Smartphone-Based DIY Home Microsurgical Training with 3D Printed Microvascular Clamps and Japanese Noodles.

We have recently incorporated simple modifications of the konjac flour noodle model to enable DIY home microsurgical training by (i) placing a smartphone on a mug to act as a microscope with at least ×3.5-5 magnification, and (ii) rather than cannulating with a 22G needle as described by others, we have found that cannulation with a 23G needle followed by a second pass with an 18G needle will create a lumen (approximately 0.83 mm) without an overly thick and unrealistic "vessel" wall. The current setup, however, did not allow realistic evaluation of anastomotic patency as the noodles became macerated after application of standard microvascular clamps, which also did not facilitate practice of back-wall anastomoses. In order to simulate the actual operative environment as much as possible, we introduced the use of 3D-printed microvascular clamps. These were modified from its previous iteration (suitable for use in silastic and chicken thigh vessels), and video recordings were submitted for internal validation by senior surgeons. A "wet" operative field where the konjac noodle lumen can be distended or collapsed, unlike other nonliving models, was noted by senior surgeons. With the 3D clamps, the noodle could now be flipped over for back-wall anastomosis and allowed patency testing upon completion as it did not become macerated, unlike that from clinical microvascular clamps. The perceived advantages of this model are numerous. Not only does it comply with the 3Rs of simulation-based training, but it can also reduce the associated costs of training by up to a hundred-fold or more when compared to a traditional rat course and potentially be extended to low-middle income countries without routine access to microsurgical training for capacity development. That it can be utilized remotely also bodes well with the current limitations on face-to-face training due to COVID restrictions and lockdowns.

Perceptions of Live Streaming Compared With an In-Person Nursing Conference: A Quality Improvement Project.

OBJECTIVE: The aim of this study was to understand registered nurses' (RNs') perceptions of attending a live streaming versus in-person continuing education event. BACKGROUND: During the COVID-19 global pandemic, in-person continuing education events for healthcare providers required conversion to digital platforms. Literature is sparse regarding healthcare providers' perceptions on attending a live streaming continuing education event. METHODS: Registered nurses completed a survey after a live streaming research conference from a large US healthcare system. Likert-scale survey items were analyzed using descriptive statistics and open-ended questions with content analysis and thematic coding. RESULTS: A total of 219 RNs participated. The RNs reported an overall positive experience with the live streaming event and indicated a preference for this platform for the future. Three benefits emerged: savings, self-care and safety, and user-friendly. Perceived drawbacks were coded with 3 themes: technical issues, impaired focus, and social/networking challenges. CONCLUSIONS: Despite challenges, live streaming conferences may be satisfying and preferable for nurses.

Pandemic response policies' democratizing effects on online learning.

The COVID-19 pandemic has changed peoples' lives in unexpected ways, especially how they allocate their time between work and other activities. Demand for online learning has surged during a period of mass layoffs and transition to remote work and schooling. Can this uptake in online learning help close longstanding skills gaps in the US workforce in a sustainable and equitable manner? We answer this question by analyzing individual engagement data of DataCamp users between October 2019 and September 2020 (n = 277,425). Exploiting the staggered adoption of actions to mitigate the spread of COVID-19 across states, we identify the causal effect at the neighborhood level. The adoption of nonessential business closures led to a 38% increase in new users and a 6% increase in engagement among existing users. We find that these increases are proportional across higher- and lower-income neighborhoods and neighborhoods with a high or low share of Black residents. This demonstrates the potential for online platforms to democratize access to knowledge and skills that are in high demand, which supports job security and facilitates social mobility.

Take-Home Laparoscopy Simulators in Pediatric Surgery: Is More Expensive Better?

Background: To increase complex minimally invasive skills (MIS), frequent training outside the clinical setting is of uttermost importance. This study compares two low-cost pediatric MIS simulators, which can easily be used preclinically. Materials and Methods: The LaparoscopyBoxx is a portable simulator without a tracking system, with costs ranging from €90 to €315. The EoSim simulator has a built-in camera and tracking system and costs range from €780 to €1800. During several pediatric surgical conferences and workshops (January 2017-December 2018), participants were asked to use both simulators. Afterward, they completed a questionnaire regarding their opinion on realism and didactic value, scored on a five-point Likert scale. Results: A total of 50 participants (24 experts and 25 target group, one unknown) evaluated one or both simulators. Both simulators scored well on the questionnaire. The LaparoscopyBoxx scored significantly better regarding the "on screen representation of the instrument actions" (mean 4.2 versus 3.5, P = .001), "training tool for pediatric surgery" (mean 4.4 versus 3.9, P = .005), and "appealing take-home simulator" (mean 4.6 versus 4.0, P = .002). Conclusion: The simulators tested in this study were both regarded an appealing take-home simulator. The LaparoscopyBoxx scored significantly better than the EoSim, even though this is a low budget simulator without tracking capabilities.

