E-Learning Based Web Programming Course in the COVID 19 Pandemic Time

The learning process in the STKIP PGRI West Sumatra Informatics Education Study Program still uses conventional learning methods, namely through face-to-face contact between lecturers and students in the class. The traditional learning method currently taking place has limitations that can hinder the learning process, such as limited time and space to interact with each other, especially during the Covid-19 pandemic. With these conditions, the online learning process is an alternative to support learning in its current state, with technological developments that can simplify the learning process and make the time more flexible and support the learning process anywhere, anytime, and anyone. An electronic learning system (E-Learning) was created from these conditions, which is expected to be an alternative solution for online learning to overcome the STKIP PGRI West Sumatra Informatics Education Study Program’s limitations, especially in introductory web programming courses. E-learning is designed using the System Development Life Cycle (SDLC) method supported by the PHP programming language and implementing the Laravel Framework. The learning process using E-learning is designed using localhost as the central server. This study’s results resulted in an E-learning application built based on the analysis and design recommended by the STKIP PGRI West Sumatra informatics education study program. With this application, it is hoped that it can simplify the online learning process, especially in existing introductory web programming courses. © 2021

COVID-19 vaccine hesitancy and uptake amongst a multiethnic hemodialysis population

Background: Broad adoption of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is key to fighting the spread of Covid-19. Hemodialysis patients are at increased risk of exposure to SARS-CoV2 and associated with high morbidity and mortality if they contract Covid-19, therefore attaining high vaccination rates in dialysis patients is of utmost importance. The aim of this study was to establish the prevalence of vaccine hesitance across the multi-ethnic population of dialysis patients in North East London, and to assess whether vaccine uptake could be improved by offering vaccination in a familiar setting by trusted healthcare professionals. Methods: Prior to the initiation of the hemodialysis vaccine programme, a survey was conducted of 837 in-centre haemodialysis patients to identify those willing to accept the vaccine. The vaccine was then offered to all haemodialysis patients during their dