Rolling e-learning: an educational model to support Italian healthcare professionals during the COVID-19 pandemic

BACKGROUND AND AIM

Rolling reviews have been widely used by the scientific community during the COVID-19 pandemic to provide guidelines and identify potential treatments in such a quickly evolving emergency. Throughout the two pandemic years, we provided independent and continuously updated (rolling) e-learning courses on COVID-19 targeted to Italian healthcare professionals with the aim of increasing dissemination based on the emerging evidence. The results of this project are presented in this brief report.

METHODS

We launched five main courses on COVID-19 - with focus on treatments and vaccines - from February 2020 to December 2022. For each course, we collected and analised participation data and, via questionnaires, customer-satisfaction data on relevance, quality, efficacy and sponsor perception.

RESULTS

From 22 February 2020 to 31 December 2022, a total of 224,459 enrollments were registered over the five courses with 192,966 passes (86%), for which Continuing Medical Education (CME) credits were awarded. Over 94% of participants considered the contents of high quality, relevant and effective for their educational needs. The absence of sponsorship perception, 83% overall, decreased relevantly for the two courses on COVID-19 vaccines (68.3%).

CONCLUSIONS

Italian healthcare professionals working during the pandemic overwhelmingly appreciated and valued the rolling e-learning offer aimed at widening the dissemination of the best practices on COVID-19. This educational model provides independent, evidence-based and tailored information with the undoubted advantages of time flexibility, remote participation and continuous update, all elements that make it a useful tool in a pandemic as well as in a post-pandemic era.

Can a validated website help improve university students' e-health literacy?

Background

The fight against fake news, mainly spread through Internet, is a major public health issue, even among undergraduate students. This study aims to evaluate the effectiveness of a website promoted by the Italian Federation of the Provincial Orders of the Medical Doctors as a first aid communication kit for health topics.

Study design

Pre-post study using a web-based survey, conducted in April-May 2019 on Medical students and October-November 2020 on Communication Sciences students at the University of Florence (Italy). Methods. Undergraduate students of both schools were exposed to the use of the "dottoremaeveroche" website. Primary and secondary outcomes measures: the Italian-electronic Health Literacy Scale self-assessment tool was used to examine subjects' electronic Health literacy, and source quality. All responses were rated on a 5-point Likert scale. Changing in perception of abilities were examined using the Wilcoxon test.

Results

The 362 participants felt moderately confident in electronic Health Literacy, with an initial Italian-electronic Health Literacy Scale overall mean score of 3.6±0.7 for medical and 3.2±0.8 for communication students. Medical students had a good idea of how to find helpful sources (3.9±0.8) and communication students felt confident in recognizing their quality (3.5±1.0). In contrast, their confidence in using Web information to make health decisions was low (medical: 2.9±1.1; communication: 2.8±1.1). All items improved significantly after "dottoremaeveroche" use (p<.001), with the overall mean score of Italian-electronic Health Literacy Scale increasing to 4.3±0.6 for medical and 4.1±0.8 for communication students.

Conclusions

Low electronic health literacy levels can affect public health efforts, as seen during the COVID-19 pandemic. The effectiveness of "dottoremaeveroche" among students showed the usefulness of online educational interventions that, if further implemented, could help combat the spread of infodemic.

A Web Tool to Help Counter the Spread of Misinformation and Fake News: Pre-Post Study Among Medical Students to Increase Digital Health Literacy

BACKGROUND

The COVID-19 pandemic was accompanied by the spread of uncontrolled health information and fake news, which also quickly became an infodemic. Emergency communication is a challenge for public health institutions to engage the public during disease outbreaks. Health professionals need a high level of digital health literacy (DHL) to cope with difficulties; therefore, efforts should be made to address this issue starting from undergraduate medical students.

