Respiratory Therapy Faculty’ Perceptions of Effective Teaching Characteristics of Clinical Instructors in the State of Georgia

Background: Clinical instructors are expected to be excellent practitioners with great teaching skills. They play a vital role in teaching the next generation of respiratory therapists (RTs). Because clinical instructors impact the learning process of teaching the next generation, it is important to identify the effective teaching characteristics that contribute to the clinical success of the student from the perspective of RT faculty. PURPOSE: The aim of this study was to identify effective behavioral teaching characteristics of clinical instructors that are deemed most and least important by RT faculty in the State of Georgia. METHODS: Data were collected through a descriptive survey. The survey was adapted and emailed to all RT faculty members listed on The Georgia Society for Respiratory Care (GSRC) website. The survey consisted of three main domains: professional competence, relationship with students, and personal attributes. Thirty-five behavioral teaching characteristics were presented on a five-point Likert scale according to importance. RESULTS: Nineteen responses were received out of forty emailed surveys, with a response rate of 47.5%. The majority of participants indicated a master degree as their highest degree. Almost 58% of the participants teach at programs that offer associate degree. The study findings indicated faculty members’ perceptions ranking of the most important behavioral teaching characteristics hold a lot of similarities and some differences. Among all provided teaching characteristics, “Facilitate critical thinking in clinical practice was perceived as the most important behavioral teaching characteristic with mean scores and S.D of (M 4.89, S.D ±0.31), respectively. In the domain of relationship with students, “Encourage students to feel free to ask questions or ask for help” was ranked the highest by the participants with a mean of 4.57 and S.D of ±0.50. In the personal attributes domain, “Able to collaborate with other disciplines” was ranked as the most important characteristic with mean scores and S.D respectively (M 4.68, S.D ±0.47). CONCULSION: Faculty from different program levels (associate, baccalaureate and master) agreed that “Facilitate critical thinking in clinical practice” was the most important characteristic. Based on these findings, it is highly recommend that clinical instructors strive to improve their attitudes toward students as the best way to achieve the goals of clinical teaching. They also showed the need for respiratory therapy programs to foster and to promote uniformly identified effective behavioral teaching characteristics

An epidemiological approach to comorbidities in patients with COPD

Chronic Obstructive Pulmonary Disease (COPD) is associated with comorbidities. Cardiovascular (CV) disease, cognitive impairment, dementia, and depression are common comorbidities in patients with COPD, leading to increased morbidity and mortality. However, there are considerable gaps in how these comorbidities are assessed, while the burden of others remains inadequately researched. This PhD applied several methodologies and used different databases to 1) explore whether circulating biomarkers from the blood (soluble Receptor for Advanced Glycation End-products - sRAGE) and urine (microalbuminuria) might have a role in COPD related to prognostication of CV risk (assessed by aortic stiffness and carotid intima-media thickness), 2) evaluate the prevalence and incidence of cognitive impairment and dementia, 3) examine the incident risk of depression, and 4) assess the risks of respiratory-related morbidities associated with antidepressant use in patients with COPD. Using data from a multisite UK study, sRAGE was not associated with aortic stiffness, carotid intima-media thickness, or CV disease in patients with COPD. However, there was a weak direct association between sRAGE and spirometric lung function measures. Data from the same cohort also showed that urinary albumin creatinine ratio (UACR) was not strongly associated with physiological CV risk measures. Nevertheless, patients with COPD and either diabetes, ischaemic heart disease, or cerebrovascular disease have increased UACR, compared to patients without these comorbidities. Microalbuminuria was also prevalent in all patients with COPD. Using a large primary care database, this PhD demonstrates that patients with COPD have increased prevalence of cognitive impairment compared to subjects without COPD, matched by age, gender and GP surgery. The incidence of cognitive impairment following COPD diagnosis was 23.1 per 1,000 person-years compared to 16.3 per 1,000 person-years in subjects without COPD. However, the prevalence and incidence of dementia were less frequently recorded in patients with COPD compared to individuals without COPD, indicating the possibility of underdiagnosis of dementia and highlighting the need for systematic assessment. The incidence of depression was also greater following COPD diagnosis, compared to subjects without COPD, which indicates the need to stay alert and target accordingly. Antidepressant use was associated with increased risks of pneumonia and COPD exacerbations relative to periods of unexposed to antidepressants in patients with COPD, raising the concern of potential side-effects and adverse events. This thesis addresses several aspects of COPD comorbidities and contributes new evidence for assessing, recognising, and managing comorbidities in patients with COPD

