Challenges in the Clinical Education Environment during the COVID-19 Outbreak: The Experiences of Medical Students

Background: The aim of the present study was to determine the challenges of medical students in the clinical education environment during the outbreak of Covid-19 to understand their experiences. Methods: This qualitative study was performed based on the hermeneutic phenomenological approach and Van Manen’s analytical method from 10th of August to 12th of September 2020 in different departments of Qazvin University of Medical Sciences, Iran. In this phenomenological study, using the purposive sampling method, the participants were selected from among medical students. The data were collected through semi-structured interviews with 12 medical students. All the interviews were recorded and transcribed, and then, the codes, categories, and themes were extracted using Van Manen’s analytical method. Results: The 5 main themes of the present study were ‘inefficient clinical education’, ‘dealing with real work conflicts’, ‘the future professional challenges’, ‘the challenges related to organizational policy’, and ‘the challenges related to the sense of stigma among the medical staff’. The most important challenges consisted of ‘moving away from the educational goals due to reduced attendance at the clinical setting’, ‘the cancellation of some clinical courses’, ‘the creation of stress in the students by professors’, ‘fear of getting sick and transmitting the disease to family members’, ‘fatigue and heavy sweating due to caring for a large number of patients while wearing isolation gowns’, ‘the prolongation of the students’ studies and delay in starting their thesis’. Conclusion: The results of this study provided a deeper insight into the perceptions, feelings, and experiences of medical students during the coronavirus pandemic

Factors related to students' satisfaction with holding e-learning during the Covid-19 pandemic based on the dimensions of e-learning

Background: E-learners' satisfaction has a significant impact on the success of the e-learning process and leads to improving the quality of the e-learning system. Many factors affect e-learning satisfaction. This study aimed to determine the factors related to students' satisfaction with e-learning during the Covid-19 pandemic based on the dimensions of e-learning. Methods: The present study was a cross-sectional study, which was conducted in 2020 among students studying in different fields of Qazvin University of Medical Sciences using stratified random sampling. To collect data three parts of questionnaires were used included the demographic information, the measuring the effectiveness of elearning, and measuring the level of satisfaction with holding e-learning during the Covid-19 period. Data were entered into spss23 and analyzed by descriptive method, chi-square, and t-test. Results: The results showed that the mean (standard deviation) score of satisfaction with e-learning in the students was 20.75 (2.13) and 59 % of them had undesirable satisfaction. There was a significant relationship between satisfaction with e-learning and variables of gender and history of attending online classes before Covid-19. Regarding the four aspects of e-learning, there was a statistically significant difference between the two groups of students with desirable satisfaction and undesirable satisfaction. The results revealed that the mean scores of dimensions of teaching and learning; feedback and evaluation; flexibility and appropriateness; and workload among students with desirable satisfaction were higher than students with undesirable satisfaction. Conclusion: Considering the results, efforts should be made to improve the quality of e-learning and the factors affecting it, because due to the prevalence of Covid-19, distance education may be held for a long time. Lack of attention to these cases can reduce the quality of education and students' level of knowledge

Lived Experiences of the Patients Hospitalized with COVID-19: A Phenomenological Study in a Province of Northwest Iran

Abstract: Abstract: COVID-19 is a serious infectious disease whose rapid and widespread spread urged the World Health Organization to declare it a global public health emergency. Understanding the experience of people infected and quarantined with COVID-19 is very important in maximizing disease control and minimizing the negative effects on patients, their families, and social networks. This study explored the experiences of patients with COVID-19 during care and quarantine in northwest Iran. A purposive sample of 11 patients with COVID-19 was recruited. Data were collected from the beginning of March to the beginning of June 2020, using semi‐structured interviews and these were analyzed according to van Manen's phenomenological method. Interviews were audiotaped, transcribed verbatim and analyzed using thematic analysis. Ultimately, four themes, Characteristics of the experience, Response to traumatic experience, Deprivation, and Confusion, and containing 19 sub-themes, emerged. After understanding the findings of this research, nurses working in the wards of patients with COVID-19 can better consider the importance of assessing and analyzing the challenges and experiences of patients during periods of illness and quarantine. Findings also enhance the identification and organization of training needs during such a pandemic and the design of nursing programs to respond to them

Machine learning-based COVID-19 diagnosis by demographic characteristics and clinical data

