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During the COVID-19 pandemic, many educational institutions followed the blended learning system. Using the participants' opinions, we evaluated the Blackboard Collaborate Platform for online team-based learning sessions for undergraduate students from different medical programs in the KSA. The participants were students on the MBBS Program (157 year two and 149 year three), together with 53 students in year one of the Nursing Program, 25 in year two of the Doctor of Pharmacy Program, and 11 in year two of the Medical Laboratory Sciences Program in Fakeeh College for Medical Sciences, KSA. To assess students' recall, engagement, and satisfaction with the sessions, an online TBL plan was designed and reviewed by the Medical Education Department. The students completed an online survey at the end of each session. All responses in this study showed a statistically significant positive difference from the neutral mid-point response (P < 0.05), reflecting high satisfaction. In the MBBS Program, the survey was completed by 40 students in year two and 76 in year three. The mean responses were 4.1 ± 0.3 and 3.9 ± 0.2 respectively (mean ± SD). In the BSN Program, 19 students completed the survey. The mean response was 4.6 ± 0.2. In the Pharm D Program, 10 students completed the survey. The mean response was 4.9 ± 0.12. In the MLS Program, eight students completed the survey. The mean response was 4.8 ± 0.12. It was concluded that online TBL using Blackboard Collaborate is a successful anatomy learning tool among FCMS students on different programs. This article is protected by copyright. All rights reserved.

Background Malnutrition status, body composition indicators, and bioelectrical impedance analysis (BIA) parameters have been associated with increased risk of death in several pathologies. The aim of this study was to describe the associations between phase angle (PhA) indicators obtained by BIA with length of hospital stay, days on mechanical ventilation, and 60‐day mortality in critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Methods This is a prospective cohort of mechanically ventilated patients with coronavirus disease 2019 (COVID‐19). We assessed nutrition risk and body composition with BIA within 48 h from intensive care unit admission. Logistic and linear regression models were used to analyze the association between variables and clinical outcomes. Survival analysis by PhA value was performed using Kaplan‐Meier curves. Results Sixty‐seven patients were included. PhA (odds ratio [OR], 0.36; P = .002), standardized PhA (SPA) (OR, 0.45; P = .001), and extracellular water/total body water ratio (OR, 3.25; P = .002) were significant predictors of 60‐day mortality. PhA

Background Coronavirus disease 2019 (COVID‐19) has caused an increase in patients requiring enteral feeding access while undergoing proning for severe acute respiratory distress syndrome (ARDS). We investigated the safety and feasibility of fluoroscopy‐guided nasojejunal (NJ) feeding tube placement in the prone position. Methods This is a retrospective cohort study of all patients who underwent fluoroscopic placement of NJ feeding tubes at a single institution between March 2020 and December 2020. Primary end points were success rate and number of attempts. Chi‐squared and Fischer exact tests were used to compare prone and supine groups. Results A total of 210 patients were included in the study: 53 patients received NJ feeding tubes while prone and 157 while supine. All but one patient in the prone group had ARDS secondary to COVID‐19, whereas 47 (30.3%) had COVID‐19 in the supine group. The rate of successful placement was 94.3% in the prone group and 100% in the supine group. Mean number of attempts was 1.1 (SD, ±0.4) in the prone and 1.0 (SD, ±0.1) in the supine group (P = .14). Prone patients had a longer median fluoroscopy time (69 s, interquartile range [IQR] = 92; vs 48 s, IQR = 43; P < .001) and received a higher radiation dose during the procedure (47 mGy, IQR = 50; vs 25 mGy, IQR = 33; P = .004). No procedural complications were reported. Conclusion Fluoroscopy‐guided NJ feeding tube placement in prone patients is feasible and safe. Patient positioning should not delay obtaining postpyloric feeding access.

The inclusion of human body dissection in anatomical science curricula has been described as a critical educational experience for the mastery of anatomical structures and concepts. To ensure that body donors are ethically acquired and suitable for anatomy education, Anatomical Donation Programs (ADPs) are tasked with the responsibility of acquiring body donors for basic and clinical science curricula. Considering the personal and institutional impact of SARS‐CoV‐2, a national survey was conducted to examine the current effect of the pandemic on ADP protocols, body donation, and the sustainability of ADPs in the United States (U.S.). Eighty‐nine U.S. ADPs were identified and contacted for optional participation in a survey to assess the impact of the SARS‐CoV‐2 pandemic on their programs. Survey data were collected and managed using REDCap electronic data capture tools. Thirty‐six ADPs (40.5% response rate) from the nine U.S. Divisions are represented in the survey results. Data were collected on ADP descriptions and demographics, SARS‐CoV‐2 impact on ADPs and protocols, and body donation and ADP sustainability. Almost all ADPs reported that the pandemic has affected their ADP operations in some way; however, the sustainability for the majority of ADPs appears likely and donor availability remains stable due to a proportional decrease in body donations and body donor requests. As the long‐term impact on ADPs has yet to be determined, the authors plan to reevaluate the lasting impact of the SARS‐CoV‐2 pandemic on body donation, ADP sustainability, and anatomical science education throughout the year 2021.

