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Introduction: The COVID-19 pandemic and duty hour restrictions have illuminated a role for surgical simulation in trainees that permits meaningful technical experience outside the operating room. There is a need for the implementation of surgical simulation infrastructure adjacent to clinical training with practical considerations for complexity and cost. This systematic review analyzes surgical simulations that train hand surgical techniques and procedures with subjective or objective competency assessment. Method(s): A systematic review was conducted according to PRISMA- P guidelines using the PubMed, Medline, Scopus, Embase, Web of Science, and Cochrane databases. Selected search terms included procedures relevant to the field of hand surgery and various types of simulation training. Data, including skills and techniques taught and assessed, model type, equipment, cost, and emphasis placed in training for each article, were extracted. Result(s): Of 2,519 articles, 40 met inclusion criteria. Models were described as: synthetic benchtop/3D-printed (40.0%), animal (22.5%), cadaveric (20.0%), augmented and virtual reality (AR/ VR;12.5%), and other computer simulation (12.5%). Three models incorporated both a physical benchtop component and an AR/ VR component. The procedures most represented included tendon repair (30.0%), fracture fixation (27.5%), wrist arthroscopy (15.0%), and carpal tunnel release (15.0%). Sixty-five percent of articles emphasized the importance of surgical simulation in a surgeon's training. Conclusion(s): A diversity of surgical simulation models exist for the practice of various aspects of hand surgery. The existing literature demonstrates their utility for increasing expertise with surgical techniques and procedures in a low-risk setting.
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In this paper, we develop a daily-frequency measure of economic and policy uncertainty for Chile, employing information obtained from Twitter accounts using web scraping techniques and following closely the methodology proposed by Baker et al. (2016). Our proposed measure, called DEPUC, aims to capture the level of general disagreement –a proxy for economic and policy uncertainty– in topics such as the economy, economic policies, uncertainty about particular events, and Chile's conjuncture situation. The index, available from 2012 onwards, shows significant hikes that coincide with several local and international episodes that provoked extraordinary levels of uncertainty in Chile, especially after the events around the civil protests in mid-October 2019 and the start of the COVID-19 pandemic in mid-March 2020. An empirical exercise reveals that the proposed measure is a significant determinant of the nominal exchange rate dynamics, especially when this variable's magnitude is high and a week after the shock occurs. On the contrary, when the exchange rate is low, the impact of uncertainty on this variable is quantitatively smaller for any forecasting horizon. These features, and others discussed in the paper, highlight the usefulness of the proposed metric as an additional indicator that policymakers can incorporate into their monitoring toolkit. © 2023, Revista de Analisis Economico. All Rights Reserved.
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Background and importance The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend the optimisation of the nutritional status of patients with SARSCoV- 2 infection through dietary advice and/or oral nutritional supplements (SNO). These should provide about 400 kcal and a minimum of 30 g of protein per serving. Aim and objectives To identify the risk of malnutrition in patients with COVID-19 who received SNO, the cause of it and the adequacy of the SNO according to ESPEN guidelines. Material and methods A cross sectional observational study was conducted between March and April 2020. Adult patients with COVID-19 who received SNO were included. Variables collected were: age, sex, body mass index (BMI), risk of malnutrition according to GLIM criteria, phenotypic criteria (weight loss (>5% in the previous 6 months) and low BMI (≤20 kg/m2 for those aged <70 years old and ≤22 kg/m2 in the elderly)) and aetiologic criteria (low intake (≥ 7 days of hyporexia) and inflammation, type of SNO, energy and protein intake, adaptation of the oral diet, evaluation by the nutrition service and reason for the consultation). The SPSS programme (V.25.0) was used for data analysis. Results 162 patients were analysed. 51.8% (85) were men with a mean age of 72.75±12.58 years. Mean BMI mean was 27.05±4.2 kg/m2. 15.2% (25) of patients presented weight loss greater and 6.7% (11) presented low BMI. 92.1% (151) had low intake and all patients fulfilled the criteria for inflammation associated with the disease. 22.6% (37) of the patients presented with a risk of malnutrition. The SNO provided a mean of 408.4±164.06 kcal/day and all were hyperprotein, with a mean of 25.96±10.08 g of protein/day. 18.3% (30) had an adapted oral diet and 16.5% (27) of the patients underwent consultation with the nutrition service, the reasons for this being: 70% (19) marked hyporexia, 18.5% (5) dysphagia and 14.8% (3) diarrhoea. Conclusion and relevance A quarter of the patients analysed presented with a risk of malnutrition. Hyporexia was the main symptom. In our hospital, it would be advisable to increase the caloric and protein intake of the SNO to comply with ESPEN recommendations.
