Croydon Neurology: Assessing the Impact of the Introduction of Patient Initiated Follow-Up

NHS England identified Patient Initiated Follow Up (PIFU) as part of NHS COVID-19 recovery, in line with the personalised- care agenda. We aimed to assess how the introduction of PIFU for neurology patients at Croydon University Hospital (CUH) has impacted patient outcomes, capacity and non-elective admissions. Data were extracted from electronic records on all patients booked into a CUH neurology PIFU appoint- ment from 1st June to 29th October 2021. Data were collected on the number of admissions or outpatient attendances for 5 years pre-PIFU appointment and compared with 0-6 months post-PIFU. 355 patients had a PIFU appointment at CUH neurology between 1st June and 29th October 2021. The most common neurological conditions prompting a PIFU appointment were epilepsy (40%), multiple sclerosis (22%) and Parkinson's disease (12%). The average number of outpatient appointments reduced from 11.0 pre-PIFU to 1.5 post-PIFU. The average number of ED attendances reduced from 3.1 pre-PIFU to 0.4 post-PIFU. Although there are significant limitations in this study (inadequate time since appointment, the pandemic), we remain keen on PIFU and had been running an advice line service before it was labelled as PIFU. Further follow-up data and patient satisfaction data is needed.

Association between Level of Knowledge Gained, Confidence, Motivation and Flexibility on Types of Learning for Bedside Teaching among Clinical Students in Four Malaysian Medical Schools during COVID-19 Pandemic

Introduction: With the arise of the COVID-19 pandemic, higher institutions are forced to change the method of delivery for bedside teaching sessions from face-to-face to online learning. However, online learning was found not effective in delivering practical knowledge and skills to students. Hence, the objective of this study was to determine the association between level of knowledge gained, confidence, motivation and flexibility on types of learning for bedside teaching sessions among clinical students in four Malaysian medical schools during COVID-19 pandemic. Methods: A cross-sectional study involving medical students from Universiti Putra Malaysia (UPM), Universiti Sains Islam Malaysia (USIM), Universiti Islam Antarabangsa (UIA) and Universiti Sains Malaysia (USM) were conducted from 1st March 2021 until 6th June 2021. An online questionnaire was distributed and it consisted of 5 sections which cover sociodemographic information, level of knowledge gained, confidence, motivation, and flexibility from bedside teaching session. The data was analysed by using SPSS software program. Results: There is a significant association between the level of knowledge gained, level of confidence, level of motivation and level of flexibility with the type of learning (online or face-to-face) during bedside teaching sessions. Results revealed that students gained a higher level of knowledge (84.9%), higher level of confidence in physical examination (93.3%), higher motivation (82.2%) and higher flexibility (64.1%) during face-to-face bedside teaching sessions compared to online learning. Conclusion: Most of the medical students in four Malaysian medical schools prefer face-to-face learning compared to online learning for bedside teaching sessions. © 2022 UPM Press. All rights reserved.

Indoor and Ambient Air Pollution in Chennai, India during COVID-19 Lockdown: An Affordable Sensors Study

The Tamil Nadu Air Pollution and Health Effects study (TAPHE-2) aims to evaluate the relationship between air pollution and birth outcome in a rural-urban cohort of 300 pregnant women. Due to COVID-19 related lockdowns, some TAPHE-2 activities were delayed;however, continuous indoor and outdoor air quality data were collected in and around Chennai, India. We report here the impact of graded COVID-19 lockdown on indoor particulate matter (PM2.5 and PM10) levels based on calibrated data from affordable real-time PM sensors called atmos™ and ambient PM levels from publicly available regulatory monitors. The study period was between 11 March and 30 June 2020 (i.e., 100 days of continuous monitoring), which coincided with four phases of a nationwide graded lockdown. Field calibration coefficients for the atmos PM were derived by collocating them with reference-grade PM monitors. The normalized root mean square error (NRMSE) of the atmos hourly PM2.5 (PM10) improved from 41% to 15% (33% to 18%) after applying the field calibration coefficients. Lockdowns resulted in significant reductions in indoor and ambient PM levels, with the highest reduction observed during lockdown phase 2 (L2) and phase 3 (L3). Reductions as high as 70%, 91%, and 62% were observed in ambient PM2.5, indoor PM2.5, and indoor PM10 relative to pre-lockdown levels (PL), respectively. The indoor PM2.5/PM10 ratio decreased during the lockdown, suggesting a decline in the fine mode dominance in PM10. The indoor-to-outdoor (I/O) ratios in PM2.5 marginally increased during L1, L2, and L3 phases compared to that of PL levels, suggesting an uneven reduction in indoor and ambient PM2.5 levels during the lockdown. © The Author's institution.

