Azila-Gbettor EM et al.

Student adjustment during Covid-19 pandemic: Exploring the moderating role of university support

CELL, February 2023; doi.org/10.1016/j.heliyon.2023.e13625

Abstract

The study investigates the moderating effect of university support on the association between fear of Cov19 and student adjustment including (a) academic; (b) psychological; and (c) social adjustment. A total of 592 students took part in the research by completing self-reported questionnaire. The respondents were chosen using a multi-stage sampling technique. The data was processed and analyzed using IBM SPSS version 24 and SEM-PLS, respectively. Results reveal fear of Cov19 negatively predict student's academic, psychological, and social adjustment. University support positively predicts student's academic, psychological, and social adjustment and further mitigate the impact of fear of Cov19 on students' academic, psychological, and social adjustment. This is the first study to examine university support as a moderator between fear of Cov19 and three dimensions of students' adjustment.

Herzlinger R. et al.

Maintaining Health Care Innovations After the Pandemic

JAMA, february 2023; doi:10.1001/jamahealthforum.2022.5404

Abstract

The COVID-19 pandemic exposed the worst failings of the health care system, but it also stimulated a flurry of innovations that could lead to a much-improved delivery system. These were innovations that were born out of necessity: telemedicine access and use skyrocketed, new hospital-at-home services emerged, ambulatory surgical centers expanded their menu of procedures, and a variety of novel therapeutics—such as widespread vaccine distribution, new medical diagnostics, and innovative monoclonal antibodies—were introduced.1 The collection of new services with flexible delivery mechanisms suggested a future that reduces the scope of the legacy and costly brick-and-mortar delivery system and instead forges ahead toward a new era of digital medicine.

With the crisis now behind us, we are witnessing an attempted retrenchment from this spate of innovation. Whereas industry leaders partnered with policy makers during the pandemic to meet the urgencies of the moment, some are now demanding a return to prepandemic delivery models. The period of creativity was made possible by emergency regulatory relaxations, targeted funding, Emergency Use Authorizations, flexible payment models, and a Federal Retail Pharmacy Program that partnered with more than 41 000 retail pharmacy locations nationwide.2 Now, dominant industry interests—as they are prone to do3—are attempting to ensure that temporary measures lapse, old funding mechanisms return to prominence, and regulatory relaxations end.

How can we retain the substantial, potentially transformational innovations that emerged during the pandemic? We argue that preserving useful innovations and combatting the pressure to discard them requires testing the innovations’ clinical quality and value. While traditional interests are making arguments that challenge the economic and quality benefits of the innovations, their business models are not subject to the same robust evaluation. The public needs access to data to scrutinize and, when appropriate, challenge these industry-led assertions. Enabling and preserving value-enhancing innovations require rethinking the health care data infrastructure.

Consider virtual care, which is by far the largest transformation in the market. Medicare saw an increase from 840 000 telehealth visits in 2019 to 52.7 million in 2020.4 Virtual care seemingly provided substantial benefits to patients—providing access during COVID-19 waves for patients receiving routine care services,5 for patients in rural communities (saving hours of travel time for appointments), for working families, and for those with demanding diseases requiring quotidian assistance from clinicians.

A legitimate debate is raging over the benefits of this transition to telehealth. Did it improve access for all populations or exacerbate health disparities? Did it provide the quality of care that could sustain or improve health outcomes? Finally, does telehealth save money, or is it yet one more costly layer atop the traditional care model?6,7

We are in danger of permitting these questions to be answered by the hospitals that worry about losing revenue from lost office visits, physicians who are employed by the hospitals, and insurers who are beholden to the hospital for access to monopolized services. These important policy debates might become resolved not by the merits of the initiatives but instead by short-run financial pressures of these legacy business models. Without definitive public data sources and support for an independent assessment of the COVID-19 response, patients, policy makers, and innovation-seeking payers will be unable to assess the economic or consumer benefits of these innovations and thus unable to counter anti-innovation arguments made by vested interests.

Another danger is letting these policy debates turn on the early experiences and almost inevitable failures of early innovating firms. Often, successful business innovation requires generations of business model development, as first movers cede to followers that learn from the mistakes of early entrants (and do not bear the cost of establishing the market). Nevertheless, the failures of first-mover firms or models are typically used to broadly attack the innovation model. Building innovative and profitable business models takes time and investment, investment that can be rapidly curtailed in an environment that favors the status quo.

One might wonder why insurance providers, which have terabytes of data, do not use them to drive efficiency-enhancing innovation on behalf of their insureds. Experience reveals, however, that insurers have not been the drivers of innovation that drives down costs. One likely reason is that when they are dependent on monopolist or oligopolist health care systems for service delivery, they are hesitant to challenge the hospitals’ core business model. Another reason is that their financial incentives, in part driven by the medical loss ratio and other regulations, do not encourage them to drive down costs; in fact, the medical loss ratio can mean that insurers benefit when spending increases. A third reason is that rethinking health care financing is onerous. It requires a facility with business model innovation that entails risk and uncertainty. Finally, even if insurance providers did find ways to use data to drive efficiencies, they are unlikely to make those data public and instead would use them to acquire private gains over their competitors.

