Nelia Afonso - Academia.edu (original) (raw)

Papers by Nelia Afonso

Annals of Emergency Medicine, Oct 1, 2013

Objective This study aims to explore the utility of cardiac ultrasound on medical students' under... more Objective This study aims to explore the utility of cardiac ultrasound on medical students' understanding of cardiac anatomy and physiology. Methods First-year medical students were enrolled and randomized into control and educational groups. Prior to and upon completion of their cardiac unit, both groups completed a 20-question test. The educational group received two sessions, consisting of lectures and hands-on scanning. The educational group obtained a parasternal long axis view of the heart and identified the left ventricle and completed a survey on their experience. Results Fifty-four first-year medical students were enrolled, with 27 randomized to each group. On the pretest, the educational and control groups averaged 10.9 (SD 2.4) and 10.0 (SD 2.7) questions correct (p = 0.19), respectively. Scores on the post-test in the educational group improved to 17.4 (SD 1.6) as compared to 15.2 (SD 2.0) (p < 0.001) in the control. All students in the educational group were able to obtain a parasternal long axis view and identify the left ventricle. On the survey, all students described ultrasound as a valuable tool and recommended integration into their curriculum. Ninety-five percent felt that ultrasound improved their knowledge of cardiac anatomy, and 86 % agreed it increased their understanding of cardiac physiology. Conclusions Introduction of ultrasound into medical school curriculum is effective. This educational intervention improved students' understanding of cardiac anatomy and physiology and was effective in improving their acquisition of basic cardiac ultrasound images. Furthermore, the students felt ultrasound to be an important skill for them to learn to improve their understanding of anatomy and physiology.

Vaccine, 2014

Vaccination of health care workers (HCW) reduces transmission of influenza among patients, yet up... more Vaccination of health care workers (HCW) reduces transmission of influenza among patients, yet uptake of vaccination remains low. If vaccination education is integrated into the early medical school curriculum, will student attitudes toward the vaccine change? The objectives of the study were to: (1) Determine influenza vaccination rates among entering medical students; (2) Assess the attitudes toward influenza vaccination; (3) Evaluate the effects of a multifaceted educational intervention on attitudes to vaccination. Entering medical students were surveyed before and after an intervention at the beginning of the influenza season. This intervention provided by an inter-professional team, included education about influenza, importance of vaccination for HCWs, followed by vaccination administration practice, and ended with students vaccinating consenting classmates. The pre-intervention surveys and intervention were completed by 124 of 125 (99%) students. Pre-intervention survey revealed 60 (48%) of students had been previously vaccinated. Of the vaccinated students 91% had been recommended vaccination by their healthcare provider compared to 43% of non-vaccinated students. More positive attitudes were noted in the vaccinated students compared to non-vaccinated students: importance of vaccination (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01); HCWs should be vaccinated (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01); recommendation of vaccine to family and friends (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). 97 (78%) students completed post-intervention surveys. Significant improvement in these attitudes was noted post-intervention compared to pre-intervention: importance of vaccination 93% versus 71% (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01); HCWs should be vaccinated 95% versus 83% (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01); recommendation to family and friends 93% versus 73% (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01); comfort with vaccine counseling 92% versus 41%; comfort with vaccine administration 84% versus 22% (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). Educating medical students and promoting the importance of vaccination early in a medical student&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s career using such an intervention is relatively simple and easily integrated into the curriculum. This intervention was successful in vaccinating all students, and demonstrated a marked positive shift in attitudes toward influenza vaccination.

Infectious Diseases in Clinical Practice, Feb 1, 2001

In the United States, bone/joint tuberculosis accounted for 2% of 18,361 cases of tuberculosis re... more In the United States, bone/joint tuberculosis accounted for 2% of 18,361 cases of tuberculosis reported in 1998 [1]. The spine, the hip, and knee joints are generally affected, and involvement of the peripheral bones is uncommon [2]. The rare occurrence of extraspinal tuberculous osteomyelitis often in the absence of pulmonary involvement can result in delayed diagnosis. We report a male patient who initially presented with bilateral breast enlargement and was investigated for gynecomastia before the diagnosis of tuberculosis of the ribs was established. A review of literature is presented.

