Postgraduate students' experiences with learning management systems at a selected nursing education institution in KwaZulu-Natal Province

Background. Learning management systems (LMS) are indispensable teaching and learning tools in nursing education, and in recent years, LMS have become a cornerstone to support online learning, particularly during the COVID-19 pandemic. The South African (SA) e-education policy requires every teacher and learner in the education and training sector to be information and communication technology (ICT)-capable, and able to use ICTs confidently and creatively to help develop the skills and knowledge they need as lifelong learners to achieve their personal goals and be full participants in their global communities. Objective. To investigate postgraduate students’ experiences with learning management systems at a selected nursing education institution in KwaZulu-Natal Province, SA. Method. An exploratory, descriptive research design was used, and the whole population of 16 postgraduate nursing education students who were exposed to Moodle as a learning management system participated in the study. Qualitative data were collected through semi-structured interviews, followed by focus group discussions, with thematic analysis used to analyse data. Results. This was the first time that most participants had been exposed to an online learning course, and the experience made them feel empowered as it provided enabled reflection and deep learning. Participants indicated that the range of interactions and level of engagement determined the eventual level of knowledge constructed. The online facilitator played a central role in guiding and supporting students, and ensuring that they achieved the learning outcomes. The online learning benefits included increased socialisation, convenience and flexibility, asynchronicity and accessibility of learning material. The challenges were the lack of real-time response, financial cost and technical issues. Conclusion. An intense ICT orientation for students is recommended to ensure that they are informed of the requirements before starting the online course. The online facilitators must be more visible in the online space, participate more often in discussions and stimulate constructive dialogue

Integrating nursing informatics into undergraduate nursing education in Africa: a scoping review

Background: Information and communication technologies have become omnipresent in healthcare systems globally, and since nurses comprise the majority of the health sector workforce, they are expected to be adequately skilled to work in a technology-mediated environment. Integrating nursing informatics into undergraduate nursing education is a cornerstone to nursing education and practice in Africa. Aim: This scoping review aimed to evidence the integration of nursing informatics into undergraduate nursing education in Africa. Methods: A scoping review of the literature used electronic databases including CINAHL Plus databases; EmCare; MEDLINE Ovid; Scopus; ERIC ProQuest; Web of Science; Google; and Google Scholar to locate papers specific to the African context. From a total of 8723 articles, 19 were selected for critique and synthesis. Results: Selected studies indicated that nursing students used several information and communication technologies tools primarily for academic purposes, and rarely for clinical practice. In Africa, the challenges for teaching informatics in nursing education included: limited information and communication technologies skills among faculty and students; poor teaching strategies; and a lack of standardization of nursing informatics competencies. Successful integration of nursing informatics into undergraduate nursing education in African countries depends on restructuring nursing informatics content and teaching strategies, capacity building of the faculty and students in information and communication technologies, political commitment, and collaborative partnership. Conclusion: Nursing informatics is scarce in undergraduate nursing education in Africa due to the implementation and adoption challenges. Responding to these challenges requires a multi-sectoral approach in the revision of undergraduate nursing curricula. Implication for nursing education, practice, policy and research: This study highlights the importance of nursing informatics in undergraduate nursing education, with its challenges and success. Nursing education policies should support the development of well-standardized nursing informatics content and appropriate teaching strategies to deliver it. Further research is needed to establish which aspects of nursing informatics are integrated into undergraduate nursing education and nursing practice, implementation process, challenges and possible solutions. Collaborative partnerships are vital to developing nursing informatics policies to better prepare graduate nurses for the African healthcare workforce in the digital era

Effect of shortened Integrated Management of Childhood Illness training on classification and treatment of under-five children seeking care in Rwanda