Cenário da educação superior à distância em saúde no Brasil: a situação da Enfermagem / Escenario de la educación superior a distancia en salud en Brasil: situación de la Enfermería / Scenario of distance higher education in health in Brazil: the situation of Nursing

Resumo Objetivo Analisar a oferta dos cursos de graduação em saúde na modalidade de Ensino a Distância no Brasil, destacando suas principais características para Enfermagem. Método Estudo transversal baseado em dados on line de cursos de graduação em saúde a distância, criados entre 2005 e 2020. Para doze graduações em saúde, destacaram-se características da criação e distribuição do ensino a distância, enfatizando-se a situação da Enfermagem. Realizaram-se testes de significância estatística (α=5%) e mapa. Resultados Verificaram-se 431 cursos de graduação em saúde, sendo a maioria deles criados entre 2017 e 2020 (≥61,4%). Para Enfermagem, o período de maior criação foi anterior (entre 2013 e 2016; 72,7%) (p=0,001). Todos os cursos eram vinculados a instituições privadas, que ofertavam 82.000 vagas, distribuídas em 1.363 Polos por todos os estados. Verificou-se predomínio em São Paulo (23,9%) e nas cidades localizadas no interior dos estados (64,3%) (p=0,001). Conclusão e implicações para prática Houve aumento significativo de cursos de graduação em saúde no ensino a distância no Brasil. Para Enfermagem, estes se caracterizaram por oferta privada e localizada no interior dos estados. Contudo, a distribuição regional ainda é desigual, concentrando Polos nas regiões mais ricas e centrais do país, e longe das áreas com maiores necessidades de saúde.

Resumen Objetivo Analizar la oferta de estudios superiores en salud bajo la modalidad de Educación a Distancia en Brasil, destacando sus principales características para Enfermería. Método Estudio transversal a partir de datos en línea de las carreras de grado en salud a distancia, creadas entre 2005 y 2020. Para doce titulaciones de salud se destacaron características de la creación y distribución de la educación a distancia, destacando la situación de Enfermería. Se realizaron pruebas de significación estadística (α = 5%) y mapa. Resultados Se detectaron 431 carreras de grado en salud, la mayoría de las cuales se crearon entre 2017 y 2020 (≥61,4%). Para Enfermería, el período de mayor creación fue anterior (entre 2013 y 2016; 72,7%) (p = 0,001). Todos los cursos estuvieron vinculados a instituciones privadas, que ofrecieron 82.000 plazas, distribuidas en 1.363 centros en todos los estados. Se registró predominio de cursos en São Paulo (23,9%) y en ciudades del interior de los estados (64,3%) (p = 0,001). Conclusión e implicaciones para la práctica Se advierte un aumento significativo en los cursos de pregrado en salud en educación a distancia en Brasil. Para Enfermería, estos se caracterizaron por una oferta privada ubicada en el interior de los estados. Sin embargo, la distribución regional sigue siendo desigual, concentrada en las regiones más ricas y céntricas del país, y lejos de las áreas con mayores necesidades de salud.

Abstract Objective To analyze the offer of undergraduate health courses in the Distance Learning modality in Brazil, highlighting its main characteristics for Nursing. Method This is a cross-sectional study based on distance health undergraduate courses online data, created between 2005 and 2020. For twelve health degrees, characteristics of the creation and distribution of distance learning were highlighted, emphasizing Nursing courses. Statistical significance tests (α = 5%) and mapping were performed. Results There were 43 undergraduate courses in health, most of which were created between 2017 and 2020 (≥61.4%). For Nursing, most courses were created in earlier years (2013 and 2016; 72.7%) (p = 0.001). The courses were linked to private institutions, which offered 82,000 seats and are distributed in 1,363 hubs across all states. Courses predominated in São Paulo (23.9%) and non-capital cities (64.3%) (p = 0.001). Conclusion and implications for the practice There has been a significant increase in distance education in Brazil's undergraduate health courses. For Nursing, the courses were characterized by private offers located in non-capital cities. However, the regional distribution is still uneven, concentrating hubs in the country's richest and most central regions and away from areas with the greatest health needs.

