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Learning Objectives: The pandemic exposed the mismatch between trainee mental health needs and their access to support services;therefore, the objective of our innovation was to support an opportunity for residents to work with a social worker/coach who could provide coaching on an emergent, urgent, or regular basis. Introduction/Background: EM training requires sleep-wake disruptions, includes potentially traumatizing encounters, all during the COVID-19 pandemic while many residents relocate away from their customary psychosocial supports for training. The shift-based training model limits access to psychosocial care and services, so trainees need just-in-time resources which can support them before mental health concerns develop. Educational Objectives: The objective of our innovation was to support an opportunity for our residents to work with a professional social worker who could provide coaching on an emergent, urgent, or regular basis. Curricular Design: The leadership team identified a clinical social worker and trained coach to provide small group and individual coaching sessions to residents (4-year urban safety-net program with 68 residents) budgeted at an initial cost of $15,000. It was agreed that what was shared in the discussion would not be shared without consent and legal limits to confidentiality were followed. Impact: From October 1, 2020 when implemented to October 1, 2021 there were 49 group and 73 individual sessions. After implementation in 2021, we compared this rotational mean score as ranked by all residents to all other wellness initiatives. Overall response rate was 80.88%. The overall mean score of the initiative was 2.25 (1-lowest and 4-highest) versus 3.73, the mean of all other wellness initiatives. Summary comments from the residents revealed the innovation was useful but shared concern regarding ability to attend sessions and capacity of social worker to relate with them. If other programs are considering implementation of a similar program recruiting someone with ED/graduate medical education experience or making sure they are oriented is key. Application of a social worker coaching program in an EM residency appears to be a feasible novel wellness intervention with potential to improve well-being, but needs framing to benefit trainees.
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Learning Objectives/Educational Objectives: Objectives included providing hands-on training to improve confidence in high-risk deliveries and neonatal resuscitation, and assuring ACGME delivery requirement compliance. : Introduction/Background: COVID19 has affected offservice rotations for emergency medicine residents by limiting provider numbers in patient care areas. To mitigate the educational impact of decreased exposure to deliveries, we developed an obstetrics (OB) simulation (sim) curriculum. Curricular Design: The curriculum consists of 4 sim sessions: 1) normal vaginal delivery & shoulder dystocia;2) breech, cord prolapse, cord presentation;3) postpartum hemorrhage & perimortem c-section;and 4) breech delivery, neonatal resuscitation, post-partum hemorrhage care. Sessions include a facilitated discussion, practice of techniques and procedures, and a comprehensive, high-fidelity sim. By the end of the 4 sessions, residents complete 13 deliveries, 1 c-section, 2 post-partum hemorrhage resuscitations, and 1 pediatric resuscitation. Throughout the year they will receive monthly e-mailed pearls for spaced repetition of knowledge. Additionally, at the end of the academic year, residents will repeat the final session, perform another c-section, and practice 5 additional deliveries. Impact/Effectiveness: After overwhelmingly positive session feedback from the class of 2020, the curriculum was added as a required adjunct to the OB rotation. The class of 2021 has completed the 4 sessions prior to rotating on OB. Residents completed a 15-item confidence and knowledge assessment prior to the 1st and 4th sessions which demonstrated a significant improvement in both median reported confidence on a 3-point likert scale (1.5 [interquartile range(IQR) 1.2-1.5]) vs 2.1 [IQR 1.9-2.3], p=0.02) and median percentage of correct responses for knowledge-based questions (18 [IQR 12-65] vs 82 [IQR 71-88], p=0.03). Residents will take the quiz at the end of the academic year to assess confidence and knowledge retention, and further refine the OB sim curriculum.
