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ObjectiveDigital health (DH) is the integration of technologies to tackle challenges in healthcare. Its applications include mobile health, remote & wireless healthcare, artificial intelligence, and robotics. Digital technologies are increasingly being used to deliver routine care, whilst simultaneously patients are increasing their uptake of DH solutions (e.g. wearables).With the adoption of DH increasing across the NHS, there is a growing need for a digitally literate workforce. However, there are no national standards on DH education for UK medical students. Consequently, this study sought to assess the current provisions, perceptions and challenges regarding DH education in the undergraduate medical curriculum.MethodsAn anonymous cross-sectional online survey was developed following a literature search and by collecting iterative feedback from both researchers and external collaborators. The survey consisted of questions in 6 areas: (a) understanding of DH;(b) existing provision of DH education;(c) interest in DH education;(d) preferred means of delivering and assessing DH education;(e) impact of the COVID-19 pandemic on DH;and (f) demographic information.The survey was administered via Qualtrics from March to October 2021, and disseminated to UK medical students via university mailing lists, social media and student representatives. Quantitative and qualitative data were collected pertaining to demographics, attitudes, preferences, and current provisions regarding DH education. Qualitative responses underwent thematic analysis. For quantitative analysis, R (version 3.5.0) and R Studio (version 1.1a) were used.Results514 complete responses were received from 39 UK medical schools in 2021. 57.2% of respondents were female, with a mean age of 22.9 ± 3.2. 65.8% of students considered DH ‘extremely important’ to future clinical practice, particularly the domains of electronic patient records, telehealth and smartphone applications. However, only 18.1% felt aware of the DH competencies required in clinical medicine. 70.2% of students reported receiving some DH education, with the highest proportion being in the form of lectures or seminars (30.5%, n=157), e-learning modules (28.6%, n=147) and ad hoc teaching during clinical placements (22.8%, n=117). However, only 25.7% felt satisfied with these provisions. Themes for student satisfaction related to a practical teaching approach, delivery of content appropriate for their training stage and coverage of topics in student interest. Conversely, student dissatisfaction originated from inadequate teaching, and subsequent fears of falling behind. 56.1% preferred DH education to be mandatory rather than elective, ideally through hands-on workshops (75.8%) and lectures and seminars (60.4%). 65.4% thought DH proficiency should be assessed in some capacity, of which 75.6% preferred formative assessment.ConclusionThis study represents the first national survey of UK medical students on DH education. Overwhelmingly, the results indicate that medical students recognise the significance of DH and would appreciate better formal integration into their curriculum;which is supported by previous similar studies in the literature. This study also identified how students would prefer to be taught and assessed on DH, in particular that they would prefer it be mandatory yet remain formative at present. Given the increasing ubiquity of DH in clinical practice, it is therefore crucial that universities and wider medical education organisations work to improve and standardise DH education, to better prepare medical students to adapt to the continuously developing digital landscape. This rings especially true in light of the recent COVID-19 pandemic which has highlighted the quintessential nature of DH to medical practice. Our intended future research from this study includes undergraduate focus groups for greater qualitative depth of information, and Delphi panels from wider medical education stakeholders into what should be included in DH education, with the eventual goal of devel ping a comprehensive and standardised national DH curriculum.
