Knowledge, attitudes, and self-reported practices (KAP) towards hand hygiene in medical students versus the public

Background The COVID-19 pandemic and its associated morbidity, mortality, and economic disruption has reignited interest in simple protective and preventive measures. Aims The aim of this study was to assess the knowledge, attitudes, and practices (KAP) of hand hygiene in a sample of medical students in Ireland and members of the public to evaluate these within the context of the COVID-19 pandemic. We also explored any differences between the two groups. Methods A 35-question survey was formulated and circulated to potential participants comprising Irish medical students and members of the public. The data was analysed using Microsoft Excel with P-values being calculated using chi-squared goodness-of-fit analysis. Results There were 356 responses to the survey, categorised into medical students and general public populations. Incomplete surveys were removed leaving 303 responses. There was no statistical difference between the groups for attitudes and self-reported practices towards hand hygiene. Statistical differences were found between the two groups in terms of knowledge. Conclusions The study showed that medical students and the public had a good knowledge base and positive attitude in regards to hand hygiene. Both groups displayed consensus that the practices are essential, especially within the current pandemic context. However, larger studies, involving multiple universities and a larger portion of the public, may be useful to ascertain whether there is a true difference in the KAP between healthcare students and the general public.

Knowledge and attitude of dental students in treating patients on antiplatelet and/ or anticoagulant medications

Background: Antiplatelet and anticoagulant medications are widely prescribed for the prevention of thromboembolic events. Dental management of patients taking such medications can be troublesome because of the possibility of excessive bleeding during surgical procedures. On the other hand, stopping these medications will increase the risk of thromboembolic complications. This study aimed to evaluate the level of knowledge and attitude of dental students and internship trainees at King Saud university in treating patients on antiplatelet and/or anticoagulant medications.Methods: A 17-question survey was distributed among dental students in third, fourth, and fifth (seniors) academic year levels, as well as internship trainees. The survey included questions aiming to evaluate participants’ knowledge in treating patients on antiplatelet and/or anticoagulant medications. A total of 281 surveys were returned complete.Results: In our study, most participants were aware of aspirin (86.1%) and warfarin (92.2%) but only a few were aware of newer medications like rivaroxaban (10.7%) or apixaban (8.2%). The majority of participants would consult with the patient’s physician (76.9%) before stopping any medications and/or would rely on local hemostatic techniques to control bleeding (70.8%).Conclusions: In this study, we concluded that only a small percentage of participants were aware of and following the latest guidelines. The findings of the present study suggest a need for educational programs and workshops regarding this topic.

Exploring Health Professionals’ Perceptions of Chemotherapy and Radiation Therapy-Related Oral Mucositis

Purpose Determine health professionals’ (HPs’) perceptions of oral mucositis (OM), including clinical presentation of chemotherapy (CT)-induced vs radiation therapy (RT)-induced OM, its assessment and management. Methods HPs involved in the care of head and neck cancer (HNC) patients receiving RT to the oral cavity/oropharynx and haematopoietic stem cell transplantation (HSCT) patients receiving mucositis-inducing CT regimens were invited to participate in a customised 20-question survey. Themes included OM presentation, assessment and management. Results Survey response rate was 81.4%. Most were nurses (33%) and specialist doctors/dentists (25%). Majority (45%) identified as part of the haematology service, followed by radiation oncology (32%). Most haematology and radiation oncology HPs (89% and 70%, respectively) agreed/strongly agreed that OM impacted patients’ ability to complete treatment. There was a significant association (p<0.01) between HPs’ specialty and their perceptions of OM manifestations. Most radiation oncology (85%) and all oral medicine HPs agreed/strongly agreed that clinical manifestations of CT-induced OM and RT-induced OM were different, whereas haematology HPs varied in their perceptions (11% disagreed, 41% were neutral and 48% agreed/strongly agreed). There was uncertainty regarding differences in management of CT vs RT-induced OM: 30% of haematology HPs and 45% of radiation oncology HPs agreed/strongly agreed but most (52% and 45%, respectively in each group) responded “neutral.” Conclusion OM was recognised to adversely impact HSCT and HNC RT patients’ ability to complete treatment. There were differences in HPs’ perceived understanding of OM manifestations and management. Interventions to address these may reduce unwanted variations in patient care and outcomes.

Teaching radiology in Egyptian medical schools: Where do we stand and how can we start?

