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This case study describes a meaningful classroom-university Work Integrated Learning (WIL) collaboration that executed course and campus objectives in a novel peer-mentorship design and prepared future event management graduates for industry while navigating the COVID-19 pandemic.A unique collaboration between two event management university courses and the Campus Activities Team (CAT), a subsidiary of the Office of Student Engagement within University Student Affairs, was offered in Fall 2020 and Fall 2021. This WIL collaboration partnered with Senior Seminar (final year) student pairs with small groups of first-year, Introduction to Event Management students (2-5). Each Intro-Senior Seminar dyad received US$400.00 in financial support from CAT to create and implement engaging campus events. Across both semesters, 21 Intro-Senior Seminar dyads created, planned, implemented, and evaluated their campus CAT events.
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Background: As COVID-19 vaccines continue to be administered worldwide, there are an increasing number of studies documenting cutaneous reactions following vaccination. Systemic reactions, such as urticarial diseases, occur. Purpose(s): The main objective of this study was to investigate the association between urticaria and recent vaccination for COVID-19. Method(s): A retrospective chart review examining the association of urticaria and COVID vaccination was conducted. Result(s): We report 17 patients who developed an urticarial reaction following vaccination against COVID and one patient who developed an urticarial reaction following a COVID infection. The vast majority of the patients were women with a mean age of 42.8 years. Conclusion(s): Cutaneous manifestations often follow COVID vaccination and infection. It may be helpful to inquire about recent infections and vaccinations in patients presenting with urticarial diseases. Copyright © 2022 Journal of Dermatology and Dermatologic Surgery.
ABSTRACT
Background: As COVID-19 vaccines continue to be administered worldwide, there are an increasing number of studies documenting cutaneous reactions following vaccination. Systemic reactions, such as urticarial diseases, occur. Purpose(s): The main objective of this study was to investigate the association between urticaria and recent vaccination for COVID-19. Method(s): A retrospective chart review examining the association of urticaria and COVID vaccination was conducted. Result(s): We report 17 patients who developed an urticarial reaction following vaccination against COVID and one patient who developed an urticarial reaction following a COVID infection. The vast majority of the patients were women with a mean age of 42.8 years. Conclusion(s): Cutaneous manifestations often follow COVID vaccination and infection. It may be helpful to inquire about recent infections and vaccinations in patients presenting with urticarial diseases. Copyright © 2022 Journal of Dermatology and Dermatologic Surgery.
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Objective: To ascertain the extent of nasogastric tube (NGT) dislodgment in COVID-19 intensive care unit (ICU) patients after the introduction of NGT bridle kits as a standard of practice, to see whether this would reduce the number of NGT insertions, patient irradiation, missed feeds, and overall cost. Background: Nasogastric feeding is the mainstay of enteral feeding for ICU patients. The usual standard of practice is to secure the tube using adhesive tape. Studies show this method has a 40% to 48% dislodgment rate. The COVID-19 ICU patient population may be at even greater risk due to the need for proning, long duration of invasive ventilation, and emergence delirium. Design: This was a 2-cycle quality improvement project. The first cycle was done retrospectively, looking at the contemporaneous standard of practice where bridle kits were not used. This gave an objective measure of the extent of NGT displacement, associated costs, and missed feeds. The second cycle was carried out prospectively, with the use of NGT bridle kits as the new standard of practice. Setting: A large United Kingdom teaching hospital with a 100-bed, single-floor ICU. Participants: Patients admitted to the ICU with COVID-19 who subsequently required sedation and invasive ventilation. Measurements: Measurements included days of feeding required, hours of feeding missed due to NGT dislodgment, total number of nasogastric tubes required per ICU stay, and number of chest radiographs for NGT position confirmation. NGT-related pressure sores were also recorded. Results: When compared to the bridled group, the unbridled group required a higher number of NGTs (2.5 vs 1.3;P< .001) and chest radiographs (3.4 vs 1.6;P< .001), had more hours of feeding missed (11.8 vs 5.0), and accumulated a slightly higher total cost (cost of NGT, chest radiographs +/- bridle kit: £211.67 vs £210, [US $284.25 vs US $282.01]). Conclusions: The use of NGT bridle kits reduces the number of NGT insertions patients require and subsequently reduces the number of chest radiographs for each patient. These patients also miss fewer feeds, with no appreciable increase in cost.
