A proposed learning environment framework for virtual care.

The way in which health care is delivered has rapidly changed since the onset of the COVID-19 pandemic, with a rapid increase in virtual delivery of clinical care. As a result, the learning environment (LE) in health professions education, which has traditionally been situated in the bricks-and-mortar clinical context, now also requires attention to the virtual space. As a frequently examined topic in the health professions literature, the LE is a critical component in the development and training of future healthcare professionals. Based on a published conceptual framework for the LE from Gruppen et al. in 2019, a conceptual framework for how the LE can manifest through virtual care space is presented here. The four components of personal, social, organizational, physical/virtual spaces are explored, with a discussion of how they can be integrated into virtual care. The authors provide suggestions that health professions educators can consider when adapting their LE to the virtual environment and highlight aspects of its integration that require further research and investigation.

La prestation des soins de santé a connu un changement fulgurant depuis le début de la pandémie de la COVID-19, notamment en raison de la virtualisation des soins cliniques. Par conséquent, l'environnement d'apprentissage (EA) qui, dans l'enseignement traditionnel des professions de la santé, se situait dans un cadre clinique physique, doit désormais inclure l'espace virtuel. Sujet souvent exploré dans la littérature en sciences de la santé, l'environnement d'apprentissage est un élément essentiel de la formation des futurs professionnels de la santé. Nous proposons un cadre conceptuel, inspiré du cadre de l'EA élaboré par Gruppen et al. en 2019, sur la façon de définir un EA dans l'espace de soins virtuel. Après avoir exploré les quatre dimensions de l'espace, à savoir personnelle, sociale, organisationnelle et physique/virtuelle, les auteurs analysent la façon de les intégrer dans les soins virtuels. Ils formulent des suggestions à l'intention des enseignants des professions de la santé concernant l'adaptation de leur environnement d'apprentissage à l'environnement virtuel, tout en soulignant les aspects d'une telle intégration qui nécessitent des recherches plus approfondies.

Clinical evidence based review and recommendations of aerosol generating medical procedures in otolaryngology - head and neck surgery during the COVID-19 pandemic.

BACKGROUND: Aerosol generating medical procedures (AGMPs) present risks to health care workers (HCW) due to airborne transmission of pathogens. During the COVID-19 pandemic, it is essential for HCWs to recognize which procedures are potentially aerosolizing so that appropriate infection prevention precautions can be taken. The aim of this literature review was to identify potential AGMPs in Otolaryngology - Head and Neck Surgery and provide evidence-based recommendations. METHODS: A literature search was performed on Medline, Embase and Cochrane Review databases up to April 3, 2020. All titles and abstracts of retrieved studies were evaluated and all studies mentioning potential AGMPs were included for formal review. Full text of included studies were assessed by two reviewers and the quality of the studies was evaluated. Ten categories of potential AGMPs were developed and recommendations were provided for each category. RESULTS: Direct evidence indicates that CO2 laser ablation, the use of high-speed rotating devices, electrocautery and endotracheal suctioning are AGMPs. Indirect evidence indicates that tracheostomy should be considered as potential AGMPs. Nasal endoscopy and nasal packing/epistaxis management can result in droplet transmission, but it is unknown if these procedures also carry the risk of airborne transmission. CONCLUSIONS: During the COVID-19 pandemic, special care should be taken when CO2 lasers, electrocautery and high-speed rotating devices are used in potentially infected tissue. Tracheal procedures like tracheostomy and endotracheal suctioning can also result in airborne transmission via small virus containing aerosols.

Gold laser versus curettage adenoidectomy: incidence of complications and otorrhea after concurrent pressure-equalization tube placement.

OBJECTIVES: To measure the incidence of postoperative complications and otorrhea in patients undergoing Gold laser or curettage adenoidectomy with pressure-equalization (PE) tube placement. STUDY DESIGN: A prospective study of 100 patients, ages 8 to 48 months, undergoing Gold laser (n = 50) or curettage adenoidectomy (n = 50) and PE tube placement in a pediatric outpatient setting. METHODS: Pediatric patients with chronic otitis media with effusion and adenoid hypertrophy after failure of medical management were included in the study. Adenoid size and middle ear status were recorded at surgery. The total adenoidectomy procedure time was recorded. All patients were evaluated at 1 week, 1 month, and 4 months postoperatively. The incidence of nasal complications and otorrhea was recorded. RESULTS: There was no statistical difference in age, race, sex, adenoid size, or middle ear status between groups. The laser group had a shorter procedure time (P = .001) and a lower incidence of otorrhea (P = .024). There was no difference in nasal complications between groups. CONCLUSIONS: The Gold laser adenoidectomy technique can be safely performed with PE tube placement and may offer advantages over the traditional curettage adenoidectomy technique.

Ets-1 activates parathyroid hormone-related protein gene expression in tumorigenic breast epithelial cells.

Parathyroid hormone-related protein (PTHrP) is produced by many tumors not associated with humoral hypercalcemia, including breast cancers. In this study, we used three human immortalized mammary epithelial cell lines that differ in tumorigenicity and PTHrP expression. Using RT-PCR we investigated 5' and 3' alternative splicing of PTHrP transcripts and promoter usage in the lines. Increased levels of P3-derived transcripts and the 1-139 mRNA isoform were observed in the most tumorigenic cell line. Transient transfection experiments identified elements close to P3 promoter that appeared to account for a portion of differential PTHrP expression among the three cell lines. Using site-directed mutagenesis, a previously described Ets-1/Sp1 binding site upstream of P3 was determined to be crucial for full activity of this promoter. RT-PCR and western blot evaluation of Ets family member expression found that Ese-1 was present in all three lines, but that appreciable levels of Ets-1 protein were present exclusively in the most tumorigenic line. Cotransfection of Ets-1 expression vectors activated PTHrP reporter constructs in the most tumorigenic line but not in the other cell lines. These findings suggest a potential mechanism by which PTHrP transcription may be regulated as a consequence of events that promote tumorigenic behavior in breast epithelial cells.

Nipple connective tissue and its development: insights from the K14-PTHrP mouse.

Parathyroid hormone-related protein (PTHrP) regulates a wide variety of developmental processes. Keratin 14 (K14) promoter-mediated overexpression of PTHrP in the epidermis during development converts the entire murine ventral skin to hairless nipple-like skin. In this report, we characterize the morphology and processes that influence the development of nipple connective tissue. The connective tissue of the nipple displayed increased levels of proteoglycans, and collagen bundles with atypical morphology, as well as increased numbers of mast cells, capillaries, nerve fibers and dermal melanocytes. The unique characteristics of nipple connective tissue were not present until mice reach 3-4 weeks of age. The adult male K14-PTHrP mouse has a less dramatic ventral skin phenotype, and does not manifest a nipple-like dermis. Ovariectomy or orchiedectomy prior to sexual maturity had no impact on the ventral skin of the male or female K14-PTHrP mice, but exposure to androgens in utero repressed many of the nipple-like characteristics in the ventral skin of the female K14-PTHrP mice.