ABSTRACT
BACKGROUND: Hospital transmission of SARS-CoV-2 has proved difficult to control, with healthcare-associated infections troublesome throughout. AIM: To understand factors contributing to hospital transmission of infections, which is necessary for containing spread. METHODS: An outbreak of 56 staff and patient cases of COVID-19 over a 31-day period in a tertiary referral unit is presented, with at least a further 29 cases identified outside of the unit and the hospital by whole genome sequencing (WGS). FINDINGS: Transmission is documented from staff to staff, staff to patients, and patients to staff, showing disruption of a tertiary referral service, despite implementation of nationally recommended control measures, superior ventilation, and use of personal protective equipment. There was extensive spread from the index case, despite this patient spending only 10 h bed bound on the ward in strict cubicle isolation and with an initial single target low level (CT = 32) polymerase chain reaction test. CONCLUSION: This investigation highlights how effectively and rapidly SARS-CoV-2 can spread in certain circumstances. It raises questions about infection control measures in place at the time and calls into question the premise that transmissibility can be reliably detected by using lower sensitivity rapid antigen lateral flow tests. We also highlight the value of early intervention in reducing impact as well as the value of WGS in understanding outbreaks.
ABSTRACT
Purpose : Exogenous endophthalmitis (EE) is the most serious complication of penetrating eye surgeries and open globe trauma (OGT). It is crucial to know the associated factors that will determine the final visual prognosis. The aim of the present study was to describe the epidemiological, clinical profile and visual outcomes (VO) predictors in patients with EE in a referral ophthalmology center. Methods : Retrospective, observational clinical study. Patients diagnosed with EE between January 2018 to September 2021 were included. Data collected included demographic characteristics, endophthalmitis origin, culture samples, microbiological diagnosis, initial and final best corrected visual acuity (BCVA), and treatment received. Major outcome was change in BCVA after endophthalmitis treatment and associated factors. T-test and Fisher's exact test for statistical analysis were used. Results : Seventy-three patients with EE were included. Surgery associated (SA) was the most common cause responsible for 39 cases (53.4%), followed by keratitis associated 18 cases (24.6%) and trauma associated (TA) 16 cases (21.9%). Gram-positive bacteria predominated in positive cultures (n= 35 [54.3%]). There was a statistically significant difference at mean age between TA group 41.1 ±18.7 years and SA group 59.9 ±20.9 years (p= 0.002). Final logMAR BCVA in the TA group was 4 ±0.9 (Snellen, light perception [LP]) and in the SA group was 2.7 ±1.7 (Snellen, Hand Motion [HM]). Fourteen (35.8%) patients in the SA group had a final BCVA ≥ 20/400;whereas in the TA group all patients had a final BCVA ≤ CF. Risk factors for non-improving BCVA after EE included OGT (p= 0.007) and initial BCVA of LP or worse (p <0.0001) in the SA group. There was no statistical difference in the final VO in patients that were treated with intravitreal injection (II) and those treated with vitrectomy (VTM) (p =0.40). Although 6 patients (75%) treated with VTM had an improvement in final BCVA compared with 12 (57.1%) of the patients just treated with II, this could be due to the sample number. We observed a tendency of diminishing cases of TA endophthalmitis after covid era, this could be associated with the isolation measures recommended. Conclusions : Surgery associated EE had a better visual prognosis than those with trauma associated EE. The initial BCVA is a meaningful indicator for final VO, being favorable when is better than HM.
ABSTRACT
We present an outbreak of 56 staff and patient cases of COVID-19 over a 31 day period in a tertiary referral unit, with at least a further 29 cases identified outside of the unit and the hospital by whole genome sequencing (WGS). We document transmission from staff-to-staff, staff-to-patients and patients-to-staff and show disruption of a tertiary referral service, despite implementation of nationally recommended control measures, superior ventilation and use of PPE. We demonstrate extensive spread from the index case, despite them spending only 10 hours bed bound on the ward in strict cubicle isolation and with an initial single target low level (CT=32) PCR test. This investigation highlights critical issues including how effectively and explosively SARS-CoV-2 can spread in certain circumstances. It raises questions about infection control measures in place at the time and calls into question the premise that transmissibility can be reliably detected using lower sensitivity rapid antigen lateral flow tests. We also highlight the value of early intervention in reducing impact as well as the value of WGS in understanding outbreaks.
ABSTRACT
Introduction: Virtual classroom training (VCT) is a novel educational method that permits accessible, distanced interactive expert instruction. We aimed to evaluate the efficacy of VCT in comparison to face-to-face training (FFT) and non-interactive computer-based learning (CBL) for basic surgical skills training. Method: 72 participants recruited from five London medical schools underwent stratified block randomisation into three equal intervention groups based on subjective and objective suturing experience. VCT was delivered via the BARCO weConnect platform and FFT was provided by expert instructors. Optimal student-to-teacher ratio was used, 12:1 for VCT and 4:1 for FFT. The assessed task was interrupted suturing with hand-tied knots. The primary outcome was post-intervention Objective Structured Assessment of Technical Skills (OSATS) score, adjudicated by two blinded experts and adjusted for baseline proficiency. Results: VCT was non-inferior to FFT (adjusted difference 0.44, 95% CI: -0.54 to 1.75, delta 0.675), VCT was superior to CBL (adjusted difference 1.69, 95% CI 0.41 to 2.96) and FFT was superior to CBL (adjusted difference 1.25, 95% CI 0.20 to 2.29). FFT alone was associated with student travel expenses (mean £4.88, SD 3.70). Instructor hours used per student for VCT and FFT were 0.25 and 0.75, respectively. Conclusions: VCT has a similar educational benefit to FFT and is a suitable modality of high-quality surgical skills education. VCT provides greater accessibility and resource efficiency compared to FFT. VCT satisfies the requirement for social distancing during the COVID-19 pandemic and is better than non-interactive CBL. VCT has the potential to improve global availability and accessibility of surgical skills training.
ABSTRACT
Teacher education in the time of the covid is unpredictable indeed. Fifty years ago, a major political overhaul of initial teacher education removed control from state education departments and began the transition of ITE to a university discipline. This led to the emergence of the teacher education professional, and the need for an association such as ATEA to maintain self-regulation and development of the field. While "on the ground" the daily practice of teacher education may not feel the same as it did in 1971, when we think about our possible futures, we argue that we must always take account of our pasts - and how they have shaped the social, political, and educational contexts we do and will experience. The things we do as teacher educators, along with how we do them, where we do them, and even who we do them with, are always changing: attention to our history is essential as we imagine shaping our future. We are indeed in an unpredictable position. We revisit our history here to argue that there is benefit now, in listening to advice from the past - and considering the possibilities of a road not yet taken.
ABSTRACT
The COVID-19 pandemic has dramatically influenced our lifestyles and sleep habits, compromising our ability to effectively process and regulate emotions. We explore a neurobiological perspective to illustrate that dreams and nightmares during the pandemic may be indicative of an increased emotional load in our waking lives. We also propose that the combined impact of daily stressors and poor sleep behaviours brought on by the COVID-19 pandemic may lead to detrimental psychological health outcomes. These negative effects are ultimately perpetuated through a vicious cycle, necessitating the development of appropriate and timely interventions. We suggest that dreams and nightmares can showcase the role COVID-19 as a chronic population stressor. As this pandemic ensues, researchers should not overlook the importance of dreams and how sleeping habits are linked to waking emotional states. © 2021, University of Toronto. All rights reserved.