The Seventh Annual Academic International Medicine Virtual Congress and Scientific Forum, June 9-12, 2022: Building a Stronger Future

As the COVID-19 pandemic continued to fade, first glimpses of "post-pandemic normal " began to emerge in the late 2021 and early 2022. This new hope came with a positive new momentum - an opportunity to transform and reinvent. Yet given a high degree of uncertainty extending well into 2022, the American College of Academic International Medicine made a strategic decision in the late 2021 to move forward with Virtual 7th Annual Congress and Scientific Forum (AIM 2022). The theme of this year's meeting was "Building a Stronger Future " and reflected the early post-pandemic optimism. Primary organization of the meeting was facilitated by the Sarasota Memorial Health Care System, Sarasota, Florida, with substantial contributions provided by Northwell Health, Long Island, New York. The Scientific Forum once again took place virtually, enabling participants from around the globe to present their research. A summary of these efforts and outcomes is provided in this article. The following core competencies are addressed in this article: Interpersonal and communication skills, Professionalism, Practice-based learning and improvement, Systems based practice.

The pandemic and the provincial press

The UK regional press, having survived years of decline, was just re-establishing itself as a successful publisher of news via digital and social media when the pandemic struck. Former regional newspaper editor Tor Clark looks at how the coronavirus crisis impacted local newspapers © John Mair, Tor Clark, Neil Fowler, Raymond Snoddy and Richard Tait 2021. All rights reserved.

Populism, the Pandemic and the Media: Journalism in the age of Covid, Trump, Brexit and Johnson

Populism is on the rise across the globe. Authoritarian populist leaders have taken over and solidified their control over many countries. Their power has been cemented during the global coronavirus pandemic, though perhaps the defeat of populist-in-chief Donald Trump in the 2020 US presidential election (despite his continuing protestations to the contrary) has seen the start of the waning of this phenomenon? In the UK Brexit is 'done';Britain is firmly out of the EU;Covid is vaccinated against;and Boris Johnson has a huge parliamentary majority and, despite never-ending problems, of his own and others' making, his grip on power with a parliamentary majority of more than 80, still seems secure. Meanwhile culture wars continue to rage. How has media, worldwide, contributed, fulled or fought this populism. Cheerleaders? Critics? Supplicants? This book examines those questions in 360 degrees with a distinguished cast of authors from journalism and academia. © John Mair, Tor Clark, Neil Fowler, Raymond Snoddy and Richard Tait 2021. All rights reserved.

Creative and visual communication of health research: development of a graphic novel to share children's neighbourhood perspectives of COVID-19 lockdowns in Aotearoa New Zealand

Research dissemination to target stakeholders including communities, policymakers and practitioners is a fundamental element of successful research projects. For many of these stakeholders, however, barriers to access and uptake exist, including time taken to publish, academic jargon, language barriers, paywalled articles and time taken to consume and understand academic outputs. Ultimately these barriers could prevent research from reaching target audiences or could severely delay the uptake of key research messages. Creative and visual dissemination approaches as a complement to traditional academic outputs offer numerous advantages and may improve real-world uptake in a timely manner. In this practitioner piece, the authors present detailed methods for the development of a graphic novel using research findings from an online survey that asked children what they liked about their neighbourhood during COVID-19 lockdowns in Aotearoa New Zealand. Here, they share critical reflections from the process of developing and disseminating this creative communication, with the aim of informing and supporting future creative and visual dissemination of research findings. © The Author(s) 2023.

SEEKING EMPIRICAL EVIDENCE TO SUPPORT ONLINE TEST VALIDATION: Building on the IELTS Indicator Assessment Model

The COVID-19 pandemic presented testing companies with a range of difficulties in 2020, to be overcome under significant time pressures. Rapid introduction and expansion of online assessment entailed particular challenges for securely delivered high-stakes assessment models, such as the International English Language Testing System (IELTS) test. IELTS Indicator – launched in April 2020 – allowed testing to continue online. As online testing for IELTS is to continue in the post-pandemic assessment landscape, understanding the implications of existing tests migrating to an online delivery mode necessitates rigorous academic inquiry, and empirical evidence on which to base future test development decisions. This chapter explores candidate experiences of IELTS Indicator, using candidate survey data (N = 2,444) gathered throughout its deployment, and examiner (n = 5) focus groups Findings reveal that candidates largely appreciated online testing, with many preferring this to a test centre. However, the variability of home environments and their technological capabilities present a significant challenge to test reliability, and other considerations do arise. © 2023 selection and editorial matter, Karim Sadeghi;individual chapters, the contributors.

