Education of Patients With Atrial Fibrillation and Evaluation of the Efficacy of a Mobile Virtual Patient Environment: Protocol for a Multicenter Pseudorandomized Controlled Trial.

BACKGROUND: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is a leading cause of mortality and morbidity. Patient knowledge about AF and its management is paramount but often limited. Patients need to be appropriately informed about treatment options, medicinal adherence, and potential consequences of nonadherence, while also understanding treatment goals and expectations from it. Mobile health apps have experienced an explosion both in their availability and acceptance as "soft interventions" for patient engagement and education; however, the prolific nature of such solutions revealed a gap in the evidence base regarding their efficacy and impact. Virtual patients (VPs), interactive computer simulations, have been used as learning activities in modern health care education. VPs demonstrably improved cognitive and behavioral skills; hence, they have been effectively implemented across undergraduate and postgraduate curricula. However, their application in patient education has been rather limited so far. OBJECTIVE: This work aims to implement and evaluate the efficacy of a mobile-deployed VP regimen for the education and engagement of patients with AF on crucial topics regarding their condition. A mobile VP app is being developed with the goal of each VP being a simple scenario with a set goal and very specific messages and will be subsequently attempted and evaluated. METHODS: A mobile VP player app is being developed so as to be used for the design of 3 educational scenarios for AF management. A pseudorandomized controlled trial for the efficacy of VPs is planned to be executed at 3 sites in Greece, Ukraine, and Kazakhstan for patients with AF. The Welch t test will be used to demonstrate the performance of patients' evaluation of the VP experience. RESULTS: Our study is at the development stage. A preliminary study regarding the system's development and feasibility was initiated in December 2022. The results of our study are expected to be available in 2024 or when the needed sample size is achieved. CONCLUSIONS: This study aims to evaluate and demonstrate the first significant evidence for the value of VP resources in outreach and training endeavors for empowering and patients with AF and fostering healthy habits among them. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/45946.

The Medical Community's Role in Communication Strategies during Health Crises-Perspective from European Union of Medical Specialists (UEMS).

The COVID-19 pandemic was complicated by the spread of false information leading to what became widely called an "infodemic". The present opinion paper was written by an ad hoc international team united under the European Union of Medical Specialists (UEMS) umbrella and reflects the organizations' effort to contribute to the resolution of these issues, by highlighting and reflecting on them and by suggesting the medical community's necessary activities resulting in the formulation of effective future communication strategies. The importance of physicians' and other health workers' role and mission as educators and leaders in communities in critical situations should be reassessed and upgraded. We need to equip future doctors with strong and sustainable leadership and communication skills through relevant undergraduate and postgraduate education programs, in order that compliance with preventive medical advice is increased. To avoid possible politically and otherwise biased communication in health crises of the future, European nations should establish independent advisory bodies providing evidence-based advice and participate in communication campaigns. Medical and other health professional organizations should build organizational and personal capacities of their members to enable them to reliably inform and adequately educate governments, populations, civic society, employers' and employees' organizations, schools and universities, and other stakeholders.

Students' mental health during the pandemic: results of the observational cross-sectional COVID-19 MEntal health inTernational for university Students (COMET-S) study.

Introduction: The aim of the study was to search rates of depression and mental health in university students, during the COVID-19 pandemic. Materials and methods: This is an observational cross-sectional study. A protocol gathering sociodemographic variables as well as depression, anxiety and suicidality and conspiracism was assembled, and data were collected anonymously and online from April 2020 through March 2021. The sample included 12,488 subjects from 11 countries, of whom 9,026 were females (72.2%; aged 21.11 ± 2.53), 3,329 males (26.65%; aged 21.61 ± 2.81) and 133 "non-binary gender" (1.06%; aged 21.02 ± 2.98). The analysis included chi-square tests, correlation analysis, ANCOVA, multiple forward stepwise linear regression analysis and Relative Risk ratios. Results: Dysphoria was present in 15.66% and probable depression in 25.81% of the total study sample. More than half reported increase in anxiety and depression and 6.34% in suicidality, while lifestyle changes were significant. The model developed explained 18.4% of the development of depression. Believing in conspiracy theories manifested a complex effect. Close to 25% was believing that the vaccines include a chip and almost 40% suggested that facemask wearing could be a method of socio-political control. Conspiracism was related to current depression but not to history of mental disorders. Discussion: The current study reports that students are at high risk for depression during the COVID-19 pandemic and identified specific risk factors. It also suggested a role of believing in conspiracy theories. Further research is important, as it is targeted intervention in students' groups that are vulnerable both concerning mental health and conspiracism.

