Global Pandemic Research Articles

OBESITY AND IN-HOSPITAL OUTCOMES AMONG PATIENTS WITH SEVERE COVID-19 IN VIET NAM

Introduction: COVID-19 (Coronavirus disease 2019) is a global pandemic. Overweight and obesity are risk factors related to mortality as well as disease severity. Overweight and obesity are also increasing in Vietnam. Data related to the characteristics of COVID-19 in this vulnerable population was limited in Vietnam. The study was conducted (1) to describe the outcomes of overweight and obese COVID-19 patients, and (2) to investigate factors associated with the outcomes of overweight and obese COVID-19 patients. Methods: A cross-sectional description was conducted at the Hospital for Tropical Diseases from July 2021 to December 2021. Patients who were (1) ≥ 18 years old (2) diagnosed with COVID-19 with a positive RT-PCR SARS-CoV-2 result and (3) had BMI ≥ 23 kg/m2. Female pregnant women or ascites were excluded from this study. To determine factors associated with mortality and ICU admission, chi-square and Fisher's Exact were used. Variables with p < 0.05 were included in the logistic regression model to investigate independent risk factors. Cases directly admitted to the ICU were excluded when analyzing risk factors for ICU admission. Results: 173 patients were recruited (70 patients (40.46%) were overweight, 74 patients (42.77%) were obesity class I and 29 patients (16.76%) were obesity class II). The overall mortality rate was 28.9%. The ICU admission rate was 46.2% with a median ICU stay of 9 (6 – 15.25) days. The rate of respiratory support was 83.8%, of which 31.8% of patients required invasive mechanical ventilation and the median duration of respiratory support was 12 (6.5 – 16.5) days. Independently factors associated with ICU admission were diabetes (OR = 2.92 (1.27 – 6.67)) and a severe or critical condition at admission (OR = 8.82 (2.51 – 31.08). Independently factors associated with death were vaccination (OR = 0.23 (0.08 – 0.63)), a severe or critical at admission (OR = 15.74 (3.46 – 71.55)) and remdesivir usage (OR = 0.78 (0.16 – 0.87)). Recommendation: Vaccination against COVID-19 has been shown to be effective in the obese and overweight population.

Spatial and Temporal Characteristic Analysis and Risk Assessment of Global Highly Pathogenic Avian Influenza H5N8 Subtype

H5N8 HPAI is a highly infectious avian disease that now poses a serious threat and potential risk to poultry farming, wild birds, and public health. In this study, to investigate the seasonality and transmission directionality of global H5N8 HPAI, the spatial and temporal analysis of H5N8 HPAI was conducted using time series decomposition and directional distribution analysis. An ecological niche model was developed for H5N8 HPAI in poultry to identify areas at high risk of H5N8 HPAI in poultry and associated risk factors. The results indicated that three global pandemics of H5N8 HPAI emerged from 2014 to 2022, all showing a southeast–northwest distribution direction. H5N8 HPAI occurred more frequently in winter and less frequently in summer. The southwestern border region and the southeastern region of North America, the southern region of South America, most of Europe, the southern border region and the northern border region of Africa, and the southwestern region and the southeastern region of Asia provide the suitable environment for the occurrence of H5N8 HPAI in poultry. Chicken density, duck density, population density, bio1 (annual mean temperature), and land cover were considered important variables for the occurrence of H5N8 HPAI in poultry. This study can help optimize the use of resources and provide new information for policymakers to carry out prevention and control efforts.

“No-one’s contribution is more valid than another’s”: Committing to inclusive democratic methodologies

In this article, we explore the power and potential of democratic research methodologies in and beyond Critical Disability Studies research contexts. We centre two funded co-produced, participatory and arts-informed projects that have been co-designed and co-led with disabled young people and people living with chronic (respiratory) illness. We critically explore some key processes, which we suggest can mitigate forms of disablism and ableism inherent to research processes which traditionally make them undemocratic spaces of inequity. Our paper offers original analyses into the very notion of democratic research which have significant applications; driven as they are by the presence of disability. These include (i) Crip time - the recognition of (disabled) people’s need for flexible forms of time; (ii) virtual methods and intimacies as routes to equity in research leadership; and (iii) flexible and slow/er research approaches. We also draw upon the ways in which the Covid-19 global pandemic has reshaped methodologies and approaches to inquiry. We advocate that, as research communities, we must come together to keep hold of these new inclusive and hybridised ways of relating and engaging in what are problematically framed as “post-Covid” times. We conclude by emphasising the importance of always committing to disrupting power dynamics through centring flexibility, accessibility and inclusivity across our inquiry with marginalised others.

