Letter to the Editor
Strategies to maintain high-quality education and communication among the paediatric and neonatal intensive care community during the COVID-19 pandemic
Estrategias educativas y de comunicación de alta calidad en cuidados intensivos pediátricos y neonatales durante la pandemia de COVID-19
a 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
b Paediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
c Pediatric Intensive Care Unit, Area de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
d Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, the Netherlands
e Pediatric Intensive Care Unit, San Bortolo Hospital, Vicenza, Italy
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"apellidos" => "Györgyi" "email" => array:1 [ 0 => "gyorgyi.zoltan@med.semmelweis-univ.hu" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Sperotto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Medina Villanueva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "M.C.J." "apellidos" => "Kneyber" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "A." "apellidos" => "Zanin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Paediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Pediatric Intensive Care Unit, Area de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, the Netherlands" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Pediatric Intensive Care Unit, San Bortolo Hospital, Vicenza, Italy" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estrategias educativas y de comunicación de alta calidad en cuidados intensivos pediátricos y neonatales durante la pandemia de COVID-19" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2275 "Ancho" => 3333 "Tamanyo" => 548054 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Countries reached by the ESPNIC webinars during the COVID-19 outbreak.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The coronavirus 2019 (COVID-19) pandemic represents a real challenge for the medical community. Considering these circumstances, the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) analyzed how to efficiently reach its members, how to easily share updated content on the new disease, and how to implement new education and communication strategies.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A discussion on the impact of the pandemic on medical education has already been started within the medical community.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> The transition to online classes and the cancellation of clinical practice sessions, rotations and medical conferences, result in less collaborative experiences and networking, which are known to impact on the career development of young investigators.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> As a first step in the process of filling this gap, starting in 2020 spring, ESPNIC offered a series of webinars (promoted via social media as #ESPNICCOVID19 webinars) focusing on the management of COVID-19 in children and neonates (webinar topic list is uploaded as Electronic Supplementary Materials <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Each webinar included 60<span class="elsevierStyleHsp" style=""></span>min of free-to-access expert teaching followed by a 20-min discussion on the topic and the possibility of true networking with the speakers during and after the sessions. Almost 3000 people attended the ESPNIC webinars from 97 different countries (distribution displayed in ESM – <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Interestingly, 15% were multidisciplinary healthcare providers not regularly working in the intensive care field. Besides the webinars, ESPNIC provided online tutorials focused on non-invasive and invasive ventilatory support, which was felt as most relevant topics for the audience in the given circumstances.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The “virtual wave” during the pandemic is confirmed by increased social media engagement in our field.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> In order to increase its educational impact, ESPNIC nominated a “Social Media board”, consisting of intensive care physicians, trainees, and communication experts. Scientific papers, literature contents, as well as qualified educational materials for young trainees, have been regularly shared, reaching over 3500 followers in the first few months. A recent analysis of the use of social media for sharing high-quality content during the pandemic identified ESPNIC as a point of reference in the networking pattern of the paediatric intensive care community.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion, the COVID-19 pandemic represented a true accelerator of the teaching evolution into remote learning. These virtual formats have been proposed and applied by academic institutions and scientific societies as the “new normal” for postgraduate and continuing medical education. However, the complete shift of standard educational activities into their online version can lead to online networking tiredness, anxiety or worry secondary to the over-use of these virtual tools, known as “Zoomfatigue”.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> This phenomenon should not be underestimated, and a real balance should be reached between communication and information overload. The evolution of information spreading through social media is also worth noting. Despite the hardship, ESPNIC remains committed to maintaining the same high-level support for its members and for the #PedsICU and #NICU community. ESPNIC's experience could represent a useful example for other scientific societies and organizations which are implementing new, creative education and communication strategies.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005"><span class="elsevierStyleBold">Authors’ contributions</span></span><p id="par0025" class="elsevierStylePara elsevierViewall">All authors equally contributed to the study's conceptualization. ZG, FS and AZ wrote the first draft of this manuscript which was then critically reviewed and amended by AM and MK. AZ gathered and analyzed the dataset about webinar participants. ZG prepared the figure and tables for the electronic supplementary material. All authors read and approved the final manuscript.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">No financial support was used or received for this work.