An epidemiological approach to comorbidities in patients with COPD

Chronic Obstructive Pulmonary Disease (COPD) is associated with comorbidities. Cardiovascular (CV) disease, cognitive impairment, dementia, and depression are common comorbidities in patients with COPD, leading to increased morbidity and mortality. However, there are considerable gaps in how these comorbidities are assessed, while the burden of others remains inadequately researched. This PhD applied several methodologies and used different databases to 1) explore whether circulating biomarkers from the blood (soluble Receptor for Advanced Glycation End-products - sRAGE) and urine (microalbuminuria) might have a role in COPD related to prognostication of CV risk (assessed by aortic stiffness and carotid intima-media thickness), 2) evaluate the prevalence and incidence of cognitive impairment and dementia, 3) examine the incident risk of depression, and 4) assess the risks of respiratory-related morbidities associated with antidepressant use in patients with COPD. Using data from a multisite UK study, sRAGE was not associated with aortic stiffness, carotid intima-media thickness, or CV disease in patients with COPD. However, there was a weak direct association between sRAGE and spirometric lung function measures. Data from the same cohort also showed that urinary albumin creatinine ratio (UACR) was not strongly associated with physiological CV risk measures. Nevertheless, patients with COPD and either diabetes, ischaemic heart disease, or cerebrovascular disease have increased UACR, compared to patients without these comorbidities. Microalbuminuria was also prevalent in all patients with COPD. Using a large primary care database, this PhD demonstrates that patients with COPD have increased prevalence of cognitive impairment compared to subjects without COPD, matched by age, gender and GP surgery. The incidence of cognitive impairment following COPD diagnosis was 23.1 per 1,000 person-years compared to 16.3 per 1,000 person-years in subjects without COPD. However, the prevalence and incidence of dementia were less frequently recorded in patients with COPD compared to individuals without COPD, indicating the possibility of underdiagnosis of dementia and highlighting the need for systematic assessment. The incidence of depression was also greater following COPD diagnosis, compared to subjects without COPD, which indicates the need to stay alert and target accordingly. Antidepressant use was associated with increased risks of pneumonia and COPD exacerbations relative to periods of unexposed to antidepressants in patients with COPD, raising the concern of potential side-effects and adverse events. This thesis addresses several aspects of COPD comorbidities and contributes new evidence for assessing, recognising, and managing comorbidities in patients with COPD

Association between antidepressants with pneumonia and exacerbation in patients with COPD: a self-controlled case series (SCCS)

Objective: To assess whether antidepressant prescriptions are associated with an increased risk of pneumonia and chronic obstructive pulmonary disease (COPD) exacerbation. Methods: A self-controlled case series was performed to investigate the rates of pneumonia and COPD exacerbation during periods of being exposed to antidepressants compared with non-exposed periods. Patients with COPD with pneumonia or COPD exacerbation and at least one prescription of antidepressant were ascertained from The Health Improvement Network in the UK. Incidence rate ratios (IRR) and 95% CI were calculated for both outcomes. Results: Of 31 253 patients with COPD with at least one antidepressant prescription, 1969 patients had pneumonia and 18 483 had a COPD exacerbation. The 90-day risk period following antidepressant prescription was associated with a 79% increased risk of pneumonia (age-adjusted IRR 1.79, 95% CI 1.54 to 2.07). These associations then disappeared once antidepressants were discontinued. There was a 16% (age-adjusted IRR 1.16, 95% CI 1.13 to 1.20) increased risk of COPD exacerbation within the 90 days following antidepressant prescription. This risk persisted and slightly increased in the remainder period ((age-adjusted IRR 1.38, 95% CI 1.34 to 1.41), but diminished after patients discounted the treatment. Conclusion: Antidepressants were associated with an increased risk of both pneumonia and exacerbation in patients with COPD, with the risks diminished on stopping the treatment. These findings suggest a close monitoring of antidepressant prescription side effects and consideration of non-pharmacological interventions