Effect of Transformational Leadership Behaviour on Employees’ Career Development in Zenith International Bank (ZIB) Plc, North East 3 Zone, Adamawa State, Nigeria: Post COVID-19 Pandemic Experience

The World Health Organisation (WHO) declared the coronavirus (COVID-19) pandemic as a global pandemic. The pandemic has left organisations with a number of challenges, including decreased revenue, decreased consumer spending, poor marketing outcomes, firm closures, reduced staff motivation, virtual working, increasing unemployment, and changes in service delivery and lifestyle. However, due to the rapid growth in global competition, advancements in technology, innovativeness, and growing demands for better customer service, organisational leaders were challenged to devise performance-improvement strategies in order to survive the challenges posed by COVID-19, particularly in Deposit Money Banks (DMBs). Against this backdrop, this study investigates the impact of transformational leadership (TL) behaviours on employee career development (i.e. employee mentoring and coaching). This study conceptualised TL behaviours as idealized influence, inspirational motivation, intellectual stimulation, and individual consideration, while career development as career coaching and career mentoring. The study used an explanatory survey research approach with a sampl of 130 employees from four (4) branches of Zenith International Bank Plc North East 3 Zone, Adamawa State. This study's data were collected via questionnaire. Descriptive statistics such as mean, standard deviation and correlation were used in analysing the data collected, while study's hypotheses were tested using the multiple regression technique. The regression results show that TL behaviours such as inspirational motivation, intellectual stimulation, and individual consideration have favourable significant effect on career development (Mentoring and coaching). While idealised influence has significant adverse effects on career development in both career mentoring and coaching. Overall, the findings indicate that TL positively and strongly predicts career development (i.e. career mentoring and coaching). As a result, this study concludes that TL actions are critical for organisational development and should be supported by managers since they improve employees' career progression within the organisation and have significant effects on numerous employee outcomes.

Typology of employers offering line manager training for mental health.

Mental ill health has a high economic impact on society and employers. National and international policy advocates line manager (LM) training in mental health as a key intervention, but little is known about employer training provisions. To explore the prevalence and characteristics of organizations that offer LM training in mental health. Secondary analysis of existing longitudinal anonymised organizational-level survey data derived from computer-assisted telephone interview surveys collected in four waves (2020:1900 firms, 2021:1551, 2022:1904, 2023:1902) in England, before, during and after a global pandemic. The proportion of organizations offering LM training in mental health increased pre- to post-pandemic (2020:50%, 2023:59%) but 41% do not currently provide it. Logistic regression confirmed that LM training is more likely to be offered by large-sized enterprises, organizations with a larger proportion of employees who are younger (aged 25-49), female, disabled and from ethnic minority communities. Sector patterns were inconsistent, but in 2023, organizations from the 'Hospitality' and 'Business Services' sectors were more likely to provide LM training than other sectors. Continued efforts are needed to increase the proportion of employers offering LM training in mental health, particularly small- to medium-sized enterprises, and organizations with predominantly male, White and/or older workforces.

Transboundary COVID-19 response on health communication in Botswana, South Africa and Zimbabwe

