Factors Related to Self-Care Ability in Patients With Severe Mental Disorders： Based on Community Patients Investigation in Beijing, China (Preprint)

UNSTRUCTURED Background: Severe Mental Disorders (SMD) have become a topic of increasing interest in research due to their serious consequences for the quality of life and functioning. In the pages that follow, it will be argued that the self-care ability and its influencing factors among SMD patients in Beijing, according to the questionnaire survey in 2019. Methods: The present study aimed to explore the factors influencing the self-care ability of SMD patients. Multi-stage sampling and proportioning sampling were used to take samples. The demographic characteristics of patients were obtained by questionnaires, and the self-care ability was measured by self-made scales. Multiple linear regression was used to analyze the influencing factors. Results: We surveyed 662 people and found that the deficiency of self-care ability is common in SMD patients. Significant relations were found between self-care ability and age, educated levels, guardian care, course of disease and physical disease (P<0.05). From a dimensional perspective, the daily basic activity was associated with educated levels and physical disease (P<0.05); the housework ability was associated with gender, educated levels, source of income, physical disease and medication adherence (P＜0.05); the social function was associated with age, educated levels, source of income, guardian care course of disease, physical disease and medication adherence (P＜0.05). Conclusion: The self-care ability of SMD patients is affected by many factors, including patient characteristics and social factors. Therefore, targeted interventions are needed to help patients restore their self-care ability, which requires the joint efforts of the government and the whole society.

793 A single-centre experience with telemedicine-integrated chronic coronary syndrome care

Aims Over the last decades, both the improvement in cardiovascular prevention programmes and the advancement in medical and invasive therapies facing ischaemic heart disease have granted an outstanding reduction in mortality rates. However, coronary heart disease remains, by far, the most common disease in developed countries, and the progressive ageing of population leads to a constantly increasing prevalence of chronic coronary syndrome (CCS). The consequence is an unsustainable demand for access to collapsing hospital clinic and doctor’s office. The dramatic Covid-19 era has become the testing ground for alternative ways to deliver healthcare avoiding in-hospital contacts, thus affirming the validity of telemedicine as a key tool to improve the patient journey. In our centre, video consults have been integrated to CCS patients’ clinical care pathway, not only preventing the risk of contagion but also laying the groundwork for a paradigm shift in clinical care course. Methods and results Since pandemic outbreak, Lazio Region offered to its inhabitants free of charge teleconsulting for both primary care and specialist referral. At the cardiovascular department of Fondazione Policlinico Gemelli IRCCS, this opportunity has been recently applied to optimize the chronic coronary syndrome patient journey. Specifically, videoconsulting has been used in different steps of CCS clinical course, replacing both in-person first visit and follow-up consultation after percutaneous myocardial revascularization. Being CCS a context in which the therapy optimization or the transition to higher level tests are mainly indicated by symptoms, these remote consultations could work as well as in-hospital visits to assess risk stratification and to consequently arrange the best therapeutic–diagnostic pathway. Besides, as COVID-19 pandemic caused significant delays, further remote visits have addressed the need to keep in contact with patients waiting for coronary angiography and to reassess their urgency criteria. In our department, over last 9 months, 141 patients have been examined and followed-up through teleconsulting, amounting to 34.1% of all supplied visits. Despite a high median age (67 ± 19.7 years), the drop-out rate of the contacted patients due to inability or denial was quite low (7.5%) and this high adherence to videoconsulting suggests time is ripe for a full telemedicine employment in clinical care course. In the cohort of patients waiting for coronary angiography, a telemedical reassessment led to a significant rate of priority class switch (42.7%), probably preventing adverse cardiac events in those individuals with worsening symptoms (systematically evaluated using Seattle Angina Questionnaire). Of note, the implementation of this parallel virtual pathway for these patients allowed us to decrease the waiting times for in-person visits at our CCS clinic, with an estimated time reduction of almost 3 months. This result supports our idea that the adoption of a remote pathway for chronic illness management, like CCS, may provide more opportunities for treatment of severe cases at in-person clinics that are often overcrowded. Conclusions In conclusion, all the potential of telehealth to empower primary and specialty health care is gradually emerging, and CCS seems the perfect setting for an integrated physical and virtual health system.