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Background: The COVID-19 pandemic has spread globally, infecting and killing millions. Those subjects with cardiovascular disease (CVD) are at higher risk of severe COVID-19 morbidity and mortality following SARSCoV- 2 infection. Purpose: To investigate the response to different treatments against COVID-19 in patients with a pre-existing CVD. Methods: We conducted a systematic review and meta-analysis following Cochrane, PRISMA and MOOSE guidelines (PROSPERO ref:CRD42020183057). Eligible articles reported in-hospital mortality rate in COVID-19 patients with CVD after testing specific treatments. Statistical concordance was performed by Cohen's kappa coefficient. The primary outcome was in-hospital mortality rate, secondary outcome was the length of hospital stay (LOS). The analysis utilised a random-effects model. Categorical variables were expressed as risk ratio (RR) and continuous variable with weighted mean difference (WMD) and standard deviation with 95% confidence interval (CI). I2 and Chi-tests were used to assess studies' heterogeneity. Publication bias was visualised by L'Abbe' plot and funnel plot with Egger's test. Subgroup analysis (pooling analysis) was also performed to compare the three groups' mortality differences: 'CVD treated' vs.'CVD untreated' vs.'no-CVD (treated and untreated)'. Meta-regression models were used to determine the effects of specific treatments and risk factors on the primary outcomes. R-studio used for analysis. Results: Of 1,673 articles retrieved, 46 studies included CVD patients from which 11 included control group, finally five were comparative studies and were included in the quantitative analysis. From those studies, the sample size was 130 (mean age 63.9±2.7 years;55.3% male). There was 100% concordance between reviewers equating to a Cohen's kappa coefficient of κ=1. The most frequent CV risk factor (CVRF) was hypertension (60%) followed by diabetes (28.5%). The most frequent CVD seen in patients was coronary artery disease at 9.09% and peripheral arterial disease at 5.4%. Mortality rate was significant higher in the CVD treated group (RR:1.52;95% CI [1.05,2.21], CVD treated vs overall population p=0.03). Meta-regression showed that no treatment was significant associated to mortality and systemic hypertension, but an independent risk factor for mortality. Pooled single analysis showed no difference between treated vs untreated CVD patients. There was certain degree of heterogeneity (I2 50%) across the studies. L'Abbe and funnel plot visualized not significant dispersion (Egger test, p=0.71). There was no difference in terms of LOS [0,79, 95% CI (-0.48, 2,05);p-value 0.22]. Conclusions: This quantitative analysis showed that CVD patients despite specific treatments were exposed to significant higher mortality when compared to the overall population. These results remark the clinical relevance to reduce CVD risk factors and ameliorate specific COVID-19 treatments to lower the risk of mortality in this group.
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During the COVID-19 pandemic, NHS services had to convert face-to-face consultations to remote consultations to facilitate the ongoing provision of healthcare. Many specialties including Oral and Maxillofacial Surgery and Rheumatology have found such virtual clinics effective and appreciated by both patients and clinicians. In Oral Medicine, whilst responses to virtual clinics have been positive, we have recognised that they are not sufficient. In this reflective piece, we describe our experiences and our approach to their use in the management of Oral Medicine and Behçet's disease patients, which has developed iteratively during the lockdown period. We also consider the role of virtual clinics in Oral Medicine in the post-COVID-19 era.
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COVID-19 , Oral Medicine , Communicable Disease Control , Humans , Pandemics , SARS-CoV-2 , TelephoneABSTRACT
This article contrasts two significant ruptures in globalisation. World War I in 1914 was a significant break from the Latin American export-oriented development that was firmly connected to economic globalisation. This article uses the Argentine case study to reveal the ramifications of the post-1914 global breakdown for the republic's internationally dependent development. It draws comparisons with the current COVID-19 crisis as a significant departure from rapid globalisation. Both events altered the trajectory of international activity. Analysis of the 1914 rupture exposes the parallels with COVID-19 and its potential severity for Latin America's internationally connected development. © 2020 The Author. Bulletin of Latin American Research published by John Wiley & Sons Ltd on behalf of Society for Latin American Studies.