Early outcomes after lung transplantation for severe COVID-19: a series of the first consecutive cases from four countries.

BACKGROUND: Lung transplantation is a life-saving treatment for patients with end-stage lung disease; however, it is infrequently considered for patients with acute respiratory distress syndrome (ARDS) attributable to infectious causes. We aimed to describe the course of disease and early post-transplantation outcomes in critically ill patients with COVID-19 who failed to show lung recovery despite optimal medical management and were deemed to be at imminent risk of dying due to pulmonary complications. METHODS: We established a multi-institutional case series that included the first consecutive transplants for severe COVID-19-associated ARDS known to us in the USA, Italy, Austria, and India. De-identified data from participating centres-including information relating to patient demographics and pre-COVID-19 characteristics, pretransplantation disease course, perioperative challenges, pathology of explanted lungs, and post-transplantation outcomes-were collected by Northwestern University (Chicago, IL, USA) and analysed. FINDINGS: Between May 1 and Sept 30, 2020, 12 patients with COVID-19-associated ARDS underwent bilateral lung transplantation at six high-volume transplant centres in the USA (eight recipients at three centres), Italy (two recipients at one centre), Austria (one recipient), and India (one recipient). The median age of recipients was 48 years (IQR 41-51); three of the 12 patients were female. Chest imaging before transplantation showed severe lung damage that did not improve despite prolonged mechanical ventilation and extracorporeal membrane oxygenation. The lung transplant procedure was technically challenging, with severe pleural adhesions, hilar lymphadenopathy, and increased intraoperative transfusion requirements. Pathology of the explanted lungs showed extensive, ongoing acute lung injury with features of lung fibrosis. There was no recurrence of SARS-CoV-2 in the allografts. All patients with COVID-19 could be weaned off extracorporeal support and showed short-term survival similar to that of transplant recipients without COVID-19. INTERPRETATION: The findings from our report show that lung transplantation is the only option for survival in some patients with severe, unresolving COVID-19-associated ARDS, and that the procedure can be done successfully, with good early post-transplantation outcomes, in carefully selected patients. FUNDING: National Institutes of Health. VIDEO ABSTRACT.

Are kids getting healthier? Pediatric otolaryngology practice changes during COVID-19

Session Description: The COVID-19 pandemic has greatly affected health care practice on multiple levels. With many schools and day cares being closed as well as increased vigilance around hygiene and infection control, many otolaryngology clinics have noticed a decline in pediatric patients being seen for otitis media, tonsillitis, and associated complications. In this panel, experts in pediatric otolaryngology and health system care delivery will discuss the variations in patient volumes as an effect of the global pandemic, using data from the Pediatric Health Information System database to facilitate a robust discussion of the impact on otolaryngology practices. In addition, panelists will discuss national trends in care delivery and the impact on care to children of varying socioeconomic and ethnic groups. Goals of the panel presentation will include (1) statistical analyses of the trend in diagnoses of common pediatric otolaryngology conditions and associated surgeries by region;(2) discussion of the pandemic's impact on pediatric otolaryngology practices, including volumes, case-mix index, revenue, and workforce implications;and (3) examination of differences in socioeconomics, including insurance status, median household income, and ethnicity, with the goal of improving the equity of care delivery during the pandemic and improving access to care for all patients. Outcome Objectives: (1) Facilitate discussion among panelists and the audience on changes in pediatric otolaryngology diagnoses and volumes as a result of the pandemic in your practice region compared with others nationwide. (2) Compare and discuss the differences between subgroups of patients who sought care during the pandemic based on socioeconomics and demographics and the implications for equity in care delivery. (3) Consider what the new equilibrium will be. Examine future scenarios and how to engage both patients and the referral base to mitigate the impact of the pandemic and strategize ways to provide optimal postpandemic care.

