ABSTRACT
Introduction As more specialists become dual accredited in internal medicine, non-gastroenterology specialists have greater exposure to gastroenterology patients over the course of their training, especially via the acute take. Simultaneously, the COVID pandemic has meant most regular local teaching has moved online with varying quality. This project aimed to evaluate 1) whether a standardised protocol can be used to successfully deliver large scale digital gastroenterology teaching that 2) is non-inferior when compared with traditional face to face teaching. Methods Teaching was delivered to internal medical trainees on the acute management of ulcerative colitis and chronic liver disease. Two sessions were delivered a year apart, initially regionally, and then nationally. This was delivered via Zoom, using a standardised protocol based on guidelines to ensure consistency, with live-polled multiple-choice questions to encourage interaction. Each session was followed by Q&A related to that topic. Feedback was taken after each session. Outcome measures analysed were: number in attendance, whether viewers would recommend this teaching to others, whether they thought it ran smoothly, and how they felt about it when compared with face-to-face teaching as measured on a Likert scale. Given the subjective nature of our hypotheses, we accept that these are surrogate markers. Results 171 trainees attended the initial regional teaching session and 469 the subsequent session. Following the first session, 98.9% of trainees would recommend the teaching to others, rising to 99.7% after the second session. 99% and 99.5% respectively agreed or strongly agreed with the statement the initial session ran smoothly, while 84.5% and 88.8% agreed or strongly agreed that digital teaching was as effective as face to face. The benefits of digital teaching were no travel (90%) ability to watch later (86%), whereas the downsides were loss of social interaction (60%) and harder to get study leave (39%). Conclusions Gastroenterology teaching for non-specialists can be delivered successfully at a large scale using a standardised protocol for digital teaching. The vast majority of trainees felt that digital sessions were as effective as face-to-face teaching with a lack of travel and flexibility on viewing time the main reported benefits.
ABSTRACT
Multidrug resistant tuberculosis (MDR-TB) and non-tuberculous mycobacterium (NTM) infections present challenges due to complex treatment regimens. Extended use of multiple antibiotics exposes patients to higher risks of side effects from anti-mycobacterial medications. A high drug toxicity profile necessitates closer monitoring. One of the more challenging issues is QTc prolongation with non-injectable regimens. This study investigates the portable AliveCor device and Kardia app to record and measure the QT interval on a 6-lead ECG. This handheld device can record an ECG trace in a minimum of 30 seconds by establishing three points of contact with electrodes to skin: two thumbs and left ankle or knee. A 6-Lead ECG by AliveCor was recorded for each patient at risk of QT prolongation (n=16) and compared to the existing 12-Lead ECG. The automated QTc readout from the 12-Lead ECG for each patient and mean QTc value calculated from each patients' respective AliveCor tracing were shown alongside each other (figure 1). The general trend suggests the AliveCor underestimates the QTc as 12/13 cases (92%) calculated the AliveCor QTc as lower than their corresponding 12-Lead QTc readout. The mean%difference between the automated 12-Lead and manually calculated AliveCor readings was 3%. The largest%difference between the two readings was 12%. The larger discrepancies could be reflected by the varying quality of the AliveCor tracings. Three patients were excluded due to poor tracings or lack of corresponding 12-Lead ECG. This study aimed to provide pilot data and evaluate the feasibility of a portable device to monitor QTc intervals for patients on potential cardiotoxic medications. It has allowed us to place in context the role for mobile monitoring in (Figure presented) modern-day clinical practice. Moreover, the recent COVID-19 pandemic has seen increasing relevance for remote monitoring. Remote monitoring can aid progression of treatment whilst protecting vulnerable patients from risk of exposure to illness. The use of AliveCor could potentially be translated into current clinical practice using calculated QTcs from the device with caution of percentage variation either side. This could facilitate the use of AliveCor as a promising and convenient screening tool before further evaluation by a 12-Lead ECG is required.
ABSTRACT
Background: Although metabolic risk factors are associated with more severe COVID-19, there is little evidence on outcomes in patients with non-alcoholic fatty liver disease(NAFLD) We here describe the clinical characteristics and outcomes of NAFLD patients in a cohort hospitalised for COVID-19 Methods: This study included all consecutive patients admitted for COVID-19 between February and April 2020 at Imperial College Healthcare NHS Trust, with either imaging of the liver available dated within one year from the admission or a known diagnosis of NAFLD Clinical data and early weaning score(EWS) were recorded NAFLD diagnosis was based on imaging or past medical history andpatients were stratified for Fibrosis-4(FIB-4)index. Clinical endpoints were admission to intensive care unit(ICU)and in-hospital mortality Results: 561 patients were admitted Overall, 193 patients were included in the study Fifty nine patients(30%) died, 9(5%) were still in hospital, and 125(65%) were discharged. The NAFLD cohort(n=61) was significantly younger(60 vs 70 5 years, p=0 046) at presentation compared to the non-NAFLD(n=132) NAFLD diagnosis was not associated with adverse outcomes However,the NAFLD group had higher C reactive protein(CRP) (107 vs 91 2 mg/L,p=0 05) compared to non-NAFLD(n=132) Among NAFLD patients, male gender(p=0 01), ferritin(p=0 003) and EWS(p=0 047) were associated with in-hospital mortality,while the presence of intermediate/high risk FIB-4 or liver cirrhosis was not Conclusion: The presence of NAFLD per se was not associated with worse outcomes in patients hospitalised for COVID-19 Though NAFLD patients were younger on admission,disease stage was not associated with clinical outcomes Yet, mortality was associated with gender and a pronounced inflammatory response in the NAFLD group.