Introduction: To facilitate rapid and effective diagnosis of COVID-19, effective screening can alleviate the challenges facing healthcare systems. We aimed to develop a machine learning-based prediction of COVID-19 diagnosis and design a graphical user interface (GUI) to diagnose COVID-19 cases by recording their symptoms and demographic features. Methods: We implemented different classification models including support vector machine (SVM), Decision tree (DT), Naïve Bayes (NB) and K-nearest neighbor (KNN) to predict the result of COVID-19 test for individuals. We trained these models by data of 16973 individuals (90% of all individuals included in data gathering) and tested by 1885 individuals (10% of all individuals). Maximum relevance minimum redundancy (MRMR) algorithms used to score features for prediction of result of COVID-19 test. A user-friendly GUI was designed to predict COVID-19 test results in individuals. Results: Study results revealed that coughing had the highest positive correlation with the positive results of COVID-19 test followed by the duration of having COVID-19 signs and symptoms, exposure to infected individuals, age, muscle pain, recent infection by COVID-19 virus, fever, respiratory distress, loss of smell or taste, nausea, anorexia, headache, vertigo, CT symptoms in lung scans, diabetes and hypertension. The values of accuracy, precision, recall, F1-score, specificity and area under receiver operating curve (AUROC) of different classification models computed in different setting of features scored by MRMR algorithm. Finally, our designed GUI by receiving each of the 42 features and symptoms from the users and through selecting one of the SVM, KNN, Naïve Bayes and decision tree models, predict the result of COVID-19 test. The accuracy, AUROC and F1-score of SVM model as the best model for diagnosis of COVID-19 test were 0.7048 (95% CI: 0.6998, 0.7094), 0.7045 (95% CI: 0.7003, 0.7104) and 0.7157 (95% CI: 0.7043, 0.7194), respectively. Conclusion: In this study we implemented a machine learning approach to facilitate early clinical decision making during COVID-19 outbreak and provide a predictive model of COVID-19 diagnosis capable of categorizing populations in to infected and non-infected individuals the same as an efficient screening tool

The Effect of Peers Support on Fear of Hypoglycemia in Iranian Patients with Type 1 Diabetes: A Clinical Trial Study

Background: Fear of hypoglycemia is a medical emergency which leads to disrupt individuals’ normal lives. Peers support is a hopeful approach to improve diabetes self‑care behaviors. This study was conducted to assess the effect of peers support on the fear of hypoglycemia in patients with type 1 diabetes. Materials and Methods: This randomized clinical trial study was performed among 60 patients with type 1 diabetes in Qazvin city from September 2019 to October 2020. Patients were assigned to control and intervention groups using a random method. The data collection tools included demographic characteristics and a standard questionnaire for Hypoglycemia Fear Survey (HFS). Patients in the intervention group were trained by skilled peers for 2 months, but those of the control group only received routine hospital training. The data were analyzed by SPSS version 16 and paired and independent t‑test. Results: The scores of the fear of hypoglycemia in diabetic patients in the two groups had no significant statistical difference before intervention (t53 = 0.93, p = 0.94). But after the intervention, the independent t‑test showed that there was a significant difference between the scores of the fear of hypoglycemia in both groups (t53 = ‑2.13, p = 0.03). Conclusions: Considering the results of the current study, peer support for diabetic patients is an effective way to reduce the fear of hypoglycemia. Therefore, it is recommended using this training method to train diabetic patients. Keywords: Diabetes mellitus, fear, hypoglycemia, Iran, peer group, type

Challenges in the clinical education environment during the outbreak of COVID‑19: Development and psychometric testing

BACKGROUND: COVID-19 pandemic poses unique physical and emotional challenges in providing clinical education. Failure to identify the challenges and problems that students face in the clinical learning environment hinders their effective learning and growth. Consequently, the progress of their skills is affected. The aim of this study was to develop a challenge in the clinical education environment of medical students during the outbreak of COVID-19 questionnaire and to test its psychometric properties. MATERIALS AND METHODS: This study is part of a larger study that was conducted using a combined consecutive method in Qazvin. In the first stage, a phenomenological study was performed with van Manen's method by interviewing 12 students at Qazvin University. To extract the items of the tool in the second stage, the concept was defined. Ultimately, the psychometric properties of the questionnaire were evaluated with face validity, content validity (quantitative and qualitative), construct validity (exploratory factor analysis), internal consistency (Cronbach's alpha), and test–retest reliability (intraclass correlation coefficient). RESULTS: The initial tool had 70 questions. After validation, 53 items remained in the final questionnaire. Four extracted dimensions were as follows: “Inadequate professional competency,” “Inefficient clinical planning” and “outcomes of learning-teaching activities,” and “the challenges related to the stigma of medical staff.” Cronbach's alpha for the whole questionnaire was 0.98 (range: 0.87–0.98). The test–retest (intraclass correlation coefficient) reliability was 0.98 (P < 0.001). CONCLUSIONS: According to the obtained results, if the items of “Inadequate professional competency,” “Inefficient clinical planning” and “outcomes of learning-teaching activities,” and “the challenges related to the stigma of medical staff,” the challenges of students’ clinical education can be reduced during the COVID-19 outbreak