A population-based study of 15,000 people on Knowledge and awareness of lung cancer symptoms and risk factors in Saudi Arabia

Background: Lung cancer is currently the most fatal form of cancer worldwide, ranking as the fourth most prevalent type in Saudi Arabia, particularly among males. This trend is expected to increase with growing population, lifestyle changes, and aging population. Understanding the awareness of the Saudi population regarding the risk factors and symptoms of lung cancer is necessary to attenuate the predicted increase in cases. Method: A cross-sectional, population-based survey was performed using a previously validated questionnaire (Lung CAM). Multiple linear regression analysis was used to assess variables associated with deficiency in knowledge and awareness of risk factors and symptoms of lung cancer. Results: Majority of the 15,099 respondents were male (65%), aged between 18 and 30 years (53%), 50% of which were educated up to a bachelor’s degree level. Overall awareness of lung cancer signs and symptoms was 53%, with painful cough and coughing up blood being the best-known symptoms. Conversely, persistent shoulder pain (44%) and clubbing fingers (47%) were the least known lung cancer symptoms. Also, 60% of the respondents showed low confidence in identifying the signs and symptoms of lung cancer. The overall awareness of the risk factors for lung cancer development was 74%, with first-hand (74%) and second-hand (68%) smoking being the most known risk factors. However, only ≤ 62% know the other non-smoking risk factors. Awareness of the risk factors and symptoms of lung cancer depended on age, gender, education, marital and employment status (p < 0.001). Conclusion: Public awareness of the risk factors and symptoms of lung cancer in Saudi Arabia is inadequate and heavily dependent on education and socio-economic status. Awareness can be improved through campaigns to raise awareness about other lesser-known lung cancer risk factors and symptoms

Perspectives, practices, and challenges of online teaching during COVID-19 pandemic: A multinational survey

The result of the movement restrictions during the COVID-19 pandemic was an impromptu and abrupt switch from in-person to online teaching. Most focus has been on the perception and experience of students during the process. The aim of this international survey is to assess staffs' perspectives and challenges of online teaching during the COVID-19 lockdown. Cross-sectional research using a validated online survey was carried out in seven countries (Brazil, Saudi Arabia, Jordan, Indonesia, India, the United Kingdom, and Egypt) between the months of December 2021 and August 2022, to explore the status of online teaching among faculty members during the COVID-19 pandemic. Variables and response are presented as percentages while logistic regression was used to assess the factors that predict levels of satisfaction and the challenges associated with online instruction. A total of 721 response were received from mainly male (53%) staffs. Most respondents are from Brazil (59%), hold a Doctorate degree (70%) and have over 10 years of working experience (62%). Although, 67% and 79% have relevant tools and received training for online teaching respectively, 44% report that online teaching required more preparation time than face-to-face. Although 41% of respondents were uncertain about the outcome of online teaching, 49% were satisfied with the process. Also, poor internet bandwidth (51%), inability to track students' engagement (18%) and Lack of technical skills (11.5%) were the three main observed limitations. Having little or no prior experience of online teaching before the COVID-19 pandemic [OR, 1.58 (95% CI, 1.35–1.85)], and not supporting the move to online teaching mode [OR, 0.56 (95% CI,0.48–0.64)] were two main factors independently linked with dissatisfaction with online teaching. While staffs who support the move to online teaching were twice likely to report no barriers [OR, 2.15 (95% CI, 1.61–2.86)]. Although, relevant tools and training were provided to support the move to online teaching during COVID-19 lockdown, barriers such as poor internet bandwidth, inability to track students’ engagement and lack of technical skills were main limitations observed internationally by teaching staffs. Addressing these barriers should be the focus of higher education institution in preparation for future disruptions to traditional teaching modes

