Background: As the incidence of COVID-19 is increasing, the Bangladesh government has announced a countrywide shutdown instead of a lockdown. Consequently, front-line healthcare workers, particularly nurses, are confronting more challenging situations at work. Objective: This study aimed to explore front-line nurses’ experiences caring for patients with COVID-19 in Dhaka, Bangladesh. Methods: A qualitative descriptive study was conducted among front-line nurses caring for patients with COVID-19. Twenty nurses were purposively chosen from January to March 2021 to participate in semi-structured online interviews. Interviews on audio and video were collected, analyzed, interpreted, transcribed verbatim, and verified by experts. Thematic analysis was used. Results: Nine themes emerged and were grouped into negative and positive experiences. The themes of negative experiences include lack of necessary medical equipment, use of non-standard personal protective equipment, work overload, long working hours, poor working environment, and lack of quality of nursing care. The positive experiences include feeling self in a patient position, nurses’ coping strategy in COVID-19 patient care, and establishing emotional control. Conclusion: The study results encourage national and international health care professionals to cope with adverse working environments. Also, the findings provide nurses with techniques for dealing with any critical situation, controlling patients’ emotions, and how empathy increases self-confidence and patient care. The research should also be used to enhance government policy, nursing council policy, ministry of health policy, and other healthcare agencies.
The novel coronavirus disease 2019 (Covid-19) has infected millions worldwide and impacted the lives of many folds more. Many clinicians share new Covid-19-related resources, research, and ideas within the online Free Open Access to Medical Education (FOAM) community of practice. This study provides a detailed content and contributor analysis of Covid-19-related tweets among the FOAM community during the first months of the pandemic. Design, Setting, and Participants In this social media content analysis study, Twitter was searched from November 1, 2019, to March 21, 2020, for English tweets discussing Covid-19 in the FOAM community. Tweets were classified into one of 13 prespecified content categories: original research, editorials, FOAM resource, public health, podcast or video, learned experience, refuting false information, policy discussion, emotional impact, blatantly false information, other Covid-19, and non-Covid-19. Further analysis of linked original research and FOAM resources was performed. One-thousand (1000) randomly selected contributor profiles and those deemed to have contributed false information were analyzed. Results The search yielded 8541 original tweets from 4104 contributors. The number of tweets in each content category were: 1557 other Covid-19 (18.2%), 1190 emotional impact (13.9%), 1122 FOAM resources (13.1%), 1111 policy discussion (13.0%), 928 advice (10.9%), 873 learned experience (10.2%), 424 non-Covid-19 (5.0%), 410 podcast or video (4.8%), 304 editorials (3.6%), 275 original research (3.2%), 245 public health (2.9%), 83 refuting false information (1.0%), and 19 blatantly false (0.2%). Conclusions Early in the Covid-19 pandemic, the FOAM community used Twitter to share Covid-19 learned experiences, online resources, crowd-sourced advice, and research and to discuss the emotional impact of Covid-19. Twitter also provided a forum for post-publication peer review of new research. Sharing blatantly false information within this community was infrequent. This study highlights several potential benefits from engaging with the FOAM community on Twitter.
ObjectivesSystematic reviews are often considered among the highest quality of evidence. Completely reported systematic reviews, however, are required so readers can assess for generalisability of the research to practice and risk of bias. The objective of this study was to assess the completeness of reporting for systematic reviews assessing the diagnostic accuracy of point-of-care ultrasound (POCUS) using the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Diagnostic Test Accuracy (PRISMA-DTA) checklist that was published in 2018.Design and settingIn this meta-research study, MEDLINE, EMBASE and Cochrane Library databases were searched, with no date restriction, on March 1st, 2020 for systematic reviews assessing the diagnostic accuracy of POCUS. Adherence to PRISMA-DTA for the main text and abstract was scored independently and in duplicate using a modified checklist. Prespecified subgroup analyses were performed.Main outcome measuresThe primary outcome was the mean PRISMA-DTA checklist adherence for the full-text and abstract.ResultsA total of 71 studies published from 2008 to 2020 met the inclusion criteria. The overall adherence for the full-text was moderate: 19.8 out of 26.0 items (76%) and for the abstract was 7.0 out of 11.0 items (64%). Although many items in the PRISMA-DTA checklist were frequently reported, several were r infrequently reported (<33% of studies), including item 5 (protocol registration), item D2 (minimally acceptable test accuracy) and item 14 (variability in target condition, index test and reference standards). Subgroup analyses showed a higher PRISMA-DTA mean adherence (SD) for high impact journals (20.9 (2.52) vs 18.9 (1.95); p<0.001), studies including supplemental materials (20.6 (2.48) vs 18.9 (2.28); p=0.004), studies citing adherence to PRISMA reporting guidelines (20.4 (1.95) vs 19.0 (3.00); p=0.038) and studies published in journals endorsing PRISMA guidelines (20.2 (2.47) vs 18.6 (2.37); p=0.025). There was variable adherence based on journal of publication (p=0.006), but not for study population (adult vs paediatric vs mixed) (p=0.62), year of publication (p=0.94), body region (p=0.78) or country (p=0.40). There was no variability in abstract adherence based on whether the abstract was structured with subheadings or not (p=0.25). A Spearman’s correlation found moderate correlation between higher word counts and abstractand full-text adherence (R=0.45, p<0.001 and R=0.38, p=0.001), respectively.ConclusionsOverall, the reporting of POCUS diagnostic accuracy systematic reviews and meta-analyses was moderate. We identified deficits in several key areas including the preregistration of systematic reviews in an online repository, handling of multiple definitions of target conditions, index tests and reference standards and specifying minimally acceptable test accuracy. Prospective registration of reviews and detailed reporting as per PRISMA-DTA during the research process could improve reporting completeness. At an editorial level, word count and supplemental material limitations may impede reporting completeness, whereas endorsement of reporting guidelines on journal websites could improve reporting.