Acute critical care course for interns to develop competence

Background All medical graduates must know how to stabilize and manage critically ill patients. A 2-day intensive course, called the acute critical care course (ACCC), was conducted to train interns in technical and non-technical skills for managing a patient whose condition is deteriorating. This analysis aims to assess the feasibility and effectiveness of ACCC for interns. Methods We developed and conducted the ACCC to train interns. It included lectures and skill stations. Twenty-four interns participated in the course. Immediate, post-course, quantitative and qualitative feedback was taken online. Qualitative information was also collected verbally and later by email. These data were analysed both quantitatively and qualitatively. Thematic analysis was used to identify, analyse and report the patterns of responses and behaviour. Results The average score for the utility of the course was 4.7 and for the skill stations it was 4.6 on a scale of 5. The qualitative analysis of the feedback emphasized the need for the course before the clinical posting and more skill-based modules rather than lectures. The interactive style of teaching and training in communication using role-play was appreciated. Few suggestions to improve the course were provided. Conclusions Implementing the ACCC needed simulation, interactive discussions, role-play, modified Pendleton’s feedback, and reflective exercise that form the basis of a range of educational principles. The blended learning set of objectives of ACCC were the pillars for this successful internship training programme.

Using The Puzzle Teaching Method To Teach Home Nursing Care Concepts: An Evaluation Study

Background: One of the participatory learning approaches is the puzzle teaching method. Depending on the nature of the subject and the type of learners, this strategy can produce a variety of outcomes. The purpose of this study was to see how well the puzzle teaching style worked in the undergraduate nursing program's home nursing care course.Methods: This is a three-year evaluation study utilizing a qualitative methodology that took place between 2016 and 2019. The teaching technique was employed for a number of sessions of a home nursing care course during the first phase, and an evaluation was conducted at the end of the course using purposive sampling and focus group interviews with 11 students. The results of the first phase's evaluation led to changes in the procedure in the second phase, and at the end of that course, the evaluation was repeated with the 13 students. Further modifications to the teaching style were made, and a re-evaluation with ten students was conducted. MAXQDA10 software was used to conduct traditional content analysis on the data. Results The benefits of the puzzle method were confirmed by participants, but the findings of the first two phases of evaluation revealed obstacles such as "ineffective involvement," "inadequate teacher supervision," "offering unnecessary content," and "lack of final summarization" by the faculty member, "ineffective involvement", "crowded classroom", "the need for evaluation “and "piece learning" . Except for "ineffective involvement," the third phase's evaluation findings suggested that all flaws and obstacles had been addressed. Conclusion: The majority of the obstacles to implementing the puzzle teaching approach can be overcome by changing a few stages and procedures. However, ineffective involvement remains a significant roadblock. To overcome this stumbling block, more research is required.

Features of Simulation Training of Emergency Medical Care for Doctors of Nonurgent Specialties in the Framework of Continuing Medical Education

According to the current legislation medical institutions of any specialization and form of ownership are obliged to provide emergency medical care without delay and free of charge. Emergency medical care is not a profile one for many specialists and, within the framework of the current law, it is necessary to introduce an emergency medical care course into the CME system for all medical specialties at least once every five years, which will correspond to both the previously adopted system of postgraduate education and the existing standards of work of medical facilities.

Comparison of a Self-Care Therapeutics Course Taught in the P1 vs the P2 Year

Objective: The objective of this study was to compare student learning outcomes, behaviors, and attitudes in a non-prescription drug and self-care therapeutics course taught in the second professional (P2) year vs the first professional (P1) year at one pharmacy school. Methods: Mean performance of students by class year on case consultations and exam scores was compared. Focus groups with student volunteers and course teaching assistants (TAs) and one-on-one interviews with a subset of instructors were conducted by an outside educational evaluation specialist to capture perceptions of student learning behaviors and attitudes. Results: There was no difference in performance on graded case consultations (mean difference = 0.16, P = .74, 95% CI [−0.77 to 1.09]), mid-term examinations (mean difference = 0.53, P = .62, 95% CI [−1.59 to 2.65]), or final examinations (mean difference = 0.73, P = .57, 95% CI [−1.83 to 3.30]) between P1 and P2 students. P1 students reported being more consistent in completing pre-class readings and in feeling less distracted by other courses than did P2 students. Students, TAs, and instructors consistently spoke about advantages of the course in the P1 year (e.g., less stress and greater eagerness to learn and apply skills at work) and disadvantages in the P2 year (e.g., distraction from concurrent P2 integrated pharmacotherapeutics course and tension between real-world experience and constraints of grading rubric). Conclusion: P1 students, despite one year earlier in their curriculum, performed equally well as P2 students. All stakeholders agree that the advantages of teaching a self-care course on students’ learning behaviors and attitudes in the P1 year outweigh disadvantages.