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015"><span class="elsevierStyleBold">Conflict of interest</span></span><p id="par0035" class="elsevierStylePara elsevierViewall">At the time of writing this manuscript, AM, MK and AZ were members of the executive committee of the European Society for Paediatric and Neonatal Intensive Care (ESPNIC). ZG and FS were members of the ESPNIC Social Media board. The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contributions" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 3 => array:2 [ "identificador" => "xack597758" "titulo" => "<span class="elsevierStyleBold">Acknowledgements</span>" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2275 "Ancho" => 3333 "Tamanyo" => 548054 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Countries reached by the ESPNIC webinars during the COVID-19 outbreak.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Date \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Topic \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">April 7, 2020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Practical guidance for nurses caring for COVID-19 patients in the PICU \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">April 13, 2020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-invasive Ventilatory Support in Children during COVID-19 Pandemic - \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">April 15, 2020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EPICENTRE presentations: a register for neonatal and paediatric COVID 19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">April 16, 2020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Joint session with the European Academy of Paediatrics (EAP) on Ethics \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">April 20, 2020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The role of ECMO in the current pandemic experience so far \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">April 25, 2020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EPICENTRE presentations #2: a register for neonatal and paediatric COVID 19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">April 28, 2020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Family-Centered Care in the PICU during the COVID-19 pandemic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">April 30, 2020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Invasive Ventilation in Children during COVID-19 pandemic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">May 6, 2020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrieval Medicine and Transport Logistic in COVID-19 Pandemic: An European Perspective \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">May 20, 2020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A conversation on perinatal and neonatal COVID19: experiences from Europe and China \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">June 10, 2020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preventing and managing clinical deterioration in the COVID-19 child \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">July 3, 2020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">What does an intensivist need to know about AKI and RRT in COVID 19? \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2881334.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Topics of the ESPNIC webinar series held between April 1, 2020 and July 31, 2020.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of COVID-19 on medical education" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.N. Ferrel" 1 => "J.J. Ryan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7759/cureus.7492" "Revista" => array:5 [ "tituloSerie" => "Cureus" "fecha" => "2020" "volumen" => "12" "paginaInicial" => "e7492" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32368424" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medical and surgical education challenges and innovations in the COVID-19 era: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Dedeilia" 1 => "M.G. Sotiropoulos" 2 => "J.G. Hanrahan" 3 => "D. Janga" 4 => "P. Dedeilias" 5 => "M. Sideris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.21873/invivo.11950" "Revista" => array:7 [ "tituloSerie" => "In Vivo" "fecha" => "2020" "volumen" => "34" "numero" => "Suppl." "paginaInicial" => "1603" "paginaFinal" => "1611" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32503818" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Kudchadkar SR, Carroll CL. Using social media for rapid information dissemination in a pandemic: #PedsICU and coronavirus disease 2019. Pediatric Crit Care Med 2020;21:e538–46. <a target="_blank" href="doi:10.1097/PCC.0000000000002474">doi:10.1097/PCC.0000000000002474</a>." ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Connecting through technology during the coronavirus disease 2019 pandemic: avoiding “zoom fatigue”" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B.K. Wiederhold" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/cyber.2020.29188.bkw" "Revista" => array:6 [ "tituloSerie" => "Cyberpsychol Behav Soc Netw" "fecha" => "2020" "volumen" => "23" "paginaInicial" => "437" "paginaFinal" => "438" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32551981" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack597758" "titulo" => "<span class="elsevierStyleBold">Acknowledgements</span>" "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">The authors thank Pamela Funes, Liliya Buyukliyska and Gianinna Di Conza Villa for their technical support.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004600000004/v1_202204210557/S2173572722000492/v1_202204210557/en/main.assets" "Apartado" => array:4 [ "identificador" => "64604" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004600000004/v1_202204210557/S2173572722000492/v1_202204210557/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572722000492?idApp=WMIE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 6 | 16 |
| 2024 October | 68 | 50 | 118 |
| 2024 September | 50 | 31 | 81 |
| 2024 August | 62 | 44 | 106 |
| 2024 July | 61 | 40 | 101 |
| 2024 June | 54 | 45 | 99 |
| 2024 May | 56 | 25 | 81 |
| 2024 April | 62 | 34 | 96 |
| 2024 March | 49 | 24 | 73 |
| 2024 February | 48 | 41 | 89 |
| 2024 January | 57 | 32 | 89 |
| 2023 December | 85 | 34 | 119 |
| 2023 November | 54 | 35 | 89 |
| 2023 October | 63 | 27 | 90 |
| 2023 September | 45 | 40 | 85 |
| 2023 August | 31 | 14 | 45 |
| 2023 July | 42 | 24 | 66 |
| 2023 June | 33 | 17 | 50 |
| 2023 May | 56 | 43 | 99 |
| 2023 April | 33 | 20 | 53 |
| 2023 March | 49 | 27 | 76 |
| 2023 February | 39 | 33 | 72 |
| 2023 January | 34 | 22 | 56 |
| 2022 December | 58 | 28 | 86 |
| 2022 November | 62 | 34 | 96 |
| 2022 October | 64 | 44 | 108 |
| 2022 September | 60 | 28 | 88 |
| 2022 August | 62 | 36 | 98 |
| 2022 July | 49 | 47 | 96 |
| 2022 June | 17 | 0 | 17 |
| 2022 May | 17 | 2 | 19 |
| 2022 April | 7 | 0 | 7 |
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