Perspectives on medical education, Feb 13, 2020

Introduction Clinical reasoning is often not explicitly taught to novice medical students. Pre-cl... more Introduction Clinical reasoning is often not explicitly taught to novice medical students. Pre-clerkship clinical skills courses are an ideal venue to teach the clinical reasoning process. The aim of the study was to evaluate the impact of a preclinical clinical reasoning curriculum through an end-of-semester objective structured clinical examination. Methods This study was conducted through our longitudinal clinical skills course. Second year medical (M2) students who received the clinical reasoning curriculum in 2018 formed the study cohort. M2 students from the previous year, who did not have the clinical reasoning curriculum, formed the comparison cohort. Several modalities were used to teach clinical reasoning including whole case approach, serial cue approach, self-explanation of pathophysiological mechanisms and comparison of closely related diagnoses. The students interviewed a standardized patient and documented the history along with three likely diagnoses. Results Students in the study cohort achieved higher scores on differential diagnosis (1.98 vs. 1.64 in the comparison cohort, p < 0.001). There was no statistically significant difference in the frequency of relevant symptoms queried between the study and comparison cohorts (3.74 vs. 3.34, p > 0.05). Discussion Our study confirms that the introduction of clinical reasoning in a pre-clerkship clinical skills curriculum increases students' ability to select rele

PubMed, Oct 1, 2006

Background: Physicians are aware of the National Cholesterol Education Program guidelines; howeve... more Background: Physicians are aware of the National Cholesterol Education Program guidelines; however, most patients fail to attain cholesterol goals. Objective: To determine whether a combined program of patient education and provider awareness could improve the National Cholesterol Education Program goal attainment among patients at high risk for cardiovascular events. Methods: One hundred seven high-risk patients with cardiovascular disease were educated in a single 15-minute session regarding their cholesterol levels, risk factors, and medication adherence. Those with scores of 2 or lower on the Morisky questionnaire were classified as low-adherence patients, and those with scores of 3 or higher were classified as high-adherence patients. Seven physicians were provided this information and were requested to evaluate the dyslipidemia management of these patients. Lipid levels were reevaluated 8 to 12 weeks after the intervention. Results: At the start of the study, 38 (35.5%) of the 107 patients were at target low-density lipoprotein cholesterol (LDL-C) levels, and 64 of the 107 patients (59.8%) were at target levels after the intervention. High-adherence patients decreased their LDL-C levels from a mean of 118.6 mg/dL (3.07 mmol/L) to 98.6 mg/dL (2.55 mmol/L); low-adherence patients increased their LDL-C levels after the intervention from 134.5 mg/dL (3.48 mmol/L) to 142.1 mg/dL (3.68 mmol/L). A comparison between the LDL-C goal achievers vs nonachievers revealed a significant difference in adherence (P = .001). Among the goal achievers, significant decreases in preintervention vs postintervention total cholesterol levels (P = .001) and LDL-C levels (P = .001) were also noted. Conclusion: This study demonstrates that an intervention simultaneously targeting patients and providers is successful in improving goal attainment among high-risk patients.

Public Health Reports, Sep 8, 2022

Objectives:Because health care personnel (HCP) are potentially at increased risk of contracting C... more Objectives:Because health care personnel (HCP) are potentially at increased risk of contracting COVID-19, high vaccination rates in this population are essential. The objective of this study was to assess vaccination status, barriers to vaccination, reasons for vaccine acceptance, and concerns about COVID-19 vaccination among HCP.Methods:We conducted an anonymous online survey at a large US health care system from April 9 through May 4, 2021, to assess COVID-19 vaccination status and endorsement of reasons for acceptance and concerns related to vaccination (based on selections from a provided list).Results:A total of 4603 HCP (12.2% response rate) completed the survey, 3947 (85.7%) had received at least 1 dose of a COVID-19 vaccine at the time of the survey, and 550 (11.9%) reported no plans to receive the vaccine. Unvaccinated HCP were 30 times more likely than vaccinated HCP to endorse religious or personal beliefs as a vaccine concern (odds ratio = 30.95; 95% CI, 21.06-45.48) and 15 times more likely to believe that personal vaccination is not needed if enough others are vaccinated (odds ratio = 14.99; 95% CI, 10.84-20.72). The more reasons endorsed for vaccination (ß = 0.60; P < .001), the higher the likelihood of having received the vaccine. However, the number of concerns about COVID-19 vaccine was not related to vaccination status (ß = 1.01; P = .64).Conclusions:Our findings suggest that reasons for vaccination acceptance and concerns about vaccination need to be considered to better understand behavioral choices related to COVID-19 vaccination among HCP, because these beliefs may affect vaccination advocacy, responses to vaccine mandates, and promotion of COVID-19 vaccine boosters.

MedEdPORTAL, Jan 5, 2015

Abstract Introduction Intimate partner violence (IPV) is a prevalent public health problem, yet m... more Abstract Introduction Intimate partner violence (IPV) is a prevalent public health problem, yet many physicians feel inadequately prepared to identify or treat affected patients. Education of healt...

MedEdPORTAL, Dec 17, 2020

Introduction: The COVID-19 pandemic has radically disrupted traditional models of medical educati... more Introduction: The COVID-19 pandemic has radically disrupted traditional models of medical education, forcing rapid evolution in the delivery of clinical training. As a result, clinical educators must quickly transition away from in-person sessions and develop effective virtual learning opportunities instead. This virtual resource was designed to replace a clinical simulation session for the physical examination course for medical students in the preclinical years. Methods: We designed an online interactive module in three sections for preclinical (first-or second-year) medical students who had not yet learned the respiratory physical exam. The first section incorporated demonstration and practice of the components of the respiratory physical exam that could be effectively taught via videoconferencing software. Following this, students conducted a telemedicine encounter with a standardized patient and received patient-centered feedback evaluating their communication skills. The final segment involved a case discussion and clinical reasoning component. Results: These sessions were implemented for 122 first-year medical students. The module was well received by the students. A majority felt that it helped improve their telemedicine communication skills (93%), interpretation of physical exam findings (84%), development of differential diagnosis (95%), and correlation of clinical and basic science content (93%). Discussion: Our pilot educational session demonstrates that this virtual instruction method is an effective tool for teaching basic clinical skills during medical school. Virtual learning resources allow remote instruction to take place and can be a supplement when face-to-face clinical teaching is not possible.

Performance Improvement Quarterly, Apr 1, 2015

in the project, the types of data to be collected, and the potential uses of the data. Phase 2, a... more in the project, the types of data to be collected, and the potential uses of the data. Phase 2, assessment, consists of actual data gathering for the needs assessment. Within this phase, data are analyzed and needs are prioritized. Th e prioritization of needs serves as the impetus for Phase 3, postassessment, which encompasses the utilization of data gathered from the needs assessment to propose solutions. Many needs assessment models do not account for a utilization phase; however, Witkin and Altschuld (1995) purport that "Phase 3 is the bridge from analysis to action-to the use of the needs assessment fi ndings" (p. 75). Identifying Needs Facing Homeless Populations A person is considered homeless if they lack a "fi xed, regular, and adequate night-time residency" and has temporary living conditions that are operated by a shelter (National Coalition for the Homeless, 2009). Individuals may fi nd themselves homeless due to loss of employment, economic turmoil, mental illness, domestic violence, and/or lack of family and friends. Th e demographics of homeless people vary in regards to age, ethnicity, educational background, and work experience. In the United States, more than 600,000 individuals are homeless, with 65% living in emergent shelters or temporary housing. As of 2013, there were approximately 11,500 individuals facing homelessness in the state of Michigan (U.S. Department of Housing and Urban Development, 2013). Homeless individuals face similar medical conditions regardless of their geographical location in the United States. Th ese conditions include overcrowding, unsanitary living conditions, mental illness, extreme weather conditions, sleep deprivation, and violence (Kehn, Ho, & Kroll, 2013; Kertesz et al., 2014; Maness & Khan, 2014). Often, vulnerable populations facing homelessness perceive many barriers to accessing health care. Th ese barriers include the cost of health care (preventative and urgent), challenges with obtaining transportation, health care professionals' perceptions of homeless individuals, and the lack of insurance coverage. Many homeless individuals have coped with their inadequate health care coverage by turning towards community agencies, medical ride services, free clinics, and fi nancial assistance for nonemergent conditions (Pieh-Holder, Callahan, & Young, 2012). Preventative care includes educational programming, health fairs, and free clinics. A Community Approach to Needs Assessment A challenge associated with addressing needs of vulnerable and underserved populations, particularly homeless individuals, is that most sustainable solutions require a community partnership rather than an individualistic approach to addressing needs (Frenk et al., 2010). Arndell, Proffi tt, Disco, and Clithero (2014) suggest that "improved outcomes among underserved populations can only be achieved through

European Journal of Cancer Prevention, Aug 1, 2008

The diagnosis of lobular carcinoma in situ (LCIS) provokes considerable anxiety in patients owing... more The diagnosis of lobular carcinoma in situ (LCIS) provokes considerable anxiety in patients owing to misconceptions about this diagnosis. Initially LCIS was considered a premalignant lesion, but it is now a marker of increased risk. The number of women diagnosed with LCIS has increased in recent years most likely owing to more rigorous breast cancer screening. Implications of this diagnosis and management options are discussed in this review.

Journal of Public Health, Dec 26, 2020

Background Medical students are among the group of frontline healthcare providers likely to be ex... more Background Medical students are among the group of frontline healthcare providers likely to be exposed to COVID-19 patients. It is important to achieve high COVID-19 vaccination coverage rates in this group as soon as a vaccine is available. As future healthcare providers, they will be entrusted with providing vaccine recommendations and counseling vaccine-hesitant patients. Methods This project used self-report to assess vaccine hesitancy and acceptance among medical students towards the novel COVID-19 vaccine. Results Nearly all participants had positive attitudes towards vaccines and agreed they would likely be exposed to COVID-19; however, only 53% indicated they would participate in a COVID-19 vaccine trial and 23% were unwilling to take a COVID-19 vaccine immediately upon FDA approval. Students willing to immediately take the vaccine were more likely to trust public health experts, have fewer concerns about side effects and agree with vaccine mandates (P < 0.05). Concern for serious side effects was independently predictive of lower odds of intent to participate in a COVID-19 vaccine trial (AOR = 0.41, P = 0.01). Conclusion This is the first study to evaluate COVID-19 vaccine hesitancy among US medical students and highlights the need for an educational curriculum about the safety and effectiveness to promote uptake of the COVID-19 vaccine.

Journal of Community Health, Mar 12, 2022

To identify psychological antecedents of COVID-19 vaccine hesitancy among healthcare personnel (H... more To identify psychological antecedents of COVID-19 vaccine hesitancy among healthcare personnel (HCP). We surveyed 4603 HCP to assess psychological antecedents of their vaccination decisions (the '5 Cs') for vaccines in general and for COVID-19 vaccines. Most HCP accept vaccines, but many expressed hesitancy about COVID-19 vaccines for the psychological antecedents of vaccination: confidence (vaccines are effective), complacency (vaccines are unnecessary), constraints (difficult to access), calculation (risks/benefits), collective responsibility (need for vaccination when others vaccinate). HCP who were hesitant only about COVID-19 vaccines differed from HCP who were consistently hesitant: those with lower confidence were more likely to be younger and women, higher constraints were more likely to have clinical positions, higher complacency were more likely to have recently cared for COVID-19 patients, and lesser collective responsibility were more likely to be non-white. These results can inform interventions to encourage uptake of COVID-19 vaccines in HCP.