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The COVID-19 pandemic has forced engineering disciplines to rethink practical activities which are imperative for development of engineering skills in higher education. The main challenge is developing new practical activities that suit remote learning whilst maintaining the experiences of an in-person lab session. This paper outlines the development and implementation of a remotely accessible undergraduate laboratory exercise using off the shelf equipment and remote learning software. In the described lab, students learn the fundamentals of digital systems and the process of using software to design logic circuits, through to implementing and analysing these circuits on an electronic board. The remote lab was successfully implemented using a camera, NI ELVIS II device with a Digital System Development Board (DSDB) and programmed using NI Multisim. The paper describes the development and transition of a traditionally in-person lab to a remote application whilst keeping the same intended learning outcomes and making sure a blended approach can be used in the future. Students remotely trigger inputs (as they would do in-person) to see the cause and effect of their design on the real hardware by pairing visual switches on screen to the physical switches on the board. The students use the camera pointed to the device to see how their designs behave when implemented on the real hardware. The designed lab has already been undertaken by more than 100 undergraduate students from a variety of engineering programmes over a series of multiple sessions. The paper discusses the feedback received from the use of surveys, semi-structured interviews and focus groups of students and academics involved in the development of these remote labs. The discussion focus includes the ease of use, relevance to core subject material and if the practical activities help with their understanding of theory. The paper then concludes by exploring future developments as well as the lessons learnt. © the authors, 2021. All Rights Reserved.
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Background Acute respiratory distress syndrome (ARDS) is a major complication in patients with severe coronavirus disease in 2019 (COVID-19). COVID-19 convalescent plasma (CCP) has been proposed as a specific therapy for patients with COVID-19. Our goal is to assess changes in oxygenation and inflammatory markers in patients after receiving CCP. Methods This is a retrospective, health system-based, a case-control study comparing hospitalized patients with COVID-19 who received CCP and were discharged (survivors) to patients who died after receiving CCP (non-survivors). We analyzed the severity of ARDS, oxygenation, and inflammatory markers of 295 patients, comparing 202 survivors to 93 non-survivors with COVID-19 who received CCP. Demographic information and laboratory data were collected on the day of the admission (initial), the day of the plasma infusion (D1), and post-infusion days 3, 7, 15, and 30 (when available). Results Survivors were younger (52.48 y versus 64.02 y;p<0.001) with no pre-existing conditions (25.2% versus 13.9%;p=0.03) compared to non-survivors. Severe ARDS (PaO2/FiO2 <100) was predictive of increased mortality after CCP in non-survivors (p<0.001). Survivors with mild (20%) or moderate (46%) ARDS on D1 had a 54% resolution of ARDS on D7 after CCP (p<0.001). After 72 hours of transfusion, supplemental oxygen requirements decreased by 63% of the survivors, compared to 33% of non-survivors (p<0.001). Inflammatory markers, including white blood cells, absolute neutrophils, platelets, C-reactive protein (CRP), lactate dehydrogenase (LDH), and creatinine, improved within three days in survivors after CCP (p<0.05). Baseline findings associated with a poor prognosis on D1 include a lower platelet count (219.02 versus 281.64, p<0.001), higher blood urea nitrogen (BUN) (35.41 versus 21.48, p<0.001), higher creatinine (2.24 versus 1.26, p<0.001), higher D-dimer (5.88 versus 2.46, p<0.001) and elevated lactate dehydrogenase (LDH) (698.3 versus 464.51, p<0.001) when comparing non-survivors to survivors, respectively. After 72 hours post-transfusion, the following changes were remarkable: normalization of creatinine with a mean of 1.07 in survivors versus 1.92 in non-survivors (p<0.001), a significant decrease in CRP improving from 129.27 to 84.25 in survivors versus 139.11 to 130.0 in non-survivors (p<0.001), and lower lactate dehydrogenase (LDH) in survivors (459.47) versus non-survivors (674.56, p<0.001). Conclusion In this retrospective, health system-based, case-control study, we found that the improvement in oxygenation, resolution of ARDS, and reduced inflammatory markers are seen in survivor patients after early COVID-19 convalescent plasma transfusion. These parameters can be used to assess response to COVID-19 convalescent plasma after 72 hours of the transfusion and could help physicians in the decision-making when administering CCP, especially if resources are scarce. [Formula presented] Disclosures: No relevant conflicts of interest to declare.
