Silica-Based Stimuli-Responsive Systems for Antitumor Drug Delivery and Controlled Release

The administration of cytotoxic drugs in classical chemotherapy is frequently limited by water solubility, low plasmatic stability, and a myriad of secondary effects associated with their diffusion to healthy tissue. In this sense, novel pharmaceutical forms able to deliver selectively these drugs to the malign cells, and imposing a space-time precise control of their discharge, are needed. In the last two decades, silica nanoparticles have been proposed as safe vehicles for antitumor molecules due to their stability in physiological medium, high surface area and easy functionalization, and good biocompatibility. In this review, we focus on silica-based nanomedicines provided with specific mechanisms for intracellular drug release. According to silica nature (amorphous, mesostructured, and hybrids) nanocarriers responding to a variety of stimuli endogenously (e.g., pH, redox potential, and enzyme activity) or exogenously (e.g., magnetic field, light, temperature, and ultrasound) are proposed. Furthermore, the incorporation of targeting molecules (e.g., monoclonal antibodies) that interact with specific cell membrane receptors allows a selective delivery to cancer cells to be carried out. Eventually, we present some remarks on the most important formulations in the pipeline for clinical approval, and we discuss the most difficult tasks to tackle in the near future, in order to extend the use of these nanomedicines to real patients.

Got Skills?

Health professional education is designed to help learners gain the knowledge, skills, and attitudes needed for practice. There has been extensive reform in health professional curriculums to emphasize the teaching, development, and assessment of clinical skills. As medical education continues to evolve due to changes in healthcare, and with the ever-increasing growth of technology, it is important to ensure that health professional students are ready to practice successfully. Many curriculums have incorporated clinical skills laboratories to provide learners a safe and protected environment to practice those skills necessary for their profession. Thus, students must acquire, maintain, and enhance their clinical skills techniques as they progress in their education and be properly assessed before they approach real patients. The emergence of the COVID-19 pandemic required educational transition to a remote platform, providing both challenges and opportunities for health education. This chapter reviews how remote skills-based courses can teach and assess clinical skills effectively.

Proof of Concept: Game-Based Mobile Learning—The First Experience With the App Actionbound as Case-Based Geocaching in Education of Veterinary Neurology

Case-based learning is a valuable tool to impart various problem-solving skills in veterinary education and stimulate active learning. Students can solve imaginary cases without the need for contact with real patients. Case-based teaching can be well performed as asynchronous remote-online class. In time of the COVID-19-pandemic, many courses in veterinary education are provided online. Therefore, students report certain fatigue when it comes to desk-based online learning. The app “Actionbound” provides a platform to design digitally interactive scavenger hunts based on global positioning system (GPS)—called “bounds” —in which the teacher can create a case study with an authentic patient via narrative elements. This app was designed for multimedia-guided museum or city tours initially. The app offers the opportunity to send the students to different geographic localizations for example in a park or locations on the University campus, like geocaching. In this way, students can walk outdoors while solving the case study. The present article describes the first experience with Actionbound as a tool for mobile game-based and case-orientated learning in veterinary education. Three veterinary neurology cases were designed as bounds for undergraduate students. In the summer term 2020, 42 students from the second to the fourth year of the University of Veterinary Medicine Hannover worked on these three cases, which were solved 88 times in total: Cases 1 and 2 were each played 30 times, and case 3 was played 28 times. Forty-seven bounds were solved from students walking through the forest with GPS, and 41 were managed indoors. After each bound, students evaluated the app and the course via a 6-point numerical Likert rating scale (1 = excellent to 6 = unsatisfactory). Students playing the bounds outdoors performed significantly better than students solving the corresponding bound at home in two of the three cases (p = 0.01). The large majority of the students rated the course as excellent to good (median 1.35, range 1–4) and would recommend the course to friends (median 1.26, range 1–3). Summarizing, in teaching veterinary neurology Actionbound's game-based character in the context of outdoor activity motivates students, might improve learning, and is highly suitable for case-based learning.

Three-Dimensional Virtual Anatomy as a New Approach for Medical Student’s Learning

Most medical and health science schools adopt innovative tools to implement the teaching of anatomy to their undergraduate students. The increase in technological resources for educational purposes allows the use of virtual systems in the field of medicine, which can be considered decisive for improving anatomical knowledge, a requisite for safe and competent medical practice. Among these virtual tools, the Anatomage Table 7.0 represents, to date, a pivotal anatomical device for student education and training medical professionals. This review focuses attention on the potential of the Anatomage Table in the anatomical learning process and clinical practice by discussing these topics based on recent publication findings and describing their trends during the COVID-19 pandemic period. The reports documented a great interest in and a positive impact of the use of this technological table by medical students for teaching gross anatomy. Anatomage allows to describe, with accuracy and at high resolution, organ structure, vascularization, and innervation, as well as enables to familiarize with radiological images of real patients by improving knowledge in the radiological and surgical fields. Furthermore, its use can be considered strategic in a pandemic period, since it ensures, through an online platform, the continuation of anatomical and surgical training on dissecting cadavers.