BMC Public Health, Jan 6, 2017

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the U... more Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. It is also well established that HPV viruses are responsible for a variety of cancers. Little is known about the prevailing knowledge and attitudes toward the HPV vaccine in our future healthcare providers, a majority of whom were among the first in the target age group to receive the vaccine; the same vaccine that they will in turn be expected to recommend to their patients. The aims of this pilot study were to examine the HPV vaccination rate among medical students and determine their knowledge about HPV and attitudes toward vaccination. Methods: To aid in the development of an HPV educational intervention, a needs assessment survey was administered to discover medical students' knowledge and attitudes toward the HPV vaccine. All medical students at a Midwestern US medical school were invited to complete the survey. Results: Two hundred fourteen of 390 medical students completed the survey with 44% having been previously vaccinated. Although 82% of all respondents believed they would recommend the vaccine to family and friends, only 40% felt knowledgeable about the vaccine and 40% felt comfortable counseling patients. More positive attitudes and better knowledge scores were found in fully vaccinated students compared to non-vaccinated students. Provider recommendation was strongly associated with HPV vaccination status. Conclusions: This study revealed the unique perspectives of U.S. millennial medical students as the first group of future healthcare providers to have personally encountered the HPV vaccine. Overall, students' knowledge as well as their comfort level in counseling patients was lacking. This assessment has guided the development of targeted educational interventions to address knowledge gaps and prepare students to appropriately discuss the vaccine with patients and parents and help protect young people from life threatening cancers.

MedEdPORTAL, May 12, 2014

Abstract Prescribing is a fundamental part of the work of new residents, who write and review man... more Abstract Prescribing is a fundamental part of the work of new residents, who write and review many prescriptions each day. It is a complex task requiring knowledge of medicines and the diseases the...

Journal of the American Dental Association, Aug 1, 2021

Background Dental students (DS) and medical students (MS) are exposed to COVID-19. It is importan... more Background Dental students (DS) and medical students (MS) are exposed to COVID-19. It is important to achieve high COVID-19 vaccination coverage rates in both these groups. We developed a survey to assess the vaccine hesitancy amongst MS and DS to COVID-19 vaccination. Methods The study was conducted at three U.S. dental schools and a medical school using an online survey which assessed (1) previous immunization behavior; (2) attitudes and perception of COVID-19 vaccines; (3) personal experience with COVID-19. Results 248 DS and 167 MS completed the survey. 45% of DS and 23% of MS were hesitant to receive the COVID-19 vaccine. In bivariate analyses, MS were 2.7 times more likely than DS to take the vaccine (OR 2.74, 95% CI 1.76, 4.31, p=0.0001). Although DS were more likely than MS (p<0.05) to have had COVID-19 and to personally know someone who had COVID-19, MS were more likely to agree with mandates and trust information about the vaccine. In multivariable analyses, after controlling for demographic variables, experience with COVID-19 and personal vaccination behaviors, being a MS or DS was no longer predictive of willingness to get the vaccine. Conclusions These results highlight the need for profession-specific curriculum designed to enhance student knowledge about the vaccine and vaccine counseling skills.

Background Intimate Partner Violence (IPV), defined as any form of sexual, physical, or emotional... more Background Intimate Partner Violence (IPV), defined as any form of sexual, physical, or emotional harm perpetrated by a current or former partner or spouse, is a prevalent public health issue. Insufficient coverage of IPV education during medical school has contributed to many graduates who perceive IPV education as irrelevant to their future practices. An experiential IPV curriculum was integrated into three preclinical courses at Oakland University William Beaumont (OUWB) School of Medicine and its effectiveness was assessed with the Physician Readiness to Manage Intimate Partner Violence Survey adapted for healthcare students (PREMIS-HS). Results from an earlier iteration of this project showed an increase in IPV knowledge as well as overall self-confidence in the cohort’s ability to address IPV issues in the future during the preclinical years. In contrast, the aim of this project was to assess the effectiveness of clerkships at IPV education during the clinical years of medical school. Methods A cohort of medical students completed the PREMIS-HS during preclinical years. This cohort was asked to complete the survey again, along with an investigator-generated survey (Clerkships Contributions survey) regarding specific clerkship contributions to IPV education. Results Results from the PREMIS-HS and Clerkships Contributions survey showed a further increase in IPV knowledge scores (30.9Â±3.5) in comparison to scores collected during preclinical years (26.1Â±4.0), with the most knowledge and skills gained during the obstetrics and gynaecology clerkship. Conclusion Incorporating IPV education during clerkship years, in addition to preclinical years, will foster future generations of physicians with skills to appropriately screen and provide resources to patients affected by IPV.