Background Radiology serves in the diagnosis and management of many diseases. Despite its rising importance and use, radiology is not a core component of a lot of medical school curricula. This survey aims to clarify current gaps in the radiological education in Egyptian medical schools. In February–May 2021, 5318 students enrolled in Egyptian medical schools were recruited and given a 20-multiple-choice-question survey assessing their radiology knowledge, radiograph interpretation, and encountered imaging experiences. We measured the objective parameters as a percentage. We conducted descriptive analysis and used Likert scales where values were represented as numerical values. Percentages were graphed afterwards. Results A total of 5318 medical students in Egypt answered our survey. Gender distribution was 45% males and 54% females. The results represented all 7 class years of medical school (six academic years and a final training year). In assessing students’ knowledge of radiology, most students (75%) reported that they received ‘too little’ education, while 20% stated the amount was ‘just right’ and only 4% reported it was ‘too much.’ Sixty-two percent of students stated they were taught radiology through medical imaging lectures. Participants’ future career plans were almost equally distributed. Near half of participants (43%) have not heard about the American College of Radiology Appropriateness Criteria (ACR-AR), while 39% have heard about it but are not familiar with. Conclusions Radiology is a novel underestimated field. Therefore, medical students need more imaging exposure. To accomplish this, attention and efforts should be directed toward undergraduate radiology education to dissolve the gap between radiology and other specialties during clinical practice. A survey answered by medical students can bridge between presence of any current defect in undergraduate radiology teaching and future solutions for this topic.

Practice patterns regarding regional corticosteroid treatment in noninfectious Uveitis: a survey study

Background Regional corticosteroid therapy for noninfectious uveitis is well-established but usage patterns have not been studied extensively. This study aims to assess practice patterns of retina and uveitis specialists regarding their preferences on the use of local corticosteroid therapy. Methods A 13-question survey was developed regarding the practice patterns of regional corticosteroid use in specific situations and populations. The survey was distributed to both the American Uveitis Society and Macula Society. Results Responses from 87 ophthalmologists were analyzed. The two most commonly used drugs were the dexamethasone intravitreal implant (Ozurdex®) and posterior sub-tenon’s triamcinolone (also known as posterior sub-Tenon’s Kenalog, or PSTK). Regional corticosteroids were used more frequently as first-line treatment in more than half of posterior uveitis cases when compared to anterior uveitis (39.1–46.0% vs 10.3%, respectively). Respondents were more willing to use regional corticosteroids in more than half of unilateral uveitis cases than in bilateral cases (54.7% vs 18.6%, respectively). A majority of respondents (67.1%) stated that they would avoid using regional corticosteroids in patients under 8 years old. Conclusions Our results demonstrate more frequent regional corticosteroid use in posterior segment uveitis, unilateral cases, and avoidance in younger pediatric patients. Overall, the variability in these responses highlights the need for guidelines regarding regional corticosteroid use.

Understanding and Application of Daptomycin-Susceptible Dose-Dependent Category for Enterococcus: A Mixed-Methods Study

Background In 2018, the Clinical Microbiology Laboratory at our institution adopted updated daptomycin Enterococcus–susceptible dose-dependent breakpoints. While the introduction of susceptible dose-dependent (SDD) was intended to guide practice toward optimal dosing, the understanding and application of daptomycin SDD breakpoints for enterococci were unknown. Methods This mixed-methods study combined a clinician survey with a retrospective pre–post prescribing analysis. An 8-question survey was distributed to infectious diseases (ID) and internal medicine (IM) clinicians. A retrospective chart review of hospitalized adults with infections due to Enterococcus spp. was conducted before (pre-SDD) and after (post-SDD) adoption of SDD reporting for enterococci. Results Survey response rates were 40 of 98 (41%) for IM and 22 of 34 (65%) for ID clinicians. ID clinicians scored significantly higher than IM clinicians in knowledge of SDD. Chart review of 474 patients (225 pre- vs 249 post-SDD) showed that daptomycin dosage following susceptibility testing was significantly higher post-SDD compared with pre-SDD (8.5 mg/kg vs 6.4 mg/kg; P &lt; .001) with no difference in empiric dosing (6.3 mg/kg vs 6.2 mg/kg; P = .67). Definitive daptomycin use varied between the pre- and post-SDD periods (35.1% vs 16.9%; P &lt; .001). Conclusions The survey revealed that ID clinicians placed more importance on and had more confidence in the SDD category over IM clinicians. SDD reporting was associated with a change in definitive daptomycin dosing. ID specialist involvement is recommended in the care of infections due to enterococci for which daptomycin is reported as SDD given their expertise.

Learning Presence and the Reconceptualization of Language and Literacy Teachers’ Online Professional Development

Besides teaching the way they were taught, teachers teach the way they learned (Oleson & Hora, 2014). Thus, if teachers are to be guided to teach online effectively, their learning experiences and the ways they learn online need to be understood. This study focused on second/foreign language and literacy teachers’ (LLTs) Learning Presence (LP) as they engaged online to update their teaching expertise in a formal, doctoral-level professional development program (PD). LP is defined as individuals’ self- and co-regulation of their behaviors in online environments in order to be effective learners (Shea et al., 2014). We undertook a mixed-method study involving a content analysis of 9 weeks of online seminar discussions, a 27-question survey that corresponded to Shea et al.’s (2014) LP framework and interviews with the LLTs. The prevalent patterns in the LLTs’ online engagement that emerged were in the Strategy Use and Monitoring LP categories. They demonstrated the nature of the engagement amongst LLTs, including peer-to-peer and heterarchical learning. The findings also provided evidence that when supported by the affordances of the online medium, the LLTs’ straddled “professionalization and professionalism” goals. In terms of the implications, the findings suggested a reconceptualization of three existing teacher PD models, including that of Darling-Hammond et al.’s (2017). The research’s limitations were also identified, pertaining to the way the study was structured, its instruments and their implementation, as well as the constraints of the LP framework itself. Finally, the study concluded with the next steps in research to address the limitations.

Villanova ReachOut Forming Connections with Older Adults

Older adults are at increased risk for loneliness and social isolation. Research on loneliness identifies increased rates of depression, increased cognitive decline, and poor cardiovascular health outcomes. The COVID-19 pandemic forced many older adults into social isolation for protection against this insidious virus. Mandated lockdowns and personal decisions to shelter-in-place produced a tremendous increase in rates of loneliness, especially among older adults. Identifying a need for communication and relationships, we created Villanova ReachOut, a program that partners interprofessional students (N= 66) with older adults (N=53) through weekly telephone or video calls. To assess the impact of our program we developed a five question survey administered via phone to older adults and a 13-item survey for volunteers to assess training, satisfaction, needs and impact of the program. Of the older adults (n=16) who completed the survey, 78.6% believe the program helped them feel less isolated throughout the pandemic and 93.8% indicated they looked forward to weekly calls with their partner . Volunteers who completed the survey (N=25), overwhelmingly stated they enjoy and look forward to their calls (100%) and their communication skills have improved (92%). Volunteers reported being paired up with an older adult for weekly conversation had a positive impact on their personal and professional development. Findings from our program evaluation provide rich data in descriptions of positive impact for both the older adult and volunteer. These findings also support the need for programs that engage in intergenerational dialogue, specifically targeting older adults and the potential older adult workforce.

Patient and Provider Experience With Cystic Fibrosis Telemedicine Clinic

In response to the novel coronavirus (COVID-19) pandemic, all in-person cystic fibrosis (CF) appointments were converted to telemedicine visits at UCSF Benioff Children's Hospital. The purpose of our study was to learn about the experiences that patients, families, and providers had with telemedicine visits and to assess their interest in using telemedicine in the future. Our hypothesis was that most patients, families, and providers want to continue telemedicine visits in the future. An anonymous 11-question survey was distributed to patients, families, and providers in November and December 2020. The survey was completed by 46 of 72 families (64% response rate) and 24 of 25 providers (96% response rate). Thirty-seven families (80%) and 21 providers (88%) were satisfied with their telemedicine experience. Thirty-three families (72%) want to have telemedicine visits in the future. Thirty-five families (76%) and 22 providers (92%) were satisfied with their experience using Zoom. Forty families (87%) and 19 providers (90%) want 2 or more visits each year to be via telemedicine. Our study showed that most families and providers were satisfied with telemedicine, would like to continue using telemedicine, and prefer to have at least 2 of the 4 recommended annual CF visits via telemedicine. Our survey identified the following benefits to telemedicine: decreased travel time, decreased cost, and avoiding exposure to COVID. However, we need to ensure that we do not exacerbate existing health disparities for families that do not speak English and/or do not have the internet capabilities to support telemedicine technology.

Reproductive Services and Conscience-Based Refusals in Obstetrics and Gynecology Training

Purpose: Professional bodies such as the American College of Obstetrics and Gynecology recognize the impact of conscience-based decisions. The first time such decisions affect patients and providers is in residency. Our study sought to determine the attitudes of program directors towards various conscience-based refusals in potential applicants to obstetrics and gynecology programs. Method: An eight-question survey was sent to 279 directors of U.S. obstetrics and gynecology residencies in 2019. The survey proposed hypothetical conscientious refusals of common aspects of obstetric and gynecology practice. The survey asked respondents to categorize their reaction to these choices and choose from a list of factors which could modify their reaction. Univariate analysis and multivariate logistic regression were performed. Results: 97 program directors (35%) responded. A majority of PDs reported that the inability to prescribe or counsel on birth control, to provide methotrexate, to counsel on abortion, or to clearly enumerate refusals was impossible to work around, likely to lower an applicant’s rank, not compatible with training, or not good for patients; collectively, these responses were grouped as “negative reactions” (73–99%). Female program directors had more negative reactions to applicants who refused to prescribe birth control (aOR 15.8, 95% CI 1.7–99.5) and counsel on abortion (aOR 3.6, 95% CI 1.2–10.8). Directors from different locations and program types did not have significantly different responses. A few program directors identified that academic strength could mitigate otherwise negatively-viewed choices. Illustrative comments of directors’ attitudes are provided. Conclusions: Program directors agree that conscientious refusal to participate in certain activities is problematic for obstetrics and gynecology residency. There are very few subjective or regional differences on this stance, and few aspects of an application modify directors’ reactions.