The relationship between fear of hypoglycemia and sleep quality among type 2 diabetic patients

Background. Fear of hypoglycemia can result in anxiety, stress, anger, depression and severe avoidance behaviors that it affects the sleep quality of diabetic patients. Therefore, the present study was conducted with the aim of investigating the relationship between fear of hypoglycemia and sleep quality among type 2 diabetic patients. Methods. The present cross-sectional study was conducted on 400 type 2 diabetic patients referred to endocrinology clinic of Velayat Hospital and Boali Hospital in Qazvin, in 2019. Data were collected using a checklist for demographic variables, the Fear of Hypoglycemia Survey (FHS-W), and the Pittsburgh sleep quality index (PSQI). Descriptive statistics and Spearman correlation test were performed for data analysis using SPSS v24. Results. In this study, the mean age of diabetic patients was 55.75 ± 10.31. The majority of the participants were female (n = 299, 74.8%) and were treated with oral anti-diabetic drugs (n = 174, 43.5%). The mean score of sleep quality in patients was 8.98 ± 3.64 and the fear of hypoglycemia was 21.27 ± 11.92. The results of this study showed that there was a signifcant relationship between the fear of hypoglycemia and the poor sleep quality among patients (P < 0.001, r = 0.305). Conclusion. The fear of hypoglycemia has a direct and signifcant relationship with poor sleep quality in diabetic patients; so that this fear reduces the quality of sleep in diabetic patients. Therefore, in order to provide adequate sleep to prevent inappropriate sleep complications, great attention should be paid to the issue of fear of hypoglycemia, and consider some actions to reduce this fear. (Clin Diabetol 2020; 10, 1: 149–154) Key words: fear of hypoglycemia, sleep quality, type 2 diabete

The relationship between fear of hypoglycemia and sleep quality among type 2 diabetic patients

Background. Fear of hypoglycemia can result in anxiety, stress, anger, depression and severe avoidance behaviors that it affects the sleep quality of diabetic patients. Therefore, the present study was conducted with the aim of investigating the relationship between fear of hypoglycemia and sleep quality among type 2 diabetic patients. Methods. The present cross-sectional study was conducted on 400 type 2 diabetic patients referred to endocrinology clinic of Velayat Hospital and Boali Hospital in Qazvin, in 2019. Data were collected using a checklist for demographic variables, the Fear of Hypoglycemia Survey (FHS-W), and the Pittsburgh sleep quality index (PSQI). Descriptive statistics and Spearman correlation test were performed for data analysis using SPSS v24. Results. In this study, the mean age of diabetic patients was 55.75 ± 10.31. The majority of the participants were female (n = 299, 74.8%) and were treated with oral anti-diabetic drugs (n = 174, 43.5%). The mean score of sleep quality in patients was 8.98 ± 3.64 and the fear of hypoglycemia was 21.27 ± 11.92. The results of this study showed that there was a significant relationship between the fear of hypoglycemia and the poor sleep quality among patients (P &lt; 0.001, r = 0.305). Conclusion. The fear of hypoglycemia has a direct and significant relationship with poor sleep quality in diabetic patients; so that this fear reduces the quality of sleep in diabetic patients. Therefore, in order to provide adequate sleep to prevent inappropriate sleep complications, great attention should be paid to the issue of fear of hypoglycemia, and consider some actions to reduce this fear

Ivermectin-Induced Clinical Improvement and Alleviation of Significant Symptoms of COVID-19 Outpatients: A Cross-Sectional Study

Although several drugs have been proposed and used to treat the COVID-19 virus, but recent clinical trials have concentrated on ivermectin. It appears that ivermectin can potentially act against COVID-19 and stop the development in its infancy. The purpose of this study was to determine the effect of ivermectin on the recovery of outpatients with COVID-19. In this cross-sectional study, we compared the symptoms reduction in COVID-19 disease in two groups of patients by administering ivermectin. A total of 347 mild outpatients in the Iranian provinces of Qazvin and Khuzestan with a conrmed PCR were enrolled. The symptoms of outpatients with COVID-19 were analyzed using SPSS (V23). In this cross-sectional study, the sex ratio was 0.64 (female/male: 37.9/59.8) and most patients were under 50 years old (72.8%). The results of this study demonstrated a signicant decrease in several COVID-19 disease symptoms, including fever, chills, dyspnea, headache, cough, fatigue, and myalgia in the group administered ivermectin compared to the control group. In addition, the odds ratio of the above symptoms was signicantly lower in patients who received ivermectin than in patients who did not receive the drug (OR = 0.16, 95% CI = 0.09, 0.27). Keywords COVID-19 Ivermectin Cross-sectional study Outpatients Sympto