Medical science educator, Aug 8, 2016

Medical Reference Services Quarterly, Oct 2, 2014

Food security is an indicator of a town's vitality. Northern Illinois Food Bank, Northern Illinoi... more Food security is an indicator of a town's vitality. Northern Illinois Food Bank, Northern Illinois University, and the rural town of of Rochelle, saw a need to identify what the current food security status was to help bridge gaps for the underserved. The purpose of this community food security needs assessment was to determine (1) the perceptions of food security, (2) awareness of existing resources available to the underserved, (3) how well these resources were able to serve those in need, and (4) if there was a need to strengthen current resources. Additionally, perceived barriers to food security related to the accessibility, availability, and affordability of food were also addressed. This mixed-methods design used focus groups and surveys. Key stakeholders, gatekeepers, and community residents were targeted for various sampling methods. The focus group data was analyzed using Krueger's Methodology. Survey data used descriptive statistics to summarize demographic variables. Cronbach's alpha coefficient was used to test the internal consistency of self-efficacy items, and crosstab analysis by Pearson's chi-square test examined associations among categorical variables. Multinomial logistic regression was used to test the association between perception of barriers and motivators and age, gender, education level, employment status and number of children in household. Multiple linear regression was used to detect associations between risk factors and self-efficacy. Life skills are a necessity to this community in overcoming food insecurity. Self-efficacy was compromised related to eating healthier; however, there was an evident desire to receive nutrition education. Community members would like to see more programs and services offered in addition to food assistance programs, such as job and life skills training, and perhaps all located in the same place that is easily accessible for community members. Implications for future research and community collaborations derived from this community-based participatory research process are discussed.

Medical science educator, Jun 6, 2015

Background Intimate partner violence (IPV) is a global public health concern (World Health Organi... more Background Intimate partner violence (IPV) is a global public health concern (World Health Organization 2013; Moreno et al. 2013). Medical students receive some training in IPV, but it may not be robust enough to translate to clinical situations. Activity An integrated longitudinal curricular thread beginning in a student's second year (M2) and culminating in a high-stakes observed structured clinical exam (OSCE) at the end of third year (M3) was implemented. Results A pre-and post-survey during the M2 year found students felt their knowledge and self-confidence had increased. M3 students' ability to screen for IPV using OSCEs showed improvement. Discussion Pilot data from our longitudinal curricular thread suggests that students were more prepared for managing patients who present with IPV in clinical situations.

Public Health Reports

Objectives: Because health care personnel (HCP) are potentially at increased risk of contracting ... more Objectives: Because health care personnel (HCP) are potentially at increased risk of contracting COVID-19, high vaccination rates in this population are essential. The objective of this study was to assess vaccination status, barriers to vaccination, reasons for vaccine acceptance, and concerns about COVID-19 vaccination among HCP. Methods: We conducted an anonymous online survey at a large US health care system from April 9 through May 4, 2021, to assess COVID-19 vaccination status and endorsement of reasons for acceptance and concerns related to vaccination (based on selections from a provided list). Results: A total of 4603 HCP (12.2% response rate) completed the survey, 3947 (85.7%) had received at least 1 dose of a COVID-19 vaccine at the time of the survey, and 550 (11.9%) reported no plans to receive the vaccine. Unvaccinated HCP were 30 times more likely than vaccinated HCP to endorse religious or personal beliefs as a vaccine concern (odds ratio = 30.95; 95% CI, 21.06-45.48...