The Role of Simulated Patient in Physiotherapy Education: A Review Article

Introduction: Using Simulated Patients (SPs) in clinical skills education is a common method of training students to improve their skills for future client encounters. This systematic review aims to provide an overview of the SP strategy in Physical Therapy (PT) education. Materials and Methods: PubMed, Scopus, and Web of Science databases were searched from January 1980 up to November 2019. Different keywords related to the topic were selected using MeSH. Any types of quantitative study design which had used simulation-based learning in physical therapy were eligible for inclusion. Two reviewers read studies and appraised them critically. Results: A total of 1049 abstracts were retrieved and after reviewing the full-text paper, 11 full- text articles met the inclusion criteria. These studies had used simulated patients for various objectives, including replicate different aspects of knowledge, self-perceived skills, real clinical practice, attitudes, and feasibility. Based on the result of studies, SP as an educational technique can improve student’s clinical reasoning skills, communication, and motivation in a safe environment. Conclusion: SP is a useful learning strategy to deliver learning activities in medical education and physical therapy curricula, facilitating feedback on students’ performance with opportunities to interact with real patients and environments.

How Demanding Is Healthcare Work? A Meta-Analytic Review of TLX Scores

This study establishes how demanding healthcare work is experienced to be and whether nurses and physicians experience different levels of workload. A meta-analytic review was conducted of 87 studies that reported Task Load Index (TLX) scores for healthcare work. Of these studies, 37 were conducted in real-life settings and 50 in lab settings without real patients. In real-life settings, clinicians experienced a workload with a mean TLX of 49 (on a 0-100 scale). Divided onto staff groups, the mean TLX for nurses was 63, which was significantly higher than the mean of 40 for physicians. Among the six TLX subscales, the main contributors to workload were mental demand, temporal demand, and effort. They were higher than physical demand and frustration. The clinicians experienced their performance – the last subscale – as closer to poor than good in 38% of the studies conducted in real-life settings. The difference between nurses and physicians was consistent across all subscales, except mental demand. Finally, it is methodologically important that TLX scores appeared not to transfer directly from lab to real-life settings. To reduce the risk of errors and burnout, new healthcare procedures and technologies should be evaluated for their impact on workload.

DEVELOPMENT OF A CHATBOT TO IDENTIFY DEPRESSION THROUGH A QUESTIONNAIRE

Purpose: to develop and test a prototype of Chatbot (Artificial Intelligence) with the purpose of applying a questionnaire to assess depression in visually impairmed invidivuals. Methods: This project was carried out in the Innovation in Health Technology Laboratory of the Sao Paulo Federal University. The Chatbot was developed using the platform BLiP. The social demography questionnaire and the Center for Epidemiological Scale Depression (CES D) were selected to collect the essential data and to identify the presence of depression, respectively. After the development, validation tests were applied to verify the functionality and structure of the chatbot. Results: The Chatbot prototype presented an excellent flow of conversation in the tests conducted. The questionnaires were applied in a satisfactory manner during the tests, showing that it could possibly be applied to real patients with depression symptoms. Software validation tests approved the prototypes function. Conclusions: The Chatbot prototype is an affordable and easy way to apply questionnaires that can be used to identify health conditions, such as the likelihood of being depressed. The Chatbot system can record the answers so it is analyzed by health care professionals to help decide if an intervention is necessary. KEYWORDS: Artificial Intelligence; Depression; Ophthalmology; Vision Disorders.

Impact of a Disaster Drill on Waiting Times in a Pediatric Emergency Department

Objective: Emergency departments should improve their preparedness for mass casualty incidents (MCIs) through periodic drills. These exercises are conducted while maintaining regular care. The aim of this study was to determine the impact of a disaster drill in a pediatric emergency department (PED) on real patients’ waiting times. Methods: On September 10, 2019, a 4-h disaster drill was conducted in the PED of a tertiary pediatric hospital, with minimal staff reinforcement (2 nurses). Cases were real patients that came to the PED during the drill. The patients that visited the PED the day before were the control group. Variables analyzed were: age, sex, destination, triage level, time-to-triage, time-to-physician, length of PED stay, and percentage of patients visited within the optimal time according to triage level. Results: Sixty-eight patients (case group) and 63 patients (control group) were analyzed; both groups were comparable except for the median age. There were no differences in time-to-triage, time-to-physician, and length of PED stay between the 2 groups. The percentage of patients visited within optimal time according to triage level was higher in the case group. Conclusions: Conducting an MCI drill in the PED, with minimal staff reinforcement, was not detrimental to real patients’ waiting times.

An online international comparison of palliative care identification in primary care using the Surprise Question

Background: The Surprise Question (‘Would I be surprised if this patient died within 12 months?’) identifies patients in the last year of life. It is unclear if ‘surprised’ means the same for each clinician, and whether their responses are internally consistent. Aim: To determine the consistency with which the Surprise Question is used. Design: A cross-sectional online study of participants located in Belgium, Germany, Italy, The Netherlands, Switzerland and UK. Participants completed 20 hypothetical patient summaries (‘vignettes’). Primary outcome measure: continuous estimate of probability of death within 12 months (0% [certain survival]–100% [certain death]). A threshold (probability estimate above which Surprise Question responses were consistently ‘no’) and an inconsistency range (range of probability estimates where respondents vacillated between responses) were calculated. Univariable and multivariable linear regression explored differences in consistency. Trial registration: NCT03697213. Setting/participants: Registered General Practitioners (GPs). Of the 307 GPs who started the study, 250 completed 15 or more vignettes. Results: Participants had a consistency threshold of 49.8% (SD 22.7) and inconsistency range of 17% (SD 22.4). Italy had a significantly higher threshold than other countries ( p = 0.002). There was also a difference in threshold levels depending on age of clinician, for every yearly increase, participants had a higher threshold. There was no difference in inconsistency between countries ( p = 0.53). Conclusions: There is variation between clinicians regarding the use of the Surprise Question. Over half of GPs were not internally consistent in their responses to the Surprise Question. Future research with standardised terms and real patients is warranted.