a multicentre cohort study of nursing and medical students

Funding Information: The authors would like to thank Daniela Abreu, MSc who established contact with the participating institutions and was responsible for implementation of the study protocol. They also wish to thank the following faculty who assisted with study implementation: University of Rzeszow: Paweł Więch, PhD, DSc, Grzegorz Kucaba, PhD, EMT-P; Jacek Szczygielski, PhD, MD; Izabela Sałacińska, PhD, CRNA; Dariusz Bazaliński, PhD, DSc; Marzena Domino, MA; Cadi Ayyad University: Abdelhamid Hachimi, MD; Houssam Rebahi, MD; Mohamed Bouskraoui, MD; University of South-Eastern Norway: Guro-Marie Eiken, MScN, RN, NP; Porto Nursing School: Paulo Machado, RN, PhD; UNITEC: Doany Gutierrez, MD; Juan Carlos Triminio MD; Karina Varela MD; Sonia Escoto MD, MSc; Lía Mineros MD, MSc; Ely Ramírez MD; Guimel Peralta MD; Odessa Henríquez MD, PhD; David Tvildiani Medical University: Sergo Tabagari, MD, PhD; Tamar Talakvadze, MD, PhD; Paata Tsagareishvili, MD; Rusudan Agladze, MD, PhD; Ketevan Kapanadze, MD; Nino Gakhokidze, MD; Red Cross Higher School of Health: Ana Sofia Jesus, Paediatric RN; NOVA Medical School: Maria Teresa Neto, MD, PhD; Catarina Limbert, MD, PhD; Rui Domingues, MD; Filipa Marujo, MD; Guilherme Lourenço, MD; Beatriz Ferreira, Medical Student; and Guangxi Medical College: Lu Zhhenzhi, NS. Funding Information: André Mestre was supported by Centro 2020, PT2020 and European Union research grant nº 41388 to Take the Wind Ltd, developers of the Body Interact™ Virtual Patient Simulator. No other investigators or participants received compensation for their role in the study. Funding Information: A.Mestre was supported by Centro 2020, PT2020 and European Union research grant nº 41388 to Take the Wind Ltd, developers of the Body InteractTM Virtual Patient Simulator. No other investigators or participants received compensation for their role in the study. The authors had access to all study data and sole responsibility for data analysis and the writing of the manuscript. All other authors have no competing interest to declare . Publisher Copyright: © 2022, The Author(s).Background: The COVID-19 pandemic has precipitated rapid changes in medical education to protect students and patients from the risk of infection. Virtual Patient Simulators (VPS) provide a simulated clinical environment in which students can interview and examine a patient, order tests and exams, prioritize interventions, and observe response to therapy, all with minimal risk to themselves and their patients. Like high-fidelity simulators (HFS), VPS are a tool to improve curricular integration. Unlike HFS, VPS require limited infrastructure investment and can be used in low-resource settings. Few studies have examined the impact of VPS training on clinical education. This international, multicenter cohort study was designed to assess the impact of small-group VPS training on individual learning process and curricular integration from the perspective of nursing and medical students. Methods: We conducted a multi-centre, international cohort study of nursing and medical students. Baseline perceptions of individual learning process and curricular integration were assessed using a 27-item pre-session questionnaire. Students subsequently participated in small-group VPS training sessions lead by a clinical tutor and then completed a 32-item post-session questionnaire, including 25 paired items. Pre- and post-session responses were compared to determine the impact of the small-group VPS experience. Results: Participants included 617 nursing and medical students from 11 institutions in 8 countries. At baseline, nursing students reported greater curricular integration and more clinical and simulation experience than did medical students. After exposure to small-group VPS training, participants reported significant improvements in 5/6 items relating to individual learning process and 7/7 items relating to curricular integration. The impact of the VPS experience was similar amongst nursing and medical students. Conclusions: In this multi-centre study, perceptions of individual learning process and curricular integration improved after exposure to small-group VPS training. Nursing and medical students showed similar impact. Small-group VPS training is an accessible, low-risk educational strategy that can improve student perceptions of individual learning process and curricular integration.publishersversionpublishe

Chronic Myeloid Leukemia and Cesarean Section: The Anesthesiologist’s Point of View

Background. Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm related to chromosomal reciprocal translocation t(9;22). Tyrosine kinase inhibitors (TKIs) such as imatinib have drastically revolutionized the course and the prognosis of this hematologic malignancy. As we know, the association pregnancy-CML is an infrequent situation. Also the use of TKI in pregnant women is unsafe with a lack of alternatives and effective therapeutic options. Thus its cessation during gestation puts those patients at high risk of developing blast crisis characterized by poor outcomes. Case Report. A 37-year-old pregnant woman, gravida 2, para 2, with a previous cesarean section in 2011, presented to the obstetric unit. Her medical past revealed that she is a newly diagnosed patient with CML managed by TKI during her preconception period. Due to the perilous use of TKI during her pregnancy, a switch to interferon-α administration was adopted. But after the completion of 36 weeks of gestation, disease progression (relapse with blast crisis), attested by biological worsening, a white blood cell count = 245000/mm3 with 32% blasts in the peripheral blood, urged the medical team to opt for cesarean delivery. She underwent general endotracheal anesthesia without any perioperative incidents and gave birth to a healthy newborn. Ten days later, the patient was started on TKI. Discussion. Although data on this specific and challenging situation are limited, this case highlights the difficulties encountered by the anesthesiologists when choosing the accurate anesthetic strategy and how important it is to weigh the risks and benefits inherent to each technique. Above all, taking into consideration the possible central nervous system (CNS) contamination by circulating blast cells when performing spinal or epidural approach is primordial. This potential adverse event (CNS blast crisis) is extremely scarce but it is responsible for high rates of morbidity and mortality

Management of Severe COVID-19 in Pregnancy

The scarcity of data concerning pregnant patients gravely infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) makes their management difficult, as most of the reported cases in the literature present mild pneumonia symptoms. The core problem is laying out evidence on coronavirus’s implications on pregnancy and delivery, as well as vertical transmission and neonatal mortality. A healthy 30-year-old pregnant woman, gravida 6, para 4, at 31 weeks of gestation, presented severe pneumonia symptoms promptly complicated with premature rupture of membranes (PROM). A nasopharyngeal swab returned positive for SARS-CoV-2 using reverse transcription polymerase chain reactions (RT-PCR). The parturient underwent a cesarean delivery. This paper is an attempt to outline management of the critical condition of COVID-19 during pregnancy

Essential Emergency and Critical Care: a consensus among global clinical experts

BackgroundGlobally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low cost and low complexity for the identification and treatment of critically ill patients across all medical specialties. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19.MethodsIn a Delphi process, consensus (>90% agreement) was sought from a diverse panel of global clinical experts. The panel iteratively rated proposed treatments and actions based on previous guidelines and the WHO/ICRC's Basic Emergency Care. The output from the Delphi was adapted iteratively with specialist reviewers into a coherent and feasible package of clinical processes plus a list of hospital readiness requirements.ResultsThe 269 experts in the Delphi panel had clinical experience in different acute medical specialties from 59 countries and from all resource settings. The agreed EECC package contains 40 clinical processes and 67 requirements, plus additions specific for COVID-19.ConclusionThe study has specified the content of care that should be provided to all critically ill patients. Implementing EECC could be an effective strategy for policy makers to reduce preventable deaths worldwide