A global COVID-19 pandemic caused untold community disruptions, a huge toll on lives and placed major burdens on the economies of developing countries. It spread worldwide within a short period of time before nations could mobilise evidence for the best responses. Communities in Botswana, South Africa and Zimbabwe were heavily disrupted. This article focuses on exploring the transboundary differences in COVID-19 responses, plus the implications for improving the health communication strategies in a pandemic age. Health practitioners and governments were ill-prepared to inform the general public about the pandemic and enforced complete shutdowns of economic and social activities. With the COVID-19 pandemic ravaging communities, there was a dearth of focused health communication on COVID-19’s end. New tools of communication and dissemination of information were embraced in the southern Africa country-specific cases. For example, content on precautionary lifestyles, individual or personal responsibility and utilisation of community health workers in the pandemic era was prioritised to prevent or minimise infections and avoid recurrence of the disease. New communication methods were important for addressing uncertainty and can be applied for any future pandemic. This health communication topic addresses the neglected, but important gap on the efficacy of processes towards better health communication strategies. The transdisciplinary methods include improved health communication strategies informed by the experiences of three Southern African Development Community countries. While such measures to arrest COVID-19 proved plausible, these countries’ projections for the future are a concern, suggesting an urgent need to enhance and strengthen health communication in southern Africa.Transdisciplinary contribution: This is a transdisciplinary exploration of health communication and its implications for COVID-19 and future pandemic responses in Botswana, South Africa and Zimbabwe.

Genetic Polymorphism of Interleukin-6 in Asymptomatic and ICU-Admitted COVID-19 Patients in Sulaymaniyah Province, Kurdistan Region of Iraq.

Background: The global pandemic of Coronavirus Disease 2019 (COVID-19) has resulted in significant fatality rates. Clinical outcomes for affected individuals range from being asymptomatic to severe illnesses requiring intensive care unit (ICU) admission. Among the various factors contributing to the variation in clinical outcomes, host genetics play a prominent role. Interleukin-6 (IL6), a key player in immune responses, has been identified as having a crucial impact on viral infections, including the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Specifically, certain variations known as single nucleotide polymorphisms (SNPs) in the IL6 promoter region have been found to significantly influence IL6 expression and the severity of viral infections. Materials and Methods: To explore the relationship between these genetic variations and COVID-19 in asymptomatic and ICU-admitted Kurdish patients, genetic sequencing was performed to determine the genotypes of nine IL6 SNPs. Results: The study findings revealed that although the proportion of the GG genotype of rs1800795 was slightly higher in asymptomatic COVID-19 cases, the difference was not statistically significant (chi2 = 2.666, p = 0.236). Notably, Kurdish patients displayed a uniform genetic makeup (monomorphic) for the dominant alleles of rs2069830 (C), rs142759801 (C), rs2069857 (C), rs2069829 (G), rs2234683 (G), rs13447446 (T), rs527770772 (C), and rs13447445 (C). Furthermore, patients carrying the haplotype GCGGCTCCC were found to have a 0.481-fold higher likelihood of being asymptomatic with COVID-19 (p = 0.016, OR = 0.481). Conclusions: This study demonstrates that the rs1800795 SNP is not statistically associated with COVID-19 at the genotype level. However, the presence of the dominant G allele of rs1800795 in the haplotype was found to be statistically associated with asymptomatic COVID-19 patients.

Democratising complex system modelling

In the contemporary context of an acute need for sustainability and swift response to imminent crises such as global warming, pandemics and economic system disruptions, the focus on responsible decision making, ethical risk assessment and mitigation at all organizational levels is an overarching goal. Our aim is to introduce a deterministic method for investigating the stability of complex systems, in order to find the most important elements of such systems and their impact on different scenarios. The novelty of the current approach lies in its compact format and intuitive nature, designed to accommodate a limited amount of computational resources. The proposed modelling method involves the mapping of complex systems from a diversity of disciplines (economic markets, resource management domain and the community impact of suburbanisation) onto a sequence of chemical reactions and involving a subsequent mathematical analysis. Mapping the results back onto the use cases shows that one can retrieve a considerable amount of detail, making the modelling strategy general enough to be adaptable and scalable while also detailed enough to provide valuable insights for practical scenarios.

How Much Potential Do Nucleoside Analogs Offer to Combat Human Corona Viruses?

Nucleoside analogs (NAs) have been extensively examined as plausible antiviral agents in recent years, in particular since the outbreak of the global pandemic of COVID-19 in 2019. In this review, the structures and antiviral properties of over 450 NAs are collected according to the type of virus, namely SARS-CoV, SARS-CoV-2, MERS-CoV, HCoV-OC43, HCoV-229E, and HCoV-NL63. The activity of the NAs against HCoV-related enzymes is also presented. Selected studies dealing with the mode of action of the NAs are discussed in detail. The repurposing of known NAs appears to be the most extensively investigated scientific approach towards efficacious anti-HCoV agents. The recently reported de novo-designed NAs seem to open up additional approaches to new drug candidates.