OBJECTIVE

The aim of this study was to investigate the DHL skills of Italian medical students and the effectiveness of an informatics course offered by the University of Florence (Italy). This course focuses on assessing the quality of medical information using the "dottoremaeveroche" (DMEVC) web resource offered by the Italian National Federation of Orders of Surgeons and Dentists, and on health information management.

METHODS

A pre-post study was conducted at the University of Florence between November and December 2020. First-year medical students participated in a web-based survey before and after attending the informatics course. The DHL level was self-assessed using the eHealth Literacy Scale for Italy (IT-eHEALS) tool and questions about the features and quality of the resources. All responses were rated on a 5-point Likert scale. Change in the perception of skills was assessed using the Wilcoxon test.

RESULTS

A total of 341 students participated in the survey at the beginning of the informatics course (women: n=211, 61.9%; mean age 19.8, SD 2.0) and 217 of them (64.2%) completed the survey at the end of the course. At the first assessment, the DHL level was moderate, with a mean total score of the IT-eHEALS of 2.9 (SD 0.9). Students felt confident about finding health-related information on the internet (mean score of 3.4, SD 1.1), whereas they doubted the usefulness of the information they received (mean score of 2.0, SD 1.0). All scores improved significantly in the second assessment. The overall mean score of the IT-eHEALS significantly increased (P<.001) to 4.2 (SD 0.6). The item with the highest score related to recognizing the quality of health information (mean score of 4.5, SD 0.7), whereas confidence in the practical application of the information received remained the lowest (mean of 3.7, SD 1.1) despite improvement. Almost all students (94.5%) valued the DMEVC as an educational tool.

CONCLUSIONS

The DMEVC tool was effective in improving medical students' DHL skills. Effective tools and resources such as the DMEVC website should be used in public health communication to facilitate access to validated evidence and understanding of health recommendations.

Digital Health Literacy and Infodemic: the impact on Italian medical students between 2019-2020

Background

The COVID-19 infodemic is putting pressure on public health systems to control the pandemic. With the internet and social media playing a key role in emergency communication, digital health literacy (DHL) can be considered a determinant of health. This study aims to assess the impact of infodemic on the skills of medical students, for whom low levels of DHL may affect the ability to identify the best available medical evidence.

Methods

A cross-sectional web-based survey was conducted at the University of Florence (Italy) in Apr-May 2019 (pre-pandemic period) and in Nov-Dec 2020 (pandemic period) to investigate DHL skills. Two different cohorts of students, both in their first year of medical school, participated in the survey. The 8-item self-assessment tool (IT-eHEALS) with a 5-point Likert scale was used to examine DHL. The change in perception of ability between the two cohorts was examined using the Wilcoxon test.

Results

A total of 329 students participated in the survey in 2019 (F: 58.1%; mean age 20.6±2.1) and 341 in 2020 (F:61.9%; mean age 19.8±2.0). In 2019, participants’ DHL level was moderate with a IT-eHEALS overall mean score (MS) of 28.4±5.8. Students had a good idea of how to find helpful health information (MS 3.9±0.8) and how to use the web for this purpose (MS 3.8±0.9), but they were less confident about the usefulness of the information they received (MS 2.9±1.1). In 2020, the medical students’ DHL level deteriorated as the overall MS of IT-eHEALS decreased to 23.4±7.2 (p < 0.01). The scores of the IT-eHEALS items were significantly lower and students indicated that they found it difficult to assess the information they found (MS 2.4±1.1; p < 0.01).

Conclusions

DHL can contrast infodemic, but the latter in turn may have a negative impact on perceived DHL skills if personal knowledge base is not well structured. Training programmes for medical students as future health care providers should be reinforces to guide their practise.

Key messages

Impact of the COVID-19 pandemic on psychological well-being of students in an Italian university: a web-based cross-sectional survey

Background

Italy was the first European country to implement a national lockdown because of the COVID-19 pandemic. Worldwide, this pandemic had a huge impact on the mental health of people in many countries causing similar reaction in terms of emotions and concerns at the population level. Our study investigated the impact of the COVID-19 pandemic on psychological well-being in a cohort of Italian university students.

