ABSTRACT
Introduction: The 6-min walk test (6MWT) is the gold standard for assessing exercise-induced impairment of gas exchange, but it is technically challenging in a busy outpatient clinic. The aim of this study was to compare the 1-min sit-to-stand test (1STST) with the 6MWT in assessment of exercise-induced oxygen desaturation in post COVID-19 patients in an outpatient setting. Method(s): A total of 447 outpatient post COVID-19 patients were recruited from post COVID-19 clinic. Both 6MWT and 1STST (a set) were performed on the same day including pulse oxygen saturation (SpO2) recording at baseline, nadir, and recovery stage. Result(s): A total of 447 sets were performed at a mean of 160 days post discharge. Majority were in category severe (n=251, 56%), critical (n=118, 26%) and moderate (n=6, 15%). At assessment, most patients were symptomatic (mMRC > 2) n= 258, 58%. There was no significant difference between nadir SpO2 for 6MWT and 1STST (p<0.075) with Bland-Altman plots showing good agreement, p<0.593 (figure 1). There was good correlation between SpO2 and 6MWT or 1STST at baseline;R=0.592 p<0.001, nadir;R=0.456 p<0.001, and recovery;R= 0.514 p<001. 1STST had 76.8% sensitivity and 42.4% specificity to detect > 4% oxygen desaturation compared with 6MWT (table 1). There was also correlation between 6MWT distance and 1STST repetition;R=0.144 p<0.002. Conclusion(s): Both 6MWT and 1STS have good agreement on nadir SpO2 and are sensitive to detect > 4% oxygen desaturation. Therefore, 1STST is an useful screening test to detect exercise-induced oxygen desaturation during outpatient assessment.
ABSTRACT
Introduction: Acute COVID-19 infection could lead to long COVID, a heterogenous condition which includes the respiratory system. But data on long-term respiratory complications are scarce and limited especially from our part of the world. Method(s): A total of 443 post COVID-19 patients were recruited from post COVID-19 clinic. The following assessments were performed in all patients;symptoms, 6-minute-walk-test (6MWT), 1-minute-sit-to-stand-test (1STST), spirometry, and chest radiograph. Result(s): Patient's mean age was 51 (13) years old, majority were male (60%), and Malay ethnicity (73%). Majority were in category severe (n=254, 57%), critical (n=122, 28%) and moderate (n=67, 15%). Abnormal spirometry (FVC <80%) were detected in 47% (n=209) of the patients. It was associated with older age groups (54 vs 49 years old, p 0.001), longer hospital admission (17 vs 13 days, p 0.016), shorter follow-up duration (140 vs 170 days, p 0.004), more likely to have oxygen desaturation >4% during 6MWT and 1STST, OR 1.8 (1.1-2.9) and OR 1.7 (1.1-2.6) respectively, and abnormal chest radiograph, OR 3.9 (2.5-6.2) compared to those with normal spirometry findings 125 patients have full lung function test and gas transfer done which showed reduced TLC (<80%) and DLCO (<80%), and normal KCO (>80%) in majority of cases;80% (n = 100), 86.4% (n = 108) and 94% (n = 117). Conclusion(s): Abnormal spirometry findings are common among post COVID-19 patients with pneumonia and are associated with poorer respiratory outcomes;exertional oxygen desaturation and abnormal chest radiograph. Therefore, these groups of patients should be referred for spirometry assessment.