A population-based study of 15,000 people on Knowledge and awareness of lung cancer symptoms and risk factors in Saudi Arabia

Background: Lung cancer is currently the most fatal form of cancer worldwide, ranking as the fourth most prevalent type in Saudi Arabia, particularly among males. This trend is expected to increase with growing population, lifestyle changes, and aging population. Understanding the awareness of the Saudi population regarding the risk factors and symptoms of lung cancer is necessary to attenuate the predicted increase in cases. Method: A cross-sectional, population-based survey was performed using a previously validated questionnaire (Lung CAM). Multiple linear regression analysis was used to assess variables associated with deficiency in knowledge and awareness of risk factors and symptoms of lung cancer. Results: Majority of the 15,099 respondents were male (65%), aged between 18 and 30 years (53%), 50% of which were educated up to a bachelor’s degree level. Overall awareness of lung cancer signs and symptoms was 53%, with painful cough and coughing up blood being the best-known symptoms. Conversely, persistent shoulder pain (44%) and clubbing fingers (47%) were the least known lung cancer symptoms. Also, 60% of the respondents showed low confidence in identifying the signs and symptoms of lung cancer. The overall awareness of the risk factors for lung cancer development was 74%, with first-hand (74%) and second-hand (68%) smoking being the most known risk factors. However, only ≤ 62% know the other non-smoking risk factors. Awareness of the risk factors and symptoms of lung cancer depended on age, gender, education, marital and employment status (p < 0.001). Conclusion: Public awareness of the risk factors and symptoms of lung cancer in Saudi Arabia is inadequate and heavily dependent on education and socio-economic status. Awareness can be improved through campaigns to raise awareness about other lesser-known lung cancer risk factors and symptoms

Exploring the Relationship Between Burnout, Resilience, and Dropout Intention Among Nursing Students During Clinical Training in Saudi Arabia

Background The issue of burnout syndrome among health discipline students is gaining heightened attention due to its serious effects, which causes them to have the intention to quit. Despite this, limited studies are available on the extent of burnout and its association with resilience and intention to drop out among clinical-level nursing students. Objective To explore the relationship between burnout, resilience, and intention to quit among nursing students. Methods An online questionnaire was used to conduct a cross-sectional study, targeting nursing students at the clinical level through a nonprobability sample. The participants were required to provide their sociodemographic, Maslach Burnout Inventory, and Connor-Davidson Resilience Scale. Data was analyzed using descriptive, inferential, and correlation tests. Results The study included a group of 564 nursing students and interns, the majority of whom were female at a percentage of 78.9%. Among this group, 65% experienced a high level of burnout, with 42% experiencing emotional exhaustion, 54% experiencing depersonalization (DP), and 77% reporting low personal achievement. A total of 48% of clinical-level students were considering quitting the nursing program. Moreover, the students reported low scores of resilience, with negative correlations observed with DP ( r  = −.12, p  = .04) and positive correlation with low personal achievement ( r  = .43, p  < .001). Conclusion Nursing students and interns faced a significant amount of burnout and showed a desire to drop out nursing program. Their level of resilience was moderately low, and it correlated with burnout subscales DP and personal accomplishment. A collaborative intervention is needed to promote resiliency and alleviate burnout symptoms during clinical training

Physicians&rsquo; Perceptions of and Barriers to Cardiopulmonary Rehabilitation for Heart Failure Patients in Saudi Arabia: A Cross-Sectional Study