Methods

We conducted a cross-sectional survey in the period immediately after the first lockdown through the administration of a questionnaire on the personal websites of students attending their undergraduate courses at the Università Cattolica del Sacro Cuore. We used the Patient-Health-Engagement-Scale, Self-Rating-Anxiety-Scale, and Self-Rating-Depression-Scale to assess engagement, anxiety symptoms, and depression symptoms of our sample.

Results

The sample size was 501 subjects, of which 35.33% were classified as anxious and 72.93% as depressed. Over 90% of respondents had good understanding of the preventive measures despite over 70% suffered from the impossibility of physically seeing friends and partners. Around 55% of students would have been willing to contribute much more to face the pandemic. An increase in the occurrences of anxiety was associated with being female, being student of the Rome campus, suffering from the impossibility of attending university, being distant from colleagues, and being unable of physically seeing one's partner. Performing physical activity reduced this likelihood.

Conclusions

University students are at risk of psychological distress in the case of traumatic events. The evolution of the pandemic is uncertain and may have long-term effects on mental health. Therefore, it is crucial to study the most effective interventions to identify vulnerable subgroups and to plan for acute and long-term psychological services to control and reduce the burden of psychological problems.

e-Health Literacy among medical students

Background

The struggle against fake medical news, nowadays widely spread by web sources, is a main issue in public health especially in a pandemic period. Even among medical students, there is a lack of eHealth literacy (eHL) skills to solve medical problems. The Italian Medical Doctors Federation (FNOMCeO) promoted a Web source as a first-aid communication kit for basic notions in health hot-topics named “dottoremaeveroche” (DMVEC). This study aims to evaluate its effectiveness in improving eHL.

Methods

Between April and November 2019, medical students from the University of Firenze (Italy) joined a cross-sectional web-based survey before and after accessing the DMVEC Web source. The 8-item self-assessment tool (IT-eHEALS) was used to examine subject's eHL, in addition to questions on source's features and its quality. All responses were rated on a 5-points Likert scale. Changing of abilities' perception was assessed using Wilcoxon test.

Results

A total of 329 joined the survey, 42% male, mean age of 20.6±2.1. Participants felt moderately confident in eHL, in fact the initial eHEALS overall mean score was 3.6± 0.7. Students had a good perception on how to find helpful health resources (mean score 3.9±0.8) and how to use the Internet to answer health questions (mean score 3.8±0.9), but their ability in using this information to make health decisions was low (mean score 2.9±1.1). All items improved after the use of DMVEC, with overall mean score of IT-eHEALS increasing to 4.3±0.6 (p < 0.0001). Regarding source's quality, mean score related to transparency of sources, an aspect underestimated at first, increased from 3.5±1.2 to 4.7±0.7 (p < 0.0001).

Conclusions

Low levels of eHL can damage public health efforts, as seen during COVID19 pandemic. DMVEC effectiveness in medical students demonstrated that the scaling up to the general population of online educational interventions, with further implementation, could help in tackling infodemic and fake news spreading.

Key messages

Moderate levels of eHL among medical students could reflect lower levels in general population, highlighting this as critical issue in public health.

Educational programs addressed to Health professionals could be adapted and empowered considering general population as target.

Renal osteodystrophy with hyperparathyroidism: the diagnostic value of intact parathormone, alkaline phosphatase, osteocalcin and procollagen