From E-Cig to Puff Bar: Otolaryngology and the vaping epidemic

Session Description: Every otolaryngologist should know about vaping. Vaping-related harm may include catastrophic lung injury, fatal accidental ingestion in children, explosion of combustible devices, accelerated nicotine addiction, and interaction with COVID-19 risk. Vaping amplifies disparities in use and addiction, mediated through social determinants of health. This panel reveals the evidence around vaping most relevant to practicing otolaryngologists trying to grasp this complex public health concern. We explain vaping epidemiology, sociological undercurrents and disparities, pathophysiology of vapingrelated disease, and what to do about it. We describe how JUUL's meteoric rise to dominance in the electronic cigarette (e-cigarette) space-growth rivaling that of Facebook-was catalyzed by social media, positioning as new technology, stealthy design, and alluring flavors. We probe the science of vaping from surgical wound healing to effects of inhaling formaldehyde, propylene glycol, heavy metals, and other vapors-risks magnified in unregulated cannabinoids. The experiences of individuals who survived vaping-related injury, from respiratory exacerbation to ventilator dependence, is testimony to the crisis. The session offers insights on vaping-related disease, persistent misconceptions, and social determinants of health. e-Cigarettes, a potential “off ramp” for adult smokers have evolved into a heavily trafficked “on ramp” for the next generation. We close with counseling pearls, advice for patients grappling with misinformation, and opportunities for our specialty to lead. Outcome Objectives: (1) Describe trends in electronic nicotine device use, interaction with social determinants of health, current slang used for these habits, and forthcoming inhaled tobacco technology. (2) Describe how sociological factors and biology interact in the pathogenesis of vaping-related respiratory injury and wound healing. (3) Discuss specific talking points for counseling patients and strategies for dispelling misconceptions around vaping-related disease.

Systemic bias and workforce inequity: Care quality and value effects

Session Description: Themes of inequity, injustice, and health disparities are woven through the history of medicine. The national and specialty-wide conversation about these critical problems has evolved in the past year in parallel with major social movements around the world. In combination with the COVID-19 pandemic, these conversations have shed light on ways in which privilege, disadvantage, and systemic biases have contributed to diminished quality of medical care and exacerbated disparities in health outcomes. This panel, sponsored by the American Academy of Otolaryngology- Head and Neck Surgery Patient Safety and Quality Improvement Committee and featuring national experts in health care quality, value, and diversity, justice, and inclusion will complement other sessions at this meeting addressing inequities in health care. In this panel, we will focus specifically on how systemic bias and workforce inequity directly contributes to disparate, low-quality, and low-value health care. We will focus on racism, sexism, and anti-LGBTQ+ bias in both the workforce and in treatment of patients, providing a review of current knowledge on the effects of these biases on the quality of surgical care in the United States, including effects on provider-patient interaction, treatment recommendations, and adherence to these recommendations. We will then address ways in which inequities in the otolaryngology workforce further limit opportunities for patient-physician racial concordance and exacerbate disparities in patient outcomes and strategies to begin addressing workforce diversity and inclusion problems. These issues will be examined for both academic and nonacademic practice settings. We will connect quality to costs of care to discuss how systemic bias affects the value of surgical care delivered to patients of different privilege and how this difference in value perpetuates injustice in health care. Outcome Objectives: (1) Define privilege, bias, equality, equity, inclusion, and justice as individual constructs in the context of medical, and specifically otolaryngologic, care. (2) Summarize current knowledge of the effects of systemic racism, sexism, and anti-LGBTQ+ bias on workforce equity and quality of care in otolaryngology. Demonstrate specific examples in otolaryngology. (3) Relate the effects of these biases to the value of otolaryngologic care.