Background: The high exposure risk to COVID among frontline healthcare workers was a major challenge to healthcare systems across the globe that warranted close monitoring through risk assessment and contact tracing strategies. The objective of our study was to characterize exposure risk factors for transmission and subsequent COVID positivity among the frontline healthcare workers in our institution during the pandemic period. Methods: The retrospective observational study conducted over a period of 6 months from June 2020 to November 2020 at a 1300-bedded South Indian tertiary care centre included frontline healthcare workers who were assessed for their identified encounter with COVID positive individual using a modified WHO COVID risk assessment tool. Results: Among a total of 4744 contacts with COVID positive individuals assessed for risk stratification during the study period , 942 (19.8%) were high risk and 3802 (80.2%) were low risk exposures respectively. 106 (2.2%) turned COVID positive during the surveillance period of 14 days. Frontline workers working in COVID areas had significant low COVID rates as compared to other areas (N=1, 0.9%). The average monthly COVID positivity rates being 1.66%, the attack rates among high risk and low risk contacts among the total HCWs screened were 5% (46/942) and 1.57% (60/3802) respectively. Shared space (70%) and IPC breaches (66%) were found to be highly prevalent in the COVID positive cohort, along with maskless encounters (43%) and multiple exposure (39%). The attack rate among the 6 identified COVID cluster groups (5.5%) were found to be higher than the attack rate (2.2%) noted among the total contacts screened and no significant association was observed between risk categories in the clusters. Discussion: Our study highlights higher risk of COVID positivity among high risk contacts as compared to low risk contacts. However, the high COVID positivity rate in low risk group among cluster transmissions and its lack of association with risk assessment highlight the suboptimal utility of the risk assessment strategy among cluster groups.
Innovation Concept: The Orange Book (OB) identifies drugs approved on the basis of safety and effectiveness by the FDA and serves as the gold standard reference for correct pharmacological therapies. It ties in closely with Choosing Wisely Canada (CWC) modelling good stewardship in antimicrobial prescriptions. The book focuses on passive didactic learning instead of active learning, which was shown to have a greater influence on prescribing behaviour. Educational video games, a form of active learning, have been shown to improve clinical skills in medical training. Contagion is a role-playing video game providing an active way of teaching antimicrobial components of the OB and CWC guidelines. Method: Phase I of Contagion was qualitatively tested on students and physicians at McMaster University for teaching effectiveness, applicability to real-life scenarios, and enjoyability. Post-game play 12 participants scored different aspects of the game on a Likert scale. Curriculum, Tool, or Material: The player is a rural physician treating infections in various communities. Each round, the player is given a crate of antibiotics. As communities are infected, the player is provided with clinical symptoms the patients present with. The player must identify the pathology and then correctly treat the communities. The player can treat empirically or order tests to identify the infectious organism. The player strategically navigates which communities to treat as there are limited actions per turn and the player must prevent communities from dying or infecting neighboring regions. Communities tend to build antibiotic resistance over time making first-line treatments unviable, thus careful strategizing and stewardship is essential. Active learning will occur when players are tasked with finding the correct answer to different presentations. After each turn, players will learn about the infecting organism, its phenotypes, and common infectious symptoms. This is considered passive learning. Conclusion: Contagion was well-received by physicians and medical students as an active learning tool to teach the OB and CWC guidelines. On preliminary user testing Contagion scored 5 in effectiveness in teaching treatments and 4.6 in teaching stewardship. An objective of this project is to perform large scale testing across schools to demonstrate the effectiveness of the learning components of the game. We hope to eventually create a tool that can be incorporated in continuing medical education for physicians.
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