University students' mental health amidst the COVID-19 pandemic in Georgia.

AIMS: We aimed to identify the prevalence of anxiety, depression, and suicidality and identify relevant risk and protecting factors among university students during the COVID-19 pandemic in Georgia. MATERIALS AND METHODS: We conducted an anonymous online survey (n = 984, convenience sample by approaching all universities in Georgia and some student organizations) using valid instruments (e.g., STAI to assess anxiety, CES-D for depression, and RASS to assess suicidality). We calculated frequencies and prevalence and applied regression analysis and Chi-square tests to identify risk and protecting factors. FINDINGS: Respondents' mental health had been significantly affected (with a high prevalence of depression (46.7%) and anxiety (79%)) during the pandemic (which coincided with political turmoil and caused an economic crisis) in Georgia. Some of the critical factors affecting mental health were: female sex (p = .000), bad general health condition (anxiety p = .001, depression p = .004), finances (anxiety and depression p < .001), reduced physical activity (anxiety p < .001, depression p = .014), and a history of self-harming (suicidality p < .001). Less family conflicts (anxiety and depression p < .05), absence of nightmares (anxiety and depression p < .001), moderate or low fears of COVID-19 (anxiety p < .001), and lower substance use (anxiety p = .023) were among the potentially protective factors. International students coped better, despite vulnerability. Medical students had a lower risk of depression. CONCLUSIONS: In the complex socioeconomic context, mental health of students in Georgia suffered a lot during the COVID-19 pandemic, requiring thorough planning and delivery of student support services in higher educational institutions during and after the pandemic.

The Approach to the COVID-19 Pandemic in Georgia-A Health Policy Analysis.

Objectives: This study aimed to analyze key COVID-19 pandemic-related policies and national strategic responses in light of Georgia's political, socioeconomic and cultural backgrounds. Methods: We applied a policy triangle framework for policy analysis, performed document and media content analysis, and described pandemic trends statistically. Results: Early introduction of stringent restrictive measures largely prevented a first wave in March-May 2020. This was communicated as a success story, prompting a public success perception. With unpopular restrictions lifted and hesitancy to embrace evidence-informed policymaking ahead of nationwide parliamentary elections, SARS-CoV-2 infection spread rapidly and was met with an insufficiently coordinated effort. Facing health system capacity saturation an almost complete lockdown was re-introduced in late 2020. Factors as delayed immunization campaign, insufficient coordination and, again, little evidence-informed policymaking eventually led to another devastating COVID-19 wave in summer of 2021. Conclusion: Georgia's pandemic health policy response was adversely impacted by a volatile political environment. National pandemic preparedness and response might benefit from an independent body with appointment procedures and operations shielded from political influences to effectively inform and communicate evidence-based pandemic policy.

Recognizing vaccine wastage in Georgia.

The COVID-19 vaccination program in the country of Georgia began on March 15, 2021, and reached its peak in the summer of 2021. Throughout the process, individuals had access to over 5.3 million doses of COVID-19 vaccines which were acquired from various sources as reported by the National Center for Disease Control and Public Health (NCDC). Factors such as widespread vaccine hesitancy and low demand led to reduced vaccine uptake, low vaccination rates, and vaccine wastage. As of August 2022, a total of 2,922,000 doses have been administered with less than 35% of the Georgian population, or 1,276,000 people, fully vaccinated with at least two doses. Over 400,000 doses have expired at NCDC's storage facilities due to low demand. Many more doses have been wasted at administration points, and there is a risk of wasting more in the future. The key reasons for wastage are widespread public hesitancy toward the newly developed vaccines, inconsistent policies and communication from government officials, rampant disinformation, and ambiguity from influential bodies in Georgian society. Despite certain limitations, logistics is not among the leading causes of wastage, as Georgia was able to develop a strong cold-chain and vaccine administration infrastructure through years of international cooperation that allowed for efficient management of the COVID-19 vaccination process. Lastly, in addition to establishing a robust reporting system and ensuring transparency of vaccine wastage data, relevant studies based on original data are required to better understand the problem. Conducting studies on health literacy in the country as a baseline for long-term interventions, as well as research that will increasingly evidence-inform further pandemic response are being recommended.