Forced choice? Is bullying pushing non-binary students into cyber schools?

Little research addresses the schooling experiences of non-binary students;no prior work explores their experiences in cyber schools. Using unique data from a US multi-state cyber charter school, we compare the factors parents of non-binary students and parents of other students stated as reasons for leaving their prior schools to attend a cyber charter school in fall 2019 (before the COVID-19 pandemic). Despite a small sample size, we found statistically significant differences, with parents of non-binary students two to three times more likely to indicate mental health, safety, and bullying related concerns as motivating their choice of cyber schooling. There were no significant differences regarding physical health, and few involving academic concerns. We also note implications, and directions for future research. © 2023 Educational Review.

Impact of the COVID-19 pandemic on surgery for severe endometriosis in the UK: a national database study.

Background: The COVID-19 pandemic has had a significant effect on healthcare services, particularly affecting patients who suffer from chronic conditions. However, the pandemic's effect on endometriosis surgery is not yet known. Objectives: To determine the impact of the COVID-19 pandemic on surgery for severe endometriosis in the UK at a national, regional and centre-level. Materials and Methods: The British Society for Gynaecological Endoscopy (BSGE) collects data nationally on all operations for severe endometriosis which involve dissection of the pararectal space. Annual audits of this database were obtained from the BSGE. Publicly available data on COVID-19 cases and population were obtained from the UK Office for National Statistics. Main outcome measures: Numbers of annual BSGE-registered endometriosis operations. Results: A total of 8204 operations were performed. The number of operations decreased by 49.4% between 2019 and 2020 and then increased in 2021, but remained 10.5% below average pre-pandemic levels, indicating at least 980 missed operations between 2019-2020. Median operations per centre decreased by 51.0% in 2020 (IQR 29.4% - 75.0%) and increased in 2021 but remained 33% below pre-pandemic levels. There was no change in the type of surgery performed. All 11 administrative regions of Great Britain had reduced numbers of operations in 2020 compared with the average for 2017-2019, with a median 44.2% decrease (range 13.3% - 67.5%). Regional reduction in operations was correlated with COVID-19 infection rates (r=0.54, 95% CI of r 0.022 - 1.00, p=0.043). Conclusion: The number of operations performed annually in the UK for severe endometriosis fell dramatically during the COVID-19 pandemic and is yet to normalise. What's new?: This study shows the dramatic effect that the COVID-19 pandemic has had on UK services for endometriosis surgery, which may continue to affect patients and clinicians for a considerable time to come.

Evaluating and Improving Questions on an Unproctored Online General Chemistry Exam

Administering exams in large enrollment courses is challenging and systems in place for accomplishing this task were upended in the spring of 2020 when a sudden transformation to online instruction and testing occurred due to the COVID-19 pandemic. In the following year, when courses remained online, approaches to improve exam security included measures like using test banks and reducing the allotted time for completing exams to reduce the sharing of information. A psychometric comparison using classical test theory of an unproctored online exam with one delivered in-person indicates both have comparable reliability. However, item-level analysis demonstrates some questions performed higher in the unproctored setting, with an important variable being the item's searchability online. Revising questions to increase generalizability and reduce searchability mitigate these performance differences. Further, changing the format for questions involving calculations from multiple-choice to open response with random number generation was found to increase difficulty and item discrimination and is a viable approach for improving exam security. © 2022 Authors.

Risk factors for persistent abnormality on chest radiographs at 12-weeks post hospitalisation with PCR confirmed COVID-19.