Remote Learning During COVID-19: Examining School Practices, Service Continuation, and Difficulties for Adolescents With and Without Attention-Deficit/Hyperactivity Disorder.

PURPOSE: This study examined remote learning practices and difficulties during initial stay-at-home orders during the COVID-19 pandemic in adolescents with and without attention-deficit/hyperactivity disorder (ADHD). METHODS: Participants were 238 adolescents (132 males; 118 with ADHD) aged 15.64-17.99 years and their parents. Adolescents and parents completed questionnaires in May/June 2020 when in-person schools were closed in the U.S. RESULTS: Twenty-two percent of families incurred financial costs to support remote learning, and only 59% of school-based services received before COVID-19 continued during COVID-19 remote learning. Adolescents with ADHD had fewer routines and more remote learning difficulties than adolescents without ADHD. Parents of adolescents with ADHD had less confidence in managing remote learning and more difficulties in supporting home learning and home-school communication. Thirty-one percent of parents of adolescents with ADHD with an Individualized Education Program (IEP) or receiving academic accommodations (504 Plan) reported remote learning to be very challenging, compared with 18% of parents of adolescents with ADHD without an IEP/504 Plan, and only 4% of parents of adolescents with neither ADHD nor an IEP/504 Plan. Fewer adolescent routines, higher negative affect, and more difficulty concentrating because of COVID-19 were each associated with greater adolescent remote learning difficulties only in adolescents with ADHD. CONCLUSIONS: This study provides initial findings of the nature and impact of remote learning during the COVID-19 pandemic. It is imperative for schools and communities to provide the necessary supports to adolescents, particularly those with mental health and/or learning difficulties, and to their parents.

Examining Cost Measurements in Production and Delivery of Three Case Studies Using E-Learning for Applied Health Sciences: Cross-Case Synthesis.

BACKGROUND: The World Health Report (2006) by the World Health Organization conveys that a significant increase is needed in global health care resourcing to meet the current and future demand for health professionals. Electronic learning (e-Learning) presents a possible opportunity to change and optimize training by providing a scalable means for instruction, thus reducing the costs for training health professionals and providing patient education. Research literature often suggests that a benefit of e-Learning is its cost-effectiveness compared with face-to-face instruction, yet there is limited evidence with respect to the comparison of design and production costs with other forms of instruction or the establishment of standards pertaining to budgeting for these costs. OBJECTIVE: To determine the potential cost favorability of e-Learning in contrast to other forms of learning, there must first be an understanding of the components and elements for building an e-Learning course. Without first taking this step, studies lack the essential financial accounting rigor for course planning and have an inconsistent basis for comparison. This study aimed to (1) establish standard ingredients for the cost of e-Learning course production and (2) determine the variance instructional design has on the production costs of e-Learning courses. METHODS: This study made use of a cross-case method among 3 case studies using mixed methods, including horizontal budget variance calculation and qualitative interpretation of responses from course designers for budget variance using total quality management themes. The different implementation-specific aspects of these cases were used to establish common principles in the composition of budgets in the production and delivery of an applied health professional e-Learning course. RESULTS: A total of 2 case studies reported significant negative budget variances caused by issues surrounding underreporting of personnel costs, inaccurate resource task estimation, lack of contingency planning, challenges in third-party resource management, and the need to update health-related materials that became outdated during course production. The third study reported a positive budget variance because of the cost efficiency derived from previous implementation, the strong working relationship of the course project team, and the use of iterative project management methods. CONCLUSIONS: This research suggests that the delivery costs of an e-Learning course could be underestimated or underreported and identifies factors that could be used to better control budgets. Through consistent management of factors affecting the cost of course production, further research could be undertaken using standard economic evaluation methods to evaluate the advantages of using e-Learning.

Evaluation of distance learning IMCI training program: the case of Tanzania.