Background: Integrated Management of Childhood Illness (IMCI) is an effective 11-day standard training; however, due to budgetary expenses and human resource constraints, many health professionals cannot take 11 days off work. As a result, shortened training curriculums (6-day) have been proposed. We used a cross-sectional study to evaluate the effect of this shortened training on appropriate IMCI classification and treatment of under-five childhood illness management in Rwanda. Methods: A cross-sectional study was conducted in 22 health centers in Rwanda, comparing data from 121 nurses, where 55 nurses completed the 11-day and 66 nurses completed the 6-day training. Among 768 children, we evaluated clinical outcomes from May 2011 to April 2012. Descriptive statistics were used to display the sociodemographic characteristics of health providers; including level of education, sex, age, and professional experiences. Bivariable and multivariable analyses were used to test for differences between nurses in the 6-day versus 11-day training on the appropriate classification and treatment of childhood illness. Results: Our findings show that at the bivariable level and after controlling for confounders in the multivariable analysis, the only significant differences detected between nurses in the long and short training was the classification of fever (adjusted odds ratio [aOR] 0.7, 95% confidence interval [CI] 0.64–0.75) and treatment of pneumonia (aOR 0.8, 95% CI 0.70–0.89). Nurses in the short training had lower odds of inappropriate misclassification and treatment for these two conditions. Conclusion: There was no difference in classification and treatment of childhood illness among nurses who completed the standard and short IMCI training courses. Short-training could be a more cost-saving option for health facilities without compromising the key outcomes related to case management

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2–4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

A first update on mapping the human genetic architecture of COVID-19

peer reviewe

Sputum Concentration Improves Diagnosis Of Pulmonary Tuberculosis Cases In Children At A Tertiary Care Institution In Rwanda

Background: Pulmonary tuberculosis diagnosis by direct sputum smear microscopy is still questionable because of its low sensitivity and this technique is not sufficient to diagnose pulmonary tuberculosis especially in people who are not able to spit out properly like children and old people; therefore another more sensitive conventional technique like concentrated sputum smear microscopy is needed in patients suspected of having pulmonary tuberculosis. We aimed to find out if the sputum concentration technique can be more sensitive than direct smear microscopy in the diagnosis of pulmonary tuberculosis according to age groups. Methods: This study was a cross-sectional, conducted on 70 participants at CHUK. The sputa were examined microscopically on direct and concentrated smears and result compared to culture. Finally the data were analyzed with MS excel and SPSS. Results: A total of 210 sputa were analyzed by direct and concentration methods with culture as a gold standard. In patients under 15 years both methods were different in sensitivity (25% vs. 75%, CI= 95%, P= 0.047), in patients of 15 years of age and more, both methods had the same sensitivity (75% vs. 75%, CI= 95%, P = 0, 87). Regardless of age groups both methods were different in sensitivity (80% vs.90.9%, C.I= 95%, P = 0.001). Conclusion: Sputum concentration is more sensitive than direct technique especially in children under 15 years. We would recommend all researchers involved in tuberculosis to increase the sample size and use different study sites to validate this method before its implementation universally.Introduction: Le diagnostic de la tuberculose pulmonaire par examen microscopique des frottis direct est encore discutable en raison de sa faible sensibilité et ne permet pas elle seule de poser le diagnostic de la tuberculose pulmonaire. Ceci est surtout le cas chez les malades qui ne sont pas en mesure de trouver le crachat à savoir les enfants et les personnes âgées. Par conséquent, une autre technique classique plus sensible comme le frottis concentré est nécessaire dans ce groupe des patients. Ce travail avait pour but de déterminer l’apport réel de la technique de concentration des crachats comparé à celui de l’examen microscopique de frottis direct dans le diagnostic de la tuberculose pulmonaire selon les groupes d’âge. Méthodes: Il s’agissait d’une étude prospective, transversale portant sur 70 patients suspect de tuberculose pulmonaire vue au CHUK. Les résultats de l’examen microscopique direct; et après concentration du crachat ont été comparés aux résultats de la culture. Les données ont été saisies et analysées avec MS Excel et SPSS. Résultats: Sur un total de 210 crachats examinés, l’approche d’examen microscopique basées sur la concentration du crachat a détecté un nombre significativement plus élevé chez les patients de moins de 15 ans (25% vs 75%, IC = 95%, P = 0,047). Chez les patients de 15 ans et plus, les deux méthodes ont détectée de façon égale avec une même sensibilité (75% contre 75%, IC = 95%, P = 0, 87). Quel que soit e le groupe d’âge, la méthode d’examen microscopique après concentration du crachat aune sensibilité légèrement supérieur qu’ à celle dont l’approche utilise un examen direct (80% vs.90.9%, IC = 95%, P = 0,001). Conclusion: L’examen microscopique basé sur la concentration du crachat est plus sensible que la technique directe surtout chez les enfants de moins de 15 ans. Nos résultats font appel à des recherches portant sur grande taille de l’échantillon et impliquant différents sites d’étude pour valider cette méthode avant sa mise en oeuvre