BACKGROUND: The long-term consequences of COVID-19 remain unclear. There is concern a proportion of patients will progress to develop pulmonary fibrosis. We aimed to assess the temporal change in CXR infiltrates in a cohort of patients following hospitalisation for COVID-19. METHODS: We conducted a single-centre prospective cohort study of patients admitted to University Hospital Southampton with confirmed SARS-CoV2 infection between 20th March and 3rd June 2020. Patients were approached for standard-of-care follow-up 12-weeks after hospitalisation. Inpatient and follow-up CXRs were scored by the assessing clinician for extent of pulmonary infiltrates; 0-4 per lung (Nil = 0, < 25% = 1, 25-50% = 2, 51-75% = 3, > 75% = 4). RESULTS: 101 patients with paired CXRs were included. Demographics: 53% male with a median (IQR) age 53.0 (45-63) years and length of stay 9 (5-17.5) days. The median CXR follow-up interval was 82 (77-86) days with median baseline and follow-up CXR scores of 4.0 (3-5) and 0.0 (0-1) respectively. 32% of patients had persistent CXR abnormality at 12-weeks. In multivariate analysis length of stay (LOS), smoking-status and obesity were identified as independent risk factors for persistent CXR abnormality. Serum LDH was significantly higher at baseline and at follow-up in patients with CXR abnormalities compared to those with resolution. A 5-point composite risk score (1-point each; LOS ≥ 15 days, Level 2/3 admission, LDH > 750 U/L, obesity and smoking-status) strongly predicted risk of persistent radiograph abnormality (0.81). CONCLUSION: Persistent CXR abnormality 12-weeks post COVID-19 was common in this cohort. LOS, obesity, increased serum LDH, and smoking-status were risk factors for radiograph abnormality. These findings require further prospective validation.

Prioritisation of outpatient appointments and elective surgery in gynaecology.

The coronavirus disease 2019 (COVID-19) pandemic continues to be a global public health concern. It has posed a multitude of challenges from managing the supply chain of personal protective equipment (PPE), reducing the spread of the virus through national restrictions, disrupting the routine delivery of healthcare services to now the race in developing novel treatments and vaccines. As the National Health Service (NHS) considers a phased restoration of non-emergency services, it is imperative to consider the high volume of patients awaiting specialist reviews and surgical procedures. Gynaecology services have to be prioritised according to the patients' clinical needs rather than their individual waiting times. In this chapter, we look at the varying aspects of prioritising non-emergency gynaecology care, including outpatient appointments and elective surgery, how innovative pathways have evolved in response to necessity, what some of the barriers have been to implement these and how this has overall impacted on individual gynaecological specialties.

COVID-19 in Women's health reducing the risk of infection to patients and staff during acute and elective hospital admission for gynaecological surgery.

The novel coronavirus SARS-Cov-2 has changed healthcare on a worldwide scale. This highly contagious respiratory virus has overwhelmed healthcare systems. Many staff were redeployed, and there was widespread cessation of non-urgent outpatient clinics and surgery. Outpatient clinics and theatre areas were converted to COVID-19 wards and intensive care units. Following the first peak, services began to recommence with new triaging and prioritisation guidance to safeguard patients and staff. Different countries and healthcare systems produced differing guidance and, in particular, variation in the best approach to continuing acute and elective surgical procedures. This chapter collates and evaluates the increasing international literature concerning the surgical management of gynaecological conditions during the pandemic, such that clear inferences, recommendations and guidance can be generated to aid clinical practice and safeguard against further major disruption arising from further COVID-19 peaks. The available data are assessed within the context of the current phase of the COVID-19 pandemic.

Erratum: Testing in the Time of COVID-19: A Sudden Transition to Unproctored Online Exams (J. Chem. Educ. (2020) 97: 9 (3413-3417) DOI: 10.1021/acs.jchemed.0c00546)

The article, Testing in the Time of COVID-19: A Sudden Transition to Unproctored Online Exams, was originally published without including Richard Spinney as an author. However, Richard Spinney made a significant scientific contribution to this work, authoring the code available as part of the Supporting Information of the paper, and his name should be included in the list of authors. © 2020 American Chemical Society and Division of Chemical Education, Inc.

Getting back to business: considerations for restarting non-cancer gynaecological surgery following the COVID-19 peak.

As we begin to pass the first peak of the coronavirus pandemic, the backlog of routine gynaecological surgical work is becoming more apparent and continues to build day by day. The potential for further pandemic surges remain; however it is imperative that elective gynaecological surgery is restored safely, ethically and in a timely manner. The risks of COVID-19 transmission and potential increased surgical morbidity must be weighed up against the patient's ongoing symptoms and quality of life. Universal screening and testing of patients attending for routine surgery, as well as staff testing and retesting, will be fundamental to reducing the risks to both patients and staff, and avoiding the higher morbidity encountered when operating on asymptomatic infected patients. The aim of this paper is to explore pathways to safely reintroduce elective benign gynaecological surgery and the challenges that will be encountered including patient counselling and informed consent, surgical prioritisation and the screening and testing of patients and staff, as well as the logistical and ethical challenges of reintroducing benign surgery during COVID-19 times.