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SESSION TITLE: Medications and Pulmonary Rehabilitation in COVID-19 Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Millions of people have survived COVID 19 infection and are living with post-acute sequelae of COVID (PASC). Multi-disciplinary programs have been established to provide follow-up to these patients. Currently, there are limited data regarding the effectiveness of these programs and it is uncertain if there is a mortality benefit. Here, we explore if the enrollment of Veterans into a multi-disciplinary COVID-19 follow-up program influences long term all-cause mortality. METHODS: We designed a retrospective cohort study at the South Texas Veteran Health Care system (STVHCS) from April 1, 2020, to December 31, 2020. Participants in the study were Veterans who survived a COVID 19 infection after 30 days and were eligible for enrollment in the STVHCS Convalescence Program (“The Program”), which conducts multi-disciplinary follow up care. Patients who died <30 days after COVID 19 diagnosis were not eligible. The primary outcome of long term all-cause mortality was defined as mortality within 31-365 days after the diagnosis of a COVID 19 infection. Demographic differences and primary outcome between the two groups (enrolled versus non-enrolled in The Program) were analyzed using Chi square for categorical variables. Continuous variables were analyzed using Student’s t-test. RESULTS: In total 2253 patients were eligible for enrollment, of which 557 were enrolled and 1696 were not enrolled. Long term all-cause mortality between the groups was 6/557 (1.07%) in the enrolled group compared to 78/1696 (4.59%) in the non-enrolled group with a p value of <0.001. There was no statistical difference between the groups based on the average Charlson comorbidity index score, 2.12 vs 2.09 respectively, with a p value = 0.85. CONCLUSIONS: Enrollment of Veterans in a COVID 19 multidisciplinary follow-up program is associated with a significant decrease in long term all-cause mortality. These differences could not be explained by inherent differences between groups. CLINICAL IMPLICATIONS: Our study shows the potential effectiveness of COVID-19 multidisciplinary follow-up programs to reduce long term all cause mortality in survivors of COVID. In addition there may be other benefits not yet explored such as reduction in symptom burden from COVID and decreased psychosocial distress. The generalizability of this study is limited by its observational study design, the voluntary nature of enrollment in the program and lack of non veterans in the population. DISCLOSURES: No relevant relationships by Ye Aung No relevant relationships by Ryan Choudhury No relevant relationships by Michael Mader No relevant relationships by Marcos Restrepo No relevant relationships by Sandra Sanchez-Reilly No relevant relationships by Monica Serra No relevant relationships by Ana Lucia Siu Chang No relevant relationships by Hanh Trinh
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BACKGROUND: The effect of hospital-associated SARS-CoV-2 infections in cardiac surgery patients remains poorly investigated, and current data are limited to small case series with conflicting results. METHODS: A multicenter European collaboration was organized to analyze the outcomes of patients who tested positive with hospital-associated SARS-CoV-2 infection after cardiac surgery. The study investigators hypothesized that early infection could be associated with worse postoperative outcomes; hence 2 groups were considered: (1) an early hospital-associated SARS-CoV-2 infection group comprising patients who had a positive molecular test result ≤7 days after surgery, with or without symptoms; and (2) a late hospital-associated SARS-CoV-2 infection group comprising patients whose test positivity occurred >7 days after surgery, with or without symptoms. The primary outcome was 30-day mortality. Secondary outcomes included all-cause mortality or morbidity at early follow-up and SARS-CoV-2-related hospital readmission. RESULTS: A total of 87 patients were included in the study. Of those, 30 were in the early group and 57 in the late group. Overall, 30-day mortality was 8%, and in-hospital mortality was 11.5%. The reintubation rate was 11.4%. Early infection was significantly associated with higher mortality (adjusted OR, 26.6; 95% CI, 2, 352.6; P < .01) when compared with the late group. At 6-month follow-up, survival probability was also significantly higher in the late infection group: 91% (95% CI, 83%, 98%) vs 75% (95% CI, 61%, 93%) in the early infection group (P = .036). Two patients experienced COVID-19-related rehospitalization. CONCLUSIONS: In this multicenter analysis, hospital-associated SARS-CoV-2 infection resulted in higher than expected postoperative mortality after cardiac surgery, especially in the early infection group.