ABSTRACT
INTRODUCTION: Our faculty used one long case (LC) and three short cases for the clinical component of the final professional examinations. During the COVID-19 pandemic, the LC had to be replaced with scenario-based clinical examination (SBCE) due to the impracticability of using recently hospitalised patients. While keeping the short case component as usual, the LC had to be replaced with SBCE in 2020 for the first time at a short notice. To evaluate the positive and negative aspects of SBCE and LC to determine the feasibility of replacing LC with SBCE in future examinations. MATERIALS AND METHODS: We compared the LC scores of three previous years with those of the SBCE and studied the feedback of the three stakeholders: students, examiners, and simulated patients (SPs), regarding their experience with SBCE and the suitability of SBCE as an alternative for LC in future examinations. RESULTS: The SBCE scores were higher than those of the LC. Most of the examiners and students were not in favour of SBCE replacing LC, as such. The SPs were more positive about the proposition. The comments of the three stakeholders brought out the plus and minus points of LC and SBCE, which prompted our proposals to make SBCE more practical for future examinations. CONCLUSION: Having analysed the feedback of the stakeholders, and the positive and negative aspects of LC and SBCE, it was evident that SBCE needed improvements. We have proposed eight modifications to SBCE to make it a viable alternative for LC.
Subject(s)
COVID-19 , Educational Measurement , Humans , Pandemics , Students , Feasibility StudiesABSTRACT
INTRODUCTION: Corticosteroids, particularly methylprednisolone, are part of the treatment for severe COVID-19 with acute respiratory distress syndrome (ARDS). In this study, we aimed to compare the mortalities of patients treated with higher versus lower doses of methylprednisolone. Secondary outcomes included oxygenation, need for mechanical ventilation, length of stay in intensive care unit (ICU), secondary infection, improvement of PaO2/FiO2 (PF) ratio, and inflammatory response as expressed by C-reactive protein (CRP). MATERIALS AND METHODS: A retrospective cohort study conducted at Sarawak General Hospital from 1st June to 30th September 2021. Patients who received intravenous methylprednisolone for severe COVID-19 in the ICU were identified and divided into two groups: higher dose (cumulative dose more than 10 mg per kg) and lower dose (cumulative dose less than 10 mg per kg). RESULTS: Out of a total of 165 patients, 40 (24.2%) patients received higher dose methylprednisolone. There was no significant difference in socio-demographic characteristics (age, gender, body mass index), COVID-19 vaccination status, laboratory parameters (lymphocyte count, CRP, lactate dehydrogenase, D-dimer), or usage of immunomodulator therapy between the groups. Overall mortality was 23.6%. Mortality in the higher dose group was twice as high compared to lower dose group (37.5% versus 19.2%) (OR 3.79, 95% CI 1.24-11.59, p<0.05). In addition, the higher dose cohort developed more secondary infections (87.5%) and had longer stays in ICU (median 11 days, IQR 8- 15). No significant difference was found between both cohorts in terms of CRP reduction, improvement of PF ratio, or the need for mechanical ventilation post methylprednisolone. CONCLUSION: In this study, the use of higher dose methylprednisolone in COVID-19 with ARDS was not associated with better clinical outcomes. A lower dose of methylprednisolone might be sufficient in treating severe COVID-19 with ARDS.
Subject(s)
COVID-19 , Coinfection , Respiratory Distress Syndrome , Humans , Methylprednisolone/therapeutic use , COVID-19 Vaccines , Retrospective Studies , Respiratory Distress Syndrome/drug therapy , C-Reactive ProteinABSTRACT
The COVID-19 pandemic has brought disruptions and constraints to K-12 STEM education, such as the shortened classroom time and the restrictions on classroom interactions. More empirical evidence is needed to inform educators and practitioners which strategies work and which do not in the pandemic context. In response to the call for more empirical evidence and the need for cultivating responsible and competent 21st century citizens, we designed and implemented a transdisciplinary STEM curriculum during the COVID-19 outbreak. In order to facilitate the smooth delivery of the learning contents and authentically engage learners in the learning process, multi-model video approaches were employed considering the characteristics of three disciplines, STEM, social service, and writing, as well as learner diversity. Pre- and post-test results indicated that students’ transdisciplinary STEM knowledge improved significantly after completing the curriculum. The integration of STEM, social service, and writing disciplines promoted the growth of students’ empathy, interest, and self-efficacy. Consistent with the quantitative results, students responded in the interview that their STEM knowledge and empathy were both enhanced. Some implementation strategies introduced in the current study are also applicable when the standard teaching order is restored in the post-COVID-19 era. © 2022, Educational Technology and Society. All rights reserved