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INTRODUCTION: Dapsone is a commonly used alternative for the prevention of Pneumocystis jirovecii pneumonia (PJP) in immunocompromised patients. However, its use is limited by its significant dose-dependent hematologic adverse effects such as dapsone-induced methemoglobinemia by inhibiting cytochrome 3A4 preventing dapsone's metabolism to its toxic hydroxylamine metabolite. We report a case of dapsone-induced methemoglobinemia in a kidney transplant recipient where oral cimetidine was trialed to reduce dapsone toxicity. METHODS: A 37-year-old woman presented to the emergency department (ED) with a complaint of exertional shortness of breath. Her past medical history was significant for a prior living-related kidney transplant secondary to cystinosis and recent PJP treated with atovaquone. She was initiated on dapsone for PJP prophylaxis five days prior (previous G6PD level was 20.7 U/g Hgb). Dapsone doses were initiated at 25 mg PO daily and uptitrated to 100 mg PO daily over the course of treatment. Upon arrival to the ED, the patient's oxygen (O2) saturation was 88% on room air. She was transitioned to high-flow nasal cannula and her O2 saturation remained between 83-85%. She was noted to have cyanotic fingernails upon physical examination. Her CT chest without contrast and V/Q scan were without abnormalities. Her COVID-19 PCR was negative. Her methemoglobin level was unable to be obtained. Her initial dapsone serum level was 1.4 mcg/mL. The patient was transferred to intensive care. As the patient remained refractory to O2 in the next 24 hours, it was decided to initiate cimetidine 400 mg PO three times daily. Within 24 hours of starting therapy, the patient's O2 saturation improved to 92-95% and her dapsone level downtrended to 0.88 mcg/mL. Her O2 continued to be weaned until she was stable for transfer to the floor. RESULTS: Dapsone-induced methemoglobinemia is rarely reported in non-deficient G6PD patients. Cimetidine may be an option in patients to reduce dapsone concentrations decreasing the length and degree of toxicity. Providers should closely monitor patients for dapsone toxicity despite G6PD testing as onset can occur as early as a few days after initiation.
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BACKGROUND: Accurate and rapid testing for SARS-COV-2 antibodies could improve the diagnosis and management of COVID-19. In this study, we aim to evaluate the diagnostic accuracy of a commercially available point-of-care lateral flow kit independently and in comparison to an established platform-based system. METHOD: Samples from 144 PCR-confirmed COVID-19 cases and 130 pre-pandemic negative controls were tested in parallel by MP Rapid 2019-NCOV IgM/IgG Combo test and Roche Elecsys. Comparison of results based on serum and capillary blood testing was undertaken. RESULTS: Sensitivity at day 15 onwards was 100% for both methods. Between days 1 and 7 post admission, the IgM/IgG Combo test and Roche Elecsys shown sensitivity of 74% (95%CI: 62%-85%) vs. 67% (95% CI: 55%-79%, P = 0.3947). Combo test specificities were 100% for IgG, 98.5% for IgM vs. Roche Elecsys specificity of 100%. Concordance analysis showed 98.5% agreement to the Roche Elecsys method (Cohen's Kappa 0.96 95% CI [0.92-0.99]). Capillary blood results showed complete agreement with serum samples using the Combo test. CONCLUSION: In comparison to Roche Elecsys, our data show that the MP Rapid 2019-NCOV IgM/IgG Combo test provides a high-confidence assay system for the detection of previous exposure to SARS-COV-2 infection with advantage of affording near-patient testing.