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Work from home (WFH) has gradually become more popular since COVID-19 started its transmission in Myanmar during the first quarter of 2020. Its consequence was a re-evaluation of the culture of workplaces and a significant change has occurred to the pattern of daytime employment distribution. In this paper, the network distribution model was built with three constraints, Distribution Bias 1, 2, and 3. These biases were determined through questionnaires, survey data collections of responses from Yangonites, and geographical data of urban employment cores. These percentile biases influenced the amount of employed population per distribution times and gave rise to two results. One was the ordinary daytime employed population and another was the improved daytime employed distribution (considering WFH). These two results were compared and contrasted with coefficient of variations, t-tests, and other correlation methods to determine the effect of WFH on the daytime employed population. With survey data, it was clarified that majorities in Yangon do favor work from home as an alternative option for future employment. Subsequently, the compared results revealed that work from home significantly decreased the amount of employment distribution and the amount of such decrements were more consistent and had less variations, hence reducing cramming during daytime distribution. © The Author(s) 2021. This article is distributed under a Creative Commons Attribution-ShareAlike 4.0 International license.
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Objective Ruptured splenic artery aneurysms (SAAs) in pregnancy are a rare but significant cause of maternal and foetal mortality. We describe an unusual presentation of SAA rupture at term with predominantly chest symptoms to encourage clinicians to consider this rare differential diagnosis in the obstetric setting, especially in context of the COVID-19 pandemic. Case report A 36-year-old pregnant female (G1P0) presented at 38 + 4 weeks with lower left-sided chest pain and a history of coryzal symptoms. She was hypotensive and tachycardic with oxygen desaturation at presentation. Chest and abdominal examinations were unremarkable. Intravenous fluids and antibiotics were commenced on the suspicion of septic shock from a chest infection. However, new-onset left shoulder-tip pain and a pathological cardiotocogram prompted an emergency Caesarean section. A female infant (APGARs 2,7) was delivered and admitted to NICU for respiratory distress. Significant haemoperitoneum was noted upon abdominal entry, which was localised to the left upper quadrant. Subsequent exploratory laparotomy revealed a large retroperitoneal haematoma and two SAAs (1.5 cm intact, proximal and 2.5 cm ruptured, distal), which were managed via splenic artery ligation and splenectomy. Total estimated blood loss was 4400 mL, requiring intraoperative transfusions of 5U packed red cells, 4U fresh-frozen plasma and 1U cryoprecipitate. Postoperative CT angiogram identified no additional aneurysms but revealed multiple partially occlusive pulmonary emboli, which were managed in ITU with intravenous heparin and, subsequently, low molecular weight heparin. Both mother and baby were discharged in stable condition on day 10. Discussion SAA commonly presents with abdominal pain but is frequently misdiagnosed, as it can mimic other abdominal and obstetric pathologies. We highlight a unique presentation of ruptured SAA with chest pain, which can resemble severe SARS-Cov-2 infection and complicate diagnosis. Importantly, early diagnosis and intervention are critical to reducing mortality. Aggressive fluid resuscitation, emergency Caesarean section and laparotomy remain the mainstay of treatment for symptomatic ruptured SAAs. Additionally, postpartum patients after surgery are at significant risk of venous thromboembolism due to their intrinsically hypercoagulable state;thus, clinicians should have a low threshold for investigation. Conclusion This case stresses the importance of recognising both the typical and atypical clinical features of ruptured SAAs and considering it as a differential for obstetric patients, especially during the COVID-19 pandemic. A multidisciplinary approach with early involvement of the surgical team is imperative to reduce morbidity and mortality.
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The coronavirus 2019 (COVID-19) pandemic has disrupted patient care across the NHS. Following the suspension of elective surgery, priority was placed in providing urgent and emergency surgery for patients with no alternative treatment. We aim to assess the outcomes of patients undergoing cardiac surgery who have COVID-19 infection diagnosed in the early postoperative period. We identified 9 patients who developed COVID-19 infection following cardiac surgery. These patients had a significant length of hospital stay and extremely poor outcomes with mortality of 44%. In conclusion, the outcome of cardiac surgical patients who contracted COVID-19 infection perioperatively is extremely poor. In order to offer cardiac surgery, units must implement rigorous protocols aimed at maintaining a COVID-19 protective environment to minimize additional life-threatening complications related to this virus infection.