The absence of the clinical, equity, and financial data that could evaluate these differing points of view is the Achilles’ heel of the US COVID-19 pandemic response.8 The massive struggles to integrate public and private data to track the pandemic did not fully succeed. For example, there is no common platform to integrate medical quality home pulse oximeter sensor data with those from electronic health records. The continued reliance on paper medical records, as illustrated by the individual Centers for Disease Control and Prevention COVID-19 vaccination status cards, caused a massive failure in vaccine safety assessment that could instead have provided large-scale postmarketing surveillance data.

Policy makers can and should play a leading role in building up a useful data infrastructure. The final rule implementing the 2016 21st Century Cures Act mandated that electronic health records have application programming interfaces to provide patients with electronic access to their data,9 and aggressive implementation of this rule can provide data access to commercial and academic evaluators. Such an open infrastructure can also invite new types of clinical services for patients, though policy makers should also develop appropriate payment models for these new digital services. Policy makers might even build a new data infrastructure to aid health care markets much as Franklin Delano Roosevelt solved a similar crisis for financial markets. During the Great Depression, Roosevelt created the US Securities and Exchange Commission to provide the uniform data repository that, for the first time, permitted evaluation of the comparative financial performance of publicly traded firms. He called it the Truth Agency to underscore its data role.10

Winston Churchill (and many others) famously said that we should never let a good crisis go to waste. We are in danger of doing exactly that: we may be wasting the benefits of a good crisis. Many heroes rose to the occasion during the COVID-19 pandemic, and the innovation model of relaxed and supportive government policy and a motivated private sector achieved several outstanding successes. But sustaining these innovations will be challenging absent data that can assess what actually happened.

The stakes are higher than many policy makers imagine. Carrying legacy health care business models into the digital age will likely cause health care costs to rise at a double-digit rate over the next few years. The pandemic unleashed decades-worth of pent-up innovation concepts that were largely blocked by competing status quo business models across the health care ecosystem. Evaluating and perhaps extending the record of successful innovation arising from the pandemic will require advocacy, courage, and data-driven leadership from across the health care ecosystem.

Rose Ephraim Matete et al.

Review on the use of eLearning in teacher education during the corona virus disease (COVID-19) pandemic in Africa

Cell, January 2023; doi.org/10.1016/j.heliyon.2023.e13308

Abstract

This study explored the use of eLearning in teacher education during COVID-19 in Africa. The literature review was an important source of information for this study and employed a historical design. From the review, the findings indicate that eLearning accommodates all people regardless of their geographical background and enhances learner-centeredness and self-study opportunities. Findings also indicate that it enhances access to updated content for students and is cost-effective as opposed to conventional methods that need the presence of the teacher, buildings, teaching and learning materials, and physical libraries. However, the findings indicate that eLearning faces the challenges such as health-related problems because of excessive use of computers for a long time which may result in low vision. Findings also indicate the challenge of the digital divide and a lack of stable Internet services and connectivity as they are rarely accessed in many teacher colleges and universities including, a lack of availability of computers for students in African countries. Further, the findings indicate the other challenge of eLearning based on its vulnerability to online attacks on the websites that may lead to questioning the quality of education provided through the eLearning model. The key argument in this study is that eLearning will remain an unavoidable option for the provision of teacher education in the world and African countries in particular at the threshold of a global pandemic similar to COVID-19 regardless of the risks involved. African Governments need to invest in digital learning by strengthening Internet connectivity and improving the Information, Communication, and Technology (ICT) infrastructure, i.e., the provision of computers and Televisions (TVs) to educational institutions to sustain students’ learning during pandemics similar to COVID-19 and other unpredictable situations.

Fei-feng Li et al.

Perceptions towards online learning among medical students during the COVID-19 pandemic

Cell, January 2023; doi.org/10.1016/j.heliyon.2023.e13119

Abstract

Social distancing has been essential during the COVID-19 pandemic to slow the spread of the disease. Online learning ensures students can participate in learning activities while also maintaining a physical distance from other students. Although online learning was used to prevent the spread of COVID-19, the development of online learning has also been promoted. Here, we sought to explore the perceptions and responses of students to online learning during the pandemic using a cross-sectional study. Electronic questionnaire was used for data collection. Statistical analyses were performed for 1614 valid questionnaires and P < 0.05 was considered statistically significant. Overall, COVID-19 had more effect on female students, such as fear of COVID-19 (2.4 times higher than the number of male students) and length of time spent learning (H = 42.449, P < 0.05). However, the higher the students’ grades were, the less the impact of COVID-19. For the style of lessons, all students would prefer shorter lessons (P < 0.05). Female and fifth-grade students were more prefer combined online and face-to-face learning, and male and freshmen students were more likely to prefer face-to-face learning after the pandemic. More than 50% of students thought the main advantage of online learning was convenience, with low efficiency being a disadvantage. The main factors negatively influencing online learning were eyestrain, poor network connections, and poor learning environments at home. In conclusion, synchronous online and face-to-face learning may become more common in future curricula, however the efficiency of online learning and the female students more attentions.

P.H. Conway et al.

The Future of Home and Community Care

N Engl J Med, August 2022; doi: 10.1056/CAT.22.0141

Abstract

Home and community care is poised to grow. Restoring these services requires a range of capabilities and risk-based payment. It is hard to believe that medical house calls used to make up 40% of all U.S doctors’ visits. Home visits used to be the norm, but somewhere in the mid-20th century something changed, and by 1980 house calls accounted for fewer than 1% of patient encounters. As a result, people have largely forgotten about the once-famous black medical bag that physicians used to carry from door to door.