4%). Of the 2169 registered participants in courses with tests, 66.9% completed post-tests. Test scores from all courses increased from the initial baseline to subsequent improvement post-course. Participants completing post-training assessment surveys reported that the online courses improved their knowledge and clinical skills (83.5%) and confidence (89.4%). Respondents managed over 19,720 COVID-19 patients after attending the courses, with 47.7% patients being moderately/severely ill. CONCLUSIONS: Participants' confidence in handling COVID-19 patients is increased by rapidly deploying mass training to a substantial target population through digital tools. The findings present a virtual education and assessment model that can be leveraged for future global public health issues, and estimates for future electronic campaigns to target.

Effects of ultrasound delivered through a mist of saline to wounds in mice with diabetes mellitus.

OBJECTIVE: To examine the effects of ultrasound administered through a fine mist of saline on surgically placed full-thickness excisional wounds in mice with experimental diabetes mellitus. METHOD: Fifty male CD-I mice received alloxan monohydrate (100 mg/kg), a drug known to induce diabetes mellitus. The animals received five ultrasound (n = 27) or sham (n = 23) treatments for 1.5 minutes, on alternate days, for 10 days, and were then sacrificed. Following sacrifice, each animal's wound was excised and the tissues prepared for qualitative and quantitative histological analysis. RESULTS: No difference in wound-surface area was found between the groups after the treatment period. However, blinded assessment of tissue sections revealed significantly increased deposition of collagen and blood vessels in the granulation tissue of animals treated with ultrasound compared with those that received sham therapy. CONCLUSION: Ultrasound delivered through a fine mist of saline significantly altered the composition of newly formed granulation tissue in animals with experimental diabetes mellitus. Further research needs to be completed to determine other effects of this novel ultrasound therapy and to examine its clinical effectiveness.

Effects of electrical stimulation on the histological properties of wounds in diabetic mice.

The purpose of this study was to identify mechanisms underlying electrically stimulated wound closure in diabetic mice. Adult male mice (n = 58) with full-thickness excisional wounds were treated five times using negative polarity over the wound site for 15 minutes each over a 16-day period with sham (0 Volts) or 5.0, 10.0, 12.5 Volts. In addition, animals (diabetic (n = 33) and nondiabetic (n = 22)) received treatments of electrical stimulation (12.5 V), or sham treatment (0 V) at wound sites which were then harvested and prepared for histological analysis at 2, 8, and 16 days postwounding. Using computerized image analysis of sections stained with a picro sirus red-fast green staining technique, we found that increasing doses of electrical stimulation reduced collagen/noncollagenous protein ratios measured in the superficial scar of nondiabetic animals, with no effect in diabetic animals. In the deep scar, lower doses of electrical stimulation (5.0 V) produced significantly (p < 0.01) increased collagen deposition in wounds of nondiabetic animals compared with sham controls. Higher doses of electrical stimulation (12.5 V) were required to produce changes in diabetic animals than were observed in nondiabetic animals. These results suggest that electrical stimulation altered collagen deposition in excisional wounds of diabetic and nondiabetic animals. Electrical stimulation had a differential effect on wound healing in diabetic compared with nondiabetic animals. These data speak to the need to study the effects of electrical stimulation on healing in disease-specific models.

Effect of laser irradiation on the growth and development of fetal mouse limbs in an in vitro model.

BACKGROUND AND OBJECTIVE: The purpose of the present study was to examine the effects of laser irradiation on the growth and development of fetal limb tissue. STUDY DESIGN/MATERIALS AND METHODS: Day 14 fetal mouse limbs (n=168) were irradiated with gallium arsenide laser (904 nm, spot size=0.002 cm2, pulse duration=200 nanoseconds, peak power=30 mW) for 1 minute each day while being maintained in an organ culture system for 3 or 5 days at the following energy densities [O (control), 0.23, 1.37, 2.75, 3.66, and 4.58 J/cm2]. RESULTS: Computer image analysis of photographic images showed that there was a significant inhibition (P < 0.05) of new tissue growth after administration of lower energy densities of laser (0.23 and 1.37 J/cm2). These low-energy densities of laser irradiation also produced increased dermal cell number and collagen fiber thickness as assessed with qualitative histologic analysis of limb development by a blinded observer. Quantitative analysis of collagen distribution by color densitometric analysis of tissue sections stained with sirus red and fast green confirmed that there was a significantly greater (P < 0.05) amount of collagen present in the dermis of limbs treated with low-energy densities of laser (0.23 and 1.37 J/cm2). CONCLUSIONS: Laser irradiation directly affected the growth and development of day 14 fetal mouse limbs in an organ culture system.