Background: Cardiopulmonary rehabilitation (CR) serves as a core component of the management strategy for patients with heart failure (HF). CR is administered by multidisciplinary healthcare providers, but their perceptions toward delivering CR to HF patients, and the factors and barriers that might influence referral, have not been studied. This study aims to assess physicians&rsquo; perceptions toward delivering CR programs to HF patients and identify factors and barriers that might influence their referral decisions. Methods: Between 15 February and 5 June 2022, a cross-sectional online survey with ten multiple-choice items was distributed to all general and cardiac physicians in Saudi Arabia. The characteristics of the respondents were described using descriptive statistics. Percentages and frequencies were used to report categorical variables. The statistical significance of the difference between categorical variables was determined using the chi-square (2) test. Logistic regression was used to identify referral factors. Results: Overall, 513 physicians (general physicians (78%) and cardiac doctors (22%)) completed the online survey, of which 65.0% (n = 332) were male. Of the general physicians, 236 (59%) had referred patients with HF to CR. Sixty-six (58%) of the cardiac doctors had referred patients with HF to CR. A hospital-supervised program was the preferred mode of delivering CR programs among 315 (79%) general physicians, while 84 (74%) cardiac doctors preferred to deliver CR programs at home. Apart from the exercise component, information about HF disease was perceived by 321 (80%) general physicians as the essential component of a CR program, while symptom management was perceived by 108 (95%) cardiac doctors as the essential component of a CR program. The most common patient-related factor that strongly influenced referral decisions was &ldquo;fatigue related to disease&rdquo; (63.40%). The availability of CR centers (48%) was the most common barrier preventing the referral of patients to CR. Conclusions: CR is an effective management strategy for HF patients, but the lack of CR centers is a major barrier to the referral of patients. A hospital-supervised program is the preferred method of delivering CR from the general physicians&rsquo; perspective, while cardiac doctors prefer home-based CR programs. Apart from the exercise component, information about HF disease and symptom management is essential components of CR programs from general physicians&rsquo; and cardiac doctors&rsquo; perspectives, respectively

Sleep Quality, Insomnia, Anxiety, Fatigue, Stress, Memory and Active Coping during the COVID-19 Pandemic

Background: The current study aimed to evaluate the impact of the coronavirus (COVID-19) pandemic on sleep quality, insomnia, anxiety, stress, fatigue and active coping in the United States. Methods: This was a cross-sectional study using a publicly available database taken from the Boston College COVID-19 Sleep and Well-Being Dataset. We have selected the most recent data that included information about sleep quality and other measures, including insomnia, anxiety, stress, fatigue and coping, collected between 22 February&ndash;8 March 2021. Results: A total of 476 subjects were included in the analysis. The mean (SD) age of the study population was 38.8 (17.8) years, and there were more females (85%) than males. The population had a mean (SD) score of the Pittsburgh Sleep Quality Index (PSQI) of 6 (3.2), with 65% having the prevalence of poor sleep quality (defined as PSQ &ge; 5; n = 311). The mean (SD) score for Insomnia Severity Index (ISI) was 6.9 (5.2), with 55 subjects (11.5%) having clinical insomnia (defined as ISI &ge; 15); of whom 9% had severe clinical insomnia. There were positive correlations between PSQI and ISI (r = 0.76, p &lt; 0.001), PROMIS fatigue scale (r = 0.53, p &lt; 0.001), Generalized Anxiety Disorder-7 (GAD-7) (r = 0.46, p &lt; 0.001), and Perceived Stress Scale (PSS) (r = 0.44, p &lt; 0.001). The PSQI was inversely correlated with the John Henryism Active Coping Scale (JHACS) and memory scale. In the multivariate regression model, JHACS, ISI, fatigue, PSS and GAD-7 were significant predictors of PSQI, and these variables accounted for 62% of the variance of PSQI, adjusted for age and gender. Conclusion: An important contribution to the literature is made by this research, which demonstrates the significant prevalence of poor sleep quality and its association with insomnia and other mental and physical well-being. It also underlines the need to prioritise policy and public health efforts to address sleep issues that have substantial health and economic effects for both individuals and the population at large