Regulatory environment for complementary and alternative medicine in Georgia-a health policy analysis.

International bodies such as the WHO call on member states to regulate and, where possible, integrate Complementary and Alternative Medicine (CAM) into health systems, to the benefit and safety of patients. Research on CAM regulations in the Republic of Georgia has been limited. The aim of this study was to identify key actors and analyse the regulatory environment for CAM in Georgia in its local and international contexts. We conducted a health policy analysis using a triangle framework of content, context and processes. We used data from national government, professional associations and academia; and drew from primary qualitative data of stakeholders' perspectives and needs regarding CAM in Georgia. The several CAM associations we identified have limited capacities for self-regulation. CAM practices are currently not effectively regulated in Georgia, while the government has no expressed intention to develop regulatory frameworks. Georgia's CAM health policy is currently not compliant with WHO and European directives and recommendations. Government, lawmakers, public administration, academia, physicians, non-physician CAM practitioners and other actors should constitute a national working group dedicated to CAM regulations in Georgia to identify, classify CAM practices; and develop core principles for policy making for safe and effective CAM practiced in Georgia's health system.

Final-year medical students' knowledge of cardiac arrest and CPR: We must do more!

BACKGROUND: Students are an important part of the community response to an out-of-hospital cardiac arrest (OHCA). If even schoolchildren now know cardio-pulmonary resuscitation (CPR), even more the reason a young doctor should know how to treat an OHCA. The aim of our study was to assess medical students' knowledge of CPR and OHCA throughout Europe. METHODS: An online survey was given to final-year students by the Medical Student Associations of different countries. RESULTS: 1012 medical students from 99 different universities and 14 different countries completed the questionnaire. A total of 82.2% attended a BLS or BLS/AED course, provided by the University in only 69.7% of cases. In 84.3% it was a mandatory part of their degree. A total of 78.6% felt able to rescue a person in OHCA. Only 49.3% knew that 'unresponsiveness' and 'absence of normal breathing' are sufficient for lay people to identify an OHCA, and less than half of those interviewed knew the incidence of OHCA in Europe and the decrease in chance of survival if CPR is not performed. The correct compression:ventilation ratio was known by 90.2%, the correct compression depth by 69.7%, whilst only 57.8% knew the right compression rate. In total, 69.7% knew that an AED must be used immediately when available, and only 57.2% recognized the AED symbol. CONCLUSIONS: Medical students' knowledge of cardiac arrest and CPR needs to be improved throughout Europe and we believe that BLS/AED training should be mandatory in all European Universities.

Georgia's healthcare system and integration of complementary medicine.

BACKGROUND: An increasing number of people in the Republic of Georgia use complementary and alternative medicine (CAM). CAM has long been practiced in the country, but is not currently part of the formal medical system. The aim of this study was to explore patients' CAM use and their perspectives of CAM complementation of existing services in Georgia's health care system. METHODOLOGY: We conducted a qualitative study exploring patient needs and wants by performing in-depth, contextual interviews with patients using CAM. We recruited participants at CAM clinics and collected data until we reached saturation. A thematic analysis involving line by line coding explored perspectives and allowed us to formulate recommendations of CAM integration in Georgia. RESULTS: Study participants voiced that they pursued cure beyond symptom relief; their disappointment in that regard with conventional medicine in Georgia directed them towards CAM as a safe and effective care setting. Most sought natural approaches as a sustained approach to their health and perceived CAM as empathetic therapeutic and preventive space. Participants were in favor of integration of CAM with conventional health services through government support and regulation. They saw coverage of payments for CAM visits and treatments as important aspect for an effective and sustainable integration. CONCLUSION: Patients favor an integration of CAM into Georgia's current healthcare systems to ensure CAM's broad availability as well as effective regulation and financing, including coverage by health insurance.