Inflammatory phenotyping predicts clinical outcome in COVID-19.

BACKGROUND: The COVID-19 pandemic has led to more than 760,000 deaths worldwide (correct as of 16th August 2020). Studies suggest a hyperinflammatory response is a major cause of disease severity and death. Identitfying COVID-19 patients with hyperinflammation may identify subgroups who could benefit from targeted immunomodulatory treatments. Analysis of cytokine levels at the point of diagnosis of SARS-CoV-2 infection can identify patients at risk of deterioration. METHODS: We used a multiplex cytokine assay to measure serum IL-6, IL-8, TNF, IL-1ß, GM-CSF, IL-10, IL-33 and IFN-γ in 100 hospitalised patients with confirmed COVID-19 at admission to University Hospital Southampton (UK). Demographic, clinical and outcome data were collected for analysis. RESULTS: Age > 70 years was the strongest predictor of death (OR 28, 95% CI 5.94, 139.45). IL-6, IL-8, TNF, IL-1ß and IL-33 were significantly associated with adverse outcome. Clinical parameters were predictive of poor outcome (AUROC 0.71), addition of a combined cytokine panel significantly improved the predictability (AUROC 0.85). In those ≤70 years, IL-33 and TNF were predictive of poor outcome (AUROC 0.83 and 0.84), addition of a combined cytokine panel demonstrated greater predictability of poor outcome than clinical parameters alone (AUROC 0.92 vs 0.77). CONCLUSIONS: A combined cytokine panel improves the accuracy of the predictive value for adverse outcome beyond standard clinical data alone. Identification of specific cytokines may help to stratify patients towards trials of specific immunomodulatory treatments to improve outcomes in COVID-19.

Vaginoscopy for office hysteroscopy: A systematic review & meta-analysis

OBJECTIVE: To investigate the effect of the vaginoscopic approach to office hysteroscopy on patients'experience of pain, when compared with the traditional approach where a vaginal speculum is used. METHODS: Medline, Embase, CINAHL and the Cochrane library were searched from inception until December 2019, in order to perform a systematic review and meta-analysis of all randomised controlled trials investigating vaginoscopy compared to traditional hysteroscopy on pain experienced by women undergoing diagnostic or operative hysteroscopy in an office setting. Data regarding procedural time, feasibility, incidence of vasovagal reactions and complications, acceptability and satisfaction were also recorded. RESULTS: The literature search returned 363 results of which seven were selected for systematic review, and six for meta-analysis. The vaginoscopic approach was associated with a statistically significant reduction in pain (4 studies including 2214 patients;SMD -0.27, 95 % CI -0.48 to -0.06), procedural time (6 studies including 2443 patients;SMD -0.25, 95 % CI -0.43 to -0.08) and the incidence of vasovagal episodes (3 studies including 2127 patients;OR 0.35;95 % CI 0.15 to 0.82). Failure rates between the two techniques were similar (p = .90). No study reported significant differences in complications or patient or clinician acceptability or satisfaction. CONCLUSION: Clinicians performing office hysteroscopy should use the vaginoscopic technique because it makes office hysteroscopy quicker, less painful and reduces the likelihood of inducing a vasovagal reaction. The traditional approach should only be used when vaginoscopy fails or when the need for cervical dilatation is anticipated.

Covid 19 pandemic and gynaecological laparoscopic surgery: knowns and unknowns.

The worldwide impact of COVID 19 continues to be felt as hospitals in all countries reduce elective and non-urgent cases to allow staffing and resources to be deployed elsewhere. Urgent gynaecological and cancer procedures are continuing, and it is imperative all theatre staff are protected and risks of SARS-CoV-2 viral transmission reduced when operating on asymptomatic, suspected or confirmed COVID 19 patients. In particular, there are concerns relating to the transmission of COVID 19 during gynaecological laparoscopic surgery, arising from the potential generation of SARS-CoV-2 contaminated aerosols from CO2 leakage and the creation of smoke from the use of energy devices. The aim of this paper is to review all the up to date evidence, including experiences from China and Italy, to guide the safe management of such patients when undergoing gynaecological procedures.