BACKGROUND: The standard 11-days IMCI (Integrated Management of Childhood Illness) training course (standard IMCI) has faced barriers such as high cost to scale up. Distance learning IMCI training program was developed as an alternative to the standard IMCI course. This article presents the evaluation results of the implementation of distance learning IMCI training program in Tanzania. METHODS: From December 2012 to end of June 2015, a total of 4806 health care providers (HCP) were trained on distance learning IMCI from 1427 health facilities {HF) in 68 districts in Tanzania. Clinical assessments were done at the end of each course and on follow up visits of health facilities 4 to 6 weeks after training. The results of those assessments are used to compare performance of health care providers trained in distance learning IMCI with those trained in the standard IMCI course. Statistical analysis is done by comparing proportions of those with appropriate performances using four WHO priority performance indicators as well as cost of conducting the courses. In addition, the perspectives of health care providers, IMCI course facilitators, policy makers and partners were gathered using either focussed group discussions or structured questionnaires. RESULTS: Distance learning IMCI allowed clusters of training courses to take place in parallel, allowing rapid expansion of IMCI coverage. Health care providers trained in distance learning IMCI performed equally well as those trained in the standard IMCI course in assessing Main Symptoms, treating sick children and counselling caretakers appropriately. They performed better in assessing Danger Signs. Distance learning IMCI gave a 70% reduction in cost of conducting the training courses. CONCLUSION: Distance learning IMCI is an alternative to scaling up IMCI as it provides an effective option with significant cost reduction in conducting training courses.

NEXus: Making Efficient Use of Limited Resources.

Faculty to teach and mentor doctoral nursing students are and will continue to be in short supply. Coupled with ever-increasing resource-constricted educational environments, doctoral programs are challenged to provide high-quality education with limited resources. The Nursing Education Exchange (NEXus) is a viable solution to help meet that challenge. This article presents an overview of the origins and evolution of NEXus, financial considerations, and basic steps for joining NEXus, along with 4 exemplars. NEXus has continued to grow since its inception in 2007. In 2015, the number of NEXus schools reached 20, with 11 schools offering both doctor of philosophy and doctor of nursing practice courses. Currently, NEXus offers over 160 courses, organized into 14 clusters such as gerontology and chronic illness. Recently, a collaboration between the National Hartford Centers of Gerontological Nursing Excellence and NEXus was formalized. This collaboration prepares faculty to address an aging population. In summary, in an era of increased demand for doctoral prepared nurses, a lack of qualified doctoral nursing faculty, and limited financial resources, the NEXus collaborative provides a model for optimal resource sharing.

Increasing the Number of Certified Registered Nurses in an Emergency Department: A Cohort Program Implementation.

Nationally, hospital emergency departments are met with challenges because of increasing patient demands, overcrowding, and the need to protect patient safety. It is imperative that frontline emergency department nurses are prepared to meet the complex needs of diverse patient populations by having appropriate continuing education, training, and institutional resources. Professional certification is associated with improved patient safety, higher organizational performance scores, professional growth, and credibility among nurses. The purpose of this article is to describe the process and outcome of a nursing professional development-practitioner-led intervention to promote professional certification among nurses in an urban adult emergency department while reducing overall cost of institutional support for certification preparation.

The Value of E-Learning for the Prevention of Healthcare-Associated Infections.

BACKGROUND Healthcare workers (HCWs) lack familiarity with evidence-based guidelines for the prevention of healthcare-associated infections (HAIs). There is good evidence that effective educational interventions help to facilitate guideline implementation, so we investigated whether e-learning could enhance HCW knowledge of HAI prevention guidelines. METHODS We developed an electronic course (e-course) and tested its usability and content validity. An international sample of voluntary learners submitted to a pretest (T0) that determined their baseline knowledge of guidelines, and they subsequently studied the e-course. Immediately after studying the course, posttest 1 (T1) assessed the immediate learning effect. After 3 months, during which participants had no access to the course, a second posttest (T2) evaluated the residual learning effect. RESULTS A total of 3,587 HCWs representing 79 nationalities enrolled: 2,590 HCWs (72%) completed T0; 1,410 HCWs (39%) completed T1; and 1,011 HCWs (28%) completed T2. The median study time was 193 minutes (interquartile range [IQR], 96-306 minutes) The median scores were 52% (IQR, 44%-62%) for T0, 80% (IQR, 68%-88%) for T1, and 74% (IQR, 64%-84%) for T2. The immediate learning effect (T0 vs T1) was +24% (IQR, 12%-34%; P300 minutes yielded the greatest residual effect (24%). CONCLUSIONS Moderate time invested in e-learning yielded significant immediate and residual learning effects. Decision makers could consider promoting e-learning as a supporting tool in HAI prevention. Infect Control Hosp Epidemiol 2016;37:1052-1059.