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Background and importance Adapt the outpatients care activity to the scenario arising out of the COVID-19 pandemic. Aim and objectives Reorganisation of the area, non in-person consultation, medication home delivery (MHD) and reduce patient attendance at day hospitals. Material and methods Phase 1 (P1): reinforcement of human resources, increase and easy the presential and telepharmacy schedule, adaptation of the facilities. Phase 2 (P2): advanced preparation of the medication, MHD, substitution of intravenous treatments by subcutaneous treatments. The telepharmacy and MHD were conducted at patients' request. Delivery routes and alternative urgent delivery systems were established. P1 activities began 2 weeks prior to the announcement of the State of Alarm (SoA, 16 March 2020) and P2 began and continues for vulnerable patients. Our project is currently underway in a proactive, selective and continuous way. Results Activities were analysed during 2020, weeks 12-19 (16 March to 10 May 2020) and compared with theoretical activity during the same period in 2019, with an increase in activity (+21%). The difference between the sum of in-person and telematic consultations and the theoretical consultations for the period was named after omitted consultations. Overall activity in weeks 12-19 was 5550 consultations, of which 4414 (79.5%) were in-person and 1136 (20.5%) telematic. The estimated activity would have been 7030 consultations, and 1480 (21% of the theoretical ones) have been omitted. In-person activity decreased from 5973 patients between weeks 12 and 19 in 2019 to 4414 in 2020 (-23.3%). Distribution of the 1136 MHD: week 12 (30), week 13 (131), week 14 (232), week 15 (190), week 16 (168), week 17 (155), week 18 (115) and week 19 (115). Waiting times for in-person consultation were reduced from an average of 5.2 min/patient in the pre-alarm period to 3 min during the alarm (-42.3%). Conclusion and relevance Our data may be used to detect areas for improvement;consultations should be made proactively and tools are needed to qualitatively analyse omitted activity. A system is needed to account for tele-assistance that has not resulted in dispensing medication or MHD.
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Background and importanceThe European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend the optimisation of the nutritional status of patients with SARS-CoV-2 infection through dietary advice and/or oral nutritional supplements (SNO). These should provide about 400 kcal and a minimum of 30 g of protein per serving.Aim and objectivesTo identify the risk of malnutrition in patients with COVID-19 who received SNO, the cause of it and the adequacy of the SNO according to ESPEN guidelines.Material and methodsA cross sectional observational study was conducted between March and April 2020. Adult patients with COVID-19 who received SNO were included. Variables collected were: age, sex, body mass index (BMI), risk of malnutrition according to GLIM criteria, phenotypic criteria (weight loss (>5% in the previous 6 months) and low BMI (≤20 kg/m2 for those aged <70 years old and ≤22 kg/m2 in the elderly)) and aetiologic criteria (low intake (≥ 7 days of hyporexia) and inflammation, type of SNO, energy and protein intake, adaptation of the oral diet, evaluation by the nutrition service and reason for the consultation). The SPSS programme (V.25.0) was used for data analysis.Results162 patients were analysed. 51.8% (85) were men with a mean age of 72.75±12.58 years. Mean BMI mean was 27.05±4.2 kg/m2. 15.2% (25) of patients presented weight loss greater and 6.7% (11) presented low BMI. 92.1% (151) had low intake and all patients fulfilled the criteria for inflammation associated with the disease. 22.6% (37) of the patients presented with a risk of malnutrition. The SNO provided a mean of 408.4±164.06 kcal/day and all were hyperprotein, with a mean of 25.96±10.08 g of protein/day. 18.3% (30) had an adapted oral diet and 16.5% (27) of the patients underwent consultation with the nutrition service, the reasons for this being: 70% (19) marked hyporexia, 18.5% (5) dysphagia and 14.8% (3) diarrhoea.Conclusion and relevanceA quarter of the patients analysed presented with a risk of malnutrition. Hyporexia was the main symptom. In our hospital, it would be advisable to increase the caloric and protein intake of the SNO to comply with ESPEN recommendations.References and/or acknowledgementsConflict of interestNo conflict of interest
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COVID-19 causes various clinical manifestations, ophthalmological manifestations present as viral conjunctivitis. After the entry of the virus, it will produce complex immune response routes, receptors for the virus are found in cells of the ocular surface, therefore it could give a local infection, it is likely that after the entry of the virus, a limited response of ocular inflammation, which could be mediated by the immune privilege approach.