Analysis of chlorhexidine, antibiotics and bacterial community composition in water environments from Brazil, Cameroon and Madagascar during the COVID-19 pandemic

The widespread of chlorhexidine and antibiotics in the water bodies, which grew during the global COVID-19 pandemic, can increase the dispersion of antibiotic resistance. We assessed the occurrence of these pharmaceutical compounds as well as SARS-CoV-2 and analysed the bacterial community structure of hospital and urban wastewaters from Brazil, Cameroon, and Madagascar. Water and wastewater samples (n = 59) were collected between January–June 2022. Chlorhexidine, azithromycin, levofloxacin, ceftriaxone, gentamicin and meropenem were screened by Ultra-High-Performance Liquid Chromatography coupled with mass spectrometer. SARS-CoV-2 was detected based on the nucleocapsid gene (in Cameroon and Madagascar), and envelope and spike protein-encoding genes (in Brazil). The total community-DNA was extracted and used for bacterial community analysis based on the 16S rRNA gene. To unravel likely interaction between pharmaceutical compounds and/or SARS-CoV-2 with the water bacterial community, multivariate statistics were performed. Chlorhexidine was found in hospital wastewater effluent from Brazil with a maximum concentration value of 89.28 μg/L. Additionally, antibiotic residues such as azithromycin and levofloxacin were also present at concentrations between 0.32–7.37 μg/L and 0.11–118.91 μg/L, respectively. In Cameroon, azithromycin was the most found antibiotic present at concentrations from 1.14 to 1.21 μg/L. In Madagascar instead, ceftriaxone (0.68–11.53 μg/L) and levofloxacin (0.15–0.30 μg/L) were commonly found. The bacterial phyla statistically significant different (P < 0,05) among participating countries were Proteobacteria, Patescibacteria and Dependentiae which were mainly abundant in waters sampled in Africa and, other phyla such as Firmicutes, Campylobacterota and Fusobacteriota were more abundant in Brazil. The phylum Caldisericota was only found in raw hospital wastewater samples from Madagascar. The canonical correspondence analysis results suggest significant correlation of azithromycin, meropenem and levofloxacin with bacteria families such as Enterococcaceae, Flavobacteriaceae, Deinococcaceae, Thermacetogeniaceae and Desulfomonilaceae, Spirochaetaceae, Methanosaetaceae, Synergistaceae, respectively. Water samples were also positive for SARS-CoV-2 with the lowest number of hospitalized COVID-19 patients in Madagascar (n = 7) and Brazil (n = 30). Our work provides new data about the bacterial community profile and the presence of pharmaceutical compounds in the hospital effluents from Brazil, Cameroon, and Madagascar, whose limited information is available. These compounds can exacerbate the spreading of antibiotic resistance and therefore pose a risk to public health.

Patient Outcomes and Healthcare Practices Before and After COVID-19 Vaccination: A Comprehensive Analysis

Abstract: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) unleashed a global pneumonia pandemic, causing significant harm to both physical and mental health. It emphasized the urgency for specialized therapies and protective measures. Approaches, including immunotherapy, antiviral drugs, and lifestyle improvements, like diet and exercise, have shown promise in controlling viral spread before widespread vaccination. However, COVID-19 vaccinations, while critical for reducing disease severity, have been associated with potential side effects, including transient cognitive impairment, rare renal disorders, physiologic anomalies, and dermatological reactions. The scientific community continues to rigorously study these issues to ensure the safety and efficacy of vaccination programs and to address the multifaceted impact of the pandemic.