In 27 patients on periodic haemodialysis, serum levels of alkaline phosphatase (ALP), osteocalcin (BGP), intact parathyroid hormone (PTHi) and its two fragments, terminal COOH (PTH-Cter) and middle molecule (PTH-MM), and procollagen type 1 carboxy-terminal extension peptide (P1CP) were measured. The same patients underwent radiography of the skull and of the hands, ultrasonography of the parathyroids and scintigraphy of the skeleton with 99mTc-MDP. The study was completed by the measurement of aluminium (Al) in the blood and the deferoxamine test (DFO). Two groups of patients emerged, one (group A, n = 14) with PTHi greatly increased (201.07 +/- 109.72 pg/mL) and the other (group B, n = 13) with values within the normal range (32.69 +/- 17.06 pg/mL) (p < 0.001). In group A, ALP, BGP and particularly P1CP were increased with a statistically significant difference compared to group B. Specific radiographic alterations were found in 12 patients of group A; 7 patients also had hypertrophy of the parathyroids. There was no difference in the scintigraphic alterations of the skeleton between the two groups. The authors conclude that it is the association of the high values of PTHi with those of the markers of bone metabolism, the normal level of Al, the negativity of the DFO test and the radiological alterations which together allow the diagnosis of renal osteodystrophy with hyperparathyroidism.

[Determination of bone mineral content and correlations with calciotropic hormones in periodic hemodialysis patients]

The investigation on several forms of uremic osteodystrophy by means of bone mineral content (BMC) measurement led to contradictory conclusions. BMC in 27 patients on periodical hemodialysis treatment was measured correlating it to the seric levels of Ca, P, Mg, alkaline phosphatase (AP), calcitonin (Ct), osteocalcin (BGP), intact parathormone (PTHi), c-terminal and mean molecule PTH. Patients on dialysis treatment from a long period of time showed high AP and low BMC levels. This correlation proved significant just for the values recorded at a third distal site of radius. Patients with BMC under the normal range showed higher BGP levels and a longer period of dialytic treatment than those presenting normal BMC. The former showed a Ct inverse correlation as to age and mineralization indexes. Higher values of Ct and BMC have been reported in males rather than in females. Hence BMC is not suited to investigate different kinds of uremic osteodystrophy. Seric PTH dosage is certainly best fitted to discriminate patients affected with hyperparathyroidism from those with low turnover osteodystrophy. BMC determination is a valid support to evaluate the bone mineral loss in patients on haemodialysis treatment. It significatively correlates to the duration of the dialytic treatment; it is higher in female than in male population; it mainly affects cortical components rather than trabecular ones and is related to a seric Ct decrease.

[Capillaroscopic studies in connective tissue inflammations]

Capillarioscopy has been unjustifiably neglected in the study of connective tissue diseases, where examination of the microcirculation is clearly important. A study of 80 cases is reported. 12 systemic lupus, 11 progressive systemic sclerosis (PSS), 20 rheumatoid arthritis (including 3 juvenile and 2 Still's disease); 9 Raynaud's disease (of which 3 idiopathic, 4 with rheumatoid arthritis and 2 with UCTD); 1 dermatomyositis; 11 other CTD (2 overlap syndrome--1 lupus + dermatomyositis; 1 lupus + PSS--3 Sjögren syndromes with rheumatoid arthritis, 1 MCTD, 2 primary mixed cryoglobulinaemia, 1 systemic vasculitis, 1 Behçet syndrome, and 1 UCTD); 9 miscellaneous forms (3 psoriatic arthropathy, 1 rheumatic pelvispondylitis, 1 allergic dermatitis, 1 pulmonary TB, 1 ulcerative colitis; 1 scapulohumeral periarthritis, 1 unclassifiable rheumatism; 7 healthy subjects). During capillarioscopy, from one to nine slides were prepared for each subject. These were interpreted separately by three persons who were unaware of the respective diagnosis. Calibre, tortuosity, length and number of capillaries were recorded, plus the visibility of the subpapillar plexus, height and number of the termal, subungual and/or ungual vallum haemorrhage, plugging. It was found that PSS, dermatomyositis, MCTD, and overlap-PSS revealed a very typical common pattern, possibly pathognomonic, namely marked reduction in the number of capillaries + megacapillaries. The other forms presented less evocative diagnostic patterns, though they were fairly indicative in some instances. Clinical correlations of particular significance with respect to prognosis, however, were not observed.