Background: Administering medication through an enteral feeding tube (FT) is a frequent cause of errors resulting in increased morbidity and cost. Studies on interventions to prevent these errors in hospitalized patients, however, are limited. Objective: The objective was to study the effect of a clinical decision support system (CDSS)–assisted pharmacy intervention on the incidence of FT-related medication errors (FTRMEs) in hospitalized patients. Methods: A pre-post intervention study was conducted between October 2014 and May 2015 in Catharina Hospital, the Netherlands. Patients who were admitted to the wards of bowel and liver disease, oncology, or neurology; using oral medication; and had an enteral FT were included. Preintervention patients were given care as usual. The intervention consisted of implementing a CDSS-assisted pharmacy check while also implementing standard operating procedures and educating personnel. An FTRME was defined as the administration of inappropriate medication through an enteral FT. The incidence was expressed as the number of FTRMEs per medication administration. Multivariate Poisson regression was used to calculate the incidence ratio (IR) comparing both phases. Results: Eighty-one patients were included, 38 during preintervention and 43 during the intervention phase. Incidence of FTRMEs in the preintervention phase was 0.15 (95% CI, 0.07–0.23) vs 0.02 (95% CI, 0.00–0.04) in the intervention phase, resulting in an adjusted IR of 0.13 (95% CI, 0.10–0.18). Discussion: Incidence of FTRMEs, as well as the IR, is comparable to previous studies. Conclusion: The intervention resulted in a substantial reduction in the incidence of FTRMEs.

Background Whether decreased physical functioning of patients with mitochondrial disease (MD) is related to altered body composition or low protein intake needs clarification at the background of the nutrition state. Methods In this 2‐site cross‐sectional study, MD patients were age‐, body mass index (BMI)–, and gender‐matched to controls. Body composition was assessed by dual‐energy x‐ray absorptiometry. Physical functioning was measured by handgrip strength, 6‐minute walking test, 30‐second sit‐to‐stand test (30SCT), and 6‐minute mastication test. Total daily protein intake was calculated by 3‐day food records. Malnutrition was assessed by Patient‐Generated Subjective Global Assessment and the Global Leadership Initiative on Malnutrition (GLIM) criteria and sarcopenia by the 2018 consensus. Data were analyzed using independent samples t‐tests, Fisher exact test, and Spearman and Pearson correlation coefficients. Results Thirty‐seven MD patients (42 ± 12 years, BMI: 23 ± 4 kg/m2, 59% females) and 37 matched controls were included. Handgrip strength was moderate, inversely related to fat mass index in both MD patients and controls, whereas it correlated with fat‐free mass index in controls solely. Protein intake was associated with muscle strength (handgrip strength and 30SCT) in MD patients but not in controls. Twenty‐seven MD patients (73%) were malnourished, and 5 (14%) were classified as sarcopenic. Conclusions Muscle strength is related to body composition and protein intake in MD patients. This, in combination with the high incidence of both malnutrition and sarcopenia, warrants individual nutrition assessment in MD patients., Journal of Parenteral and Enteral Nutrition, 45 (1), ISSN:0148-6071, ISSN:1941-2444

Introduction Recent studies have revealed the extended nature of smooth muscle structures in the pelvic floor, revising the conventional understanding of the “perineal body.” Our aim was to clarify the three‐dimensional configuration and detailed histological properties of the smooth muscle structures in the region anterior to the rectum and anal canal in men. Materials and methods Four male cadavers were subjected to macroscopic and immunohistological examinations. The pelvis was dissected from the perineal side, as in the viewing angle during transperineal surgeries. Serial transverse sections of the region anterior to the rectum and anal canal were stained with Masson's trichrome and immunohistological stains to identify connective tissue, smooth muscle, and skeletal muscle. Results There was a series of smooth muscle structures continuous with the longitudinal muscle of the rectum in the central region of the pelvic floor, and three representative elements were identified: the anterior bundle of the longitudinal muscle located between the external anal sphincter and bulbospongiosus; bilateral plate‐like structures with transversely‐oriented and dense smooth muscle fibers; and the rectourethral muscle located between the rectum and urethra. In addition, hypertrophic tissue with smooth muscle fibers extended from the longitudinal muscle in the anterolateral portion of the rectum and contacted the levator ani. Conclusions The series of smooth muscle structures had fiber orientations and densities that differed among locations. The widespread arrangement of the smooth muscle in the pelvic floor suggests a mechanism of dynamic coordination between the smooth and skeletal muscles.

Rationale Malnutrition is highly prevalent in hospitalized patients, but seldom recognized and treated. Malnutrition poses several adverse events, such as increased infection rates, length of hospital stay, and mortality, as well as costs. Early nutrition interventions have been shown to decrease the associated malnutrition burdens, leading to relevant savings. Thus, this study aims to evaluate the cost-effectiveness of nutrition therapy, including oral supplements to at-risk or malnourished adult inpatients admitted to the Brazilian Public System (SUS) hospitals. Method A cost-effectiveness model, encompassing a one-year period regarding total costs, length of hospital stay, readmissions, and mortality related to malnutrition, was developed, having the provision of early nutrition therapy as the intervention variable. The number of avoided hospitalization days prevented hospital readmissions and deaths defined the effectiveness of the model. All the costs were estimated based on the SUS database. Results Early nutrition therapy provided to all at-risk or malnourished patients would represent cost-effectiveness of US$92.24, US$544.59, US$1,848.12, and US$3,698.92, per day of hospitalization avoided, for additional patients having access to hospitalization, for preventing readmission, and death, respectively. The highest impact on savings was represented by the mean reduction in the length of hospital stay. Conclusion Early oral nutrition intervention to at risk of malnutrition or malnourished patients resulted in overall reduced hospital costs. These findings provide a rationale to tackle the implementation of educational programs focusing on the care of inpatients with malnutrition or its risk. This article is protected by copyright. All rights reserved.

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