Masked face recognition using domain adaptation

Wearing facial masks has become a must in our daily life due to the global COVID-19 pandemic. However, the performance of a face recognition system is severely degraded due to the fact that the face images in the gallery are unmasked faces while the probe face images captured by the camera are masked faces, making the probe face images different from gallery face images in the activated region and the distribution domain. In this paper, we propose a novel face recognition system to address the issue. The system is integrated with a domain adaptation layer and a feature refinement layer. The feature refinement layer is based on the structure of the self-attention mechanism to align activated regions of unmasked faces with those of masked faces. The domain adaptation layer works by adapting the system from the unmasked face domain to the synthetically masked face domain and the real- world masked face domain. The system is tested on real-world data through face verification and face identification. The face verification accuracy is improved by 6.83% for the RMFD_FV dataset and 4.2% for the MFR2 dataset, and the face identification accuracy is improved by 15.43% for the MFRFI dataset.

The Moderating Effects of Gender and Age in the Relationship Between 
Job Insecurity and 
Turnover Intention 
During the Global Pandemic

This article explores the effect of perceived job insecurity on employees’ turnover intention during the global pandemic. A conceptual model was developed and tested with data collected from 398 faculty members in higher educational institutions in Southern India. After checking the instrument’s psychometric properties using structural equation modelling, the hypotheses were tested using hierarchical regression. The results indicate that three dimensions of job insecurity—the perceived threat to job features, the perceived threat to total job and the feeling of powerlessness—are positively associated with turnover intentions of faculty members. The results also reveal that age and gender moderated the relationship between (a) perceived threat to total job and turnover intention and (b) feeling of powerlessness and turnover intention. This study recommends that administrators not underestimate the perils of perceived job insecurity in terms of turnover intentions and steps need to be taken to ensure that employees feel safe and continue to work. This study highlights a simple fact: If adequate steps are not taken, crises like the global pandemic may adversely affect organisations.

A comparison of students' preferences for face-to-face and online laboratory sessions: insights from students' perception of their learning experiences in an immunology course.

The COVID-19 global pandemic has prompted educators in universities to reconsider their teaching methods, mainly due to the social distancing measures imposed within the classroom settings. On the other hand, the growing importance of continuing education opportunities for adult learners after graduation has seen the need to transform traditional teaching modes that primarily depend on face-to-face interaction into virtual modes, which are deemed more time- and cost-efficient. These major shifts in social and economic developments have a significant impact on the evolution of curriculum planning in higher education. Education that has scientific inquiry components inevitably comes into question, as conventional beliefs that experiments should be hands-on and will not be as effective if conducted virtually cast doubts on the move to the online space. This paper discusses the background of an impending shift in a university's approach to more online-based laboratory classes in an immunology course, as well as the exploration of the potential of conducting online laboratory experiments based on student perceptions.

Defining the balance between optimal immunity and immunopathology in influenza virus infection.

Influenza A viruses remain a global threat to human health, with continued pandemic potential. In this Review, we discuss our current understanding of the optimal immune responses that drive recovery from influenza virus infection, highlighting the fine balance between protective immune mechanisms and detrimental immunopathology. We describe the contribution of innate and adaptive immune cells, inflammatory modulators and antibodies to influenza virus-specific immunity, inflammation and immunopathology. We highlight recent human influenza virus challenge studies that advance our understanding of susceptibility to influenza and determinants of symptomatic disease. We also describe studies of influenza virus-specific immunity in high-risk groups following infection and vaccination that inform the design of future vaccines to promote optimal antiviral immunity, particularly in vulnerable populations. Finally, we draw on lessons from the COVID-19 pandemic to refocus our attention to the ever-changing, highly mutable influenza A virus, predicted to cause future global pandemics.

“We want our freedom back, that’s our only need”: a qualitative study of health and social needs among asylum seekers and undocumented migrants crossing the borders from Belarus to Lithuania

BackgroundThe influx of undocumented migrants and asylum seekers into Lithuania, particularly during the COVID-19 pandemic, presents unique public health challenges. This study employs the Social Determinants of Health framework to explore the healthcare and social needs of this vulnerable population.MethodsIn May 2022, we carried out a qualitative study through semi-structured interviews with asylum seekers across four centers in Lithuania. Employing both purposive and snowball sampling techniques, we selected participants for our investigation. The study comprised 21 interviews—19 conducted in Arabic and 2 in English—with durations ranging between 20 and 40 min each. We audio-recorded all interviews, transcribed them verbatim, and subsequently performed a thematic analysis using Atlas.ti software. This process of design and analysis strictly followed the principles of thematic analysis as outlined by Braun and Clarke, guaranteeing methodological precision and rigor.Findings21 interviews revealed critical insights into the healthcare access challenges, mental health issues, and social integration barriers faced by the participants. Key themes included ‘Healthcare Needs and the Impact of the COVID-19 Pandemic ‘and ‘Social needs and Aspirations Amidst Pandemic-Induced Uncertainty ‘. The findings highlight the multifaceted healthcare and social needs of asylum seekers, juxtaposed against significant barriers they face. Access to medical services is hindered by long waiting times and financial constraints, especially for specialized care such as dental services. Communication issues during medical appointments due to language barriers and the lack of gender-specific healthcare, such as access to gynecological services, further exacerbate the challenges. Additionally, the COVID-19 pandemic introduces hurdles such as limited testing, isolation measures, language-specific information barriers, and insufficient social distancing practices. Mental health has emerged as a critical concern, with asylum seekers reporting significant stress and emotional exhaustion due to uncertainty and restrictive living conditions. Social needs extend to delayed asylum application processes, inconsistent language education opportunities, inadequate clothing, and nutrition that lacks cultural sensitivity, and living conditions characterized by overcrowding and insufficient facilities. The restricted freedom of movement within asylum seeking centres severely impacts their psychological well-being, underscoring a deep longing for autonomy and a better life despite the myriad of challenges faced.DiscussionThe study illustrates the complex interplay between migration, health, and social factors in the context of a global pandemic. It highlights the need for culturally sensitive healthcare services, mental health support, and structured language education programs. Offering educational avenues alongside language courses for children and adults is essential for fostering social inclusion and securing economic prosperity. Addressing the challenge of language barriers is of utmost importance, as these barriers significantly impede undocumented migrants’ and asylum seekers employment opportunities and their access to crucial services. The findings emphasized immigration as a health determinant and underscored the importance of inclusive health policies and advocacy for undocumented migrants and asylum seekers’ rights and needs.ConclusionThere is an urgent need for comprehensive policies and practices that are grounded in the principles of equity, compassion, and human rights. Additionally, advocating for practice adaptations that are culturally sensitive, linguistically inclusive, and responsive to the unique challenges faced by undocumented migrants and asylum seekers. As global migration continues to rise, these findings are crucial for informing public health strategies and social services that cater to the diverse needs of this vulnerable population.

Research Protocol and Recruitment Redesign of a Study of Pregnant Women and Their Infants During the COVID-19 Pandemic: Childhood Allergy and the NeOnatal Environment (CANOE)

BackgroundRecruitment for research studies is a challenging endeavor that was further complicated by the COVID-19 pandemic. We launched a new NIH-supported multi-center birth cohort, “Childhood Allergy and the NeOnatal Environment” (CANOE) in January 2020 across four sites. While the pandemic temporarily halted clinical research, we restructured the study and instituted novel recruitment methods that we hypothesized would enable brisk enrollment when research activities resumed. ObjectiveDevelop protocol modifications and recruitment methods that promote successful recruitment of diverse populations in clinical research despite a global pandemic. MethodsWhile study activities were suspended, we modified recruitment strategies to limit in-person contact, shifting toward alternative HIPAA-compliant methods like clinician referrals, institutional social media, and telemedicine screening and consent procedures. Protocol changes included reducing the frequency of in-person visits, leveraging clinical care visits to collect biospecimens, expanded self-collection of samples at home, and making study materials available online. ResultsRemote methods, including targeted social media posts, mailed letters, and email, combined with in-clinic recruitment with modifications for social distancing led to successful recruitment at all sites. Rates of consent have been similar across recruitment sites, with the highest rates of enrollment of mother-infant dyads realized by sites that implemented multiple recruitment strategies. ConclusionsStudy procedures that prioritize health and safety measures such as social distancing, study participant convenience, and diverse recruitment strategies enable successful enrollment of pregnant women and their newborns into clinical research while adhering to public health restrictions during a global pandemic.

Is empowerment enough? Exploring lessons from the COVID‐19 pandemic

AbstractThe COVID‐19 global pandemic was a crisis that disproportionately impacted marginalized communities. In one such community—Baltimore, Maryland—we sought to explore how individuals experienced, managed, and recovered from the pandemic. Through five focus groups with 16 participants, four themes emerged: demonstration of empowerment, hopelessness and powerlessness, mental health detriment, and misalignment of resources and needs. Although empowerment was demonstrated, we surprisingly found that participants also exhibited powerlessness and hopelessness, both of which can inhibit engagement in the empowerment process. Implications for FCS professionals, community educators, and policymakers are included.

Rapid Implementation of the Virtual Clinic Concept in an Oncology Department to Minimize the Exposure of Patients with Cancer to COVID-19.

The global pandemic was an emerging challenge that significantly impacted healthcare systems and the delivery of care. Prompt actions and adaptive techniques, such as the virtual clinic, were implemented to ensure the quality and continuity of the care provided. The aim of this quality improvement project was to ensure the smooth implementation and effectiveness of the virtual clinic during the COVID-19 crisis. A specialized team of multidisciplinary healthcare providers was established to systematically ensure the implementation of the virtual clinic within the Department of Oncology. The team used multiple Plan-Do-Study-Act (PDSA) cycles of the quality improvement model to achieve the final goal and facilitate the transition to the virtual clinic. A total of 29 weekly virtual clinic sessions were conducted, covering various oncology services. From March to December 2020, 81% of the scheduled patients (3888) responded to virtual clinic calls. Physicians initiated 234 unplanned virtual clinic calls to follow up on a patient's condition. In addition, 916 medications were shipped to patients as needed. A patient satisfaction survey in May 2020 indicated an overall satisfaction rate of 92% with the virtual clinic process. Staff satisfaction was also high (91%), and 88% of the physicians believed that the virtual clinic would continue beyond the pandemic. Implementing the virtual clinic is achievable through following systematic steps and effectively addressing emerging challenges as required. The concept of the virtual clinic was well accepted by patients and staff.

Attitude, knowledge, and barriers of Chinese clinical and nursing students in implementing complementary and alternative medicine for COVID-19：a cross-sectional study

BackgroundComplementary and alternative medicine (CAM) has emerged to combat the global COVID-19 pandemic. However, no studies have been conducted to evaluate the attitudes, knowledge, and barriers of Chinese clinical and nursing students in implementing CAM during this period. ObjectiveThe aim of this study was to investigate the attitude, knowledge, and barriers of Chinese clinical and nursing students in using CAM in the context of COVID-19. MethodsAn online-based cross-sectional survey was carried out among Chinese medical students, majoring in clinical medicine or nursing, in Nanjing, Jiangsu Province, and Zhengzhou, Henan Province from May to July, 2022. A total of 402 clinical and 644 nursing students responded to a self-administered questionnaire through the Questionnaire Star and WeChat APPs. SPSS 25 (version 25) was used for data analysis. Proportions were compared by Chi-square test. Level of significance between groups was analyzed using independent student t-test and Mann-Whitney U test. ResultsThe average score of attitude was 46.63 (SD: 7.38) in clinical students and 49.84 (SD: 6.76) in nursing students. The top four most commonly used CAM treatments in China were proprietary Chinese medicine, diet therapy, decoction, and acupuncture and moxibustion (59.66%, 22.28%, 11.66%, 9.85%). The students had a good mastery of knowledge about CAM-based prevention and control of COVID-19 (mean score 7.36). The score of CAM knowledge in nursing students was significantly higher than that in clinical students (7.56 VS 7.04, P=0.000). Gender, grade, previous use, age, and knowledge score could affect students’ attitude towards CAM. The main barriers in spreading CAM use included time-consumption, bad taste, and fear of treatment-related pain (24.5%). Compared with clinical students, nursing students were more likely to recommend CAM to patients in the future (P=0.002). ConclusionsDuring the COVID-19 pandemic, nursing students were more positive towards CAM use, had a better mastery of CAM knowledge than clinical students. CAM is expected to provide better outcomes in COVID-19 patients. Future studies should focus on the changes in students’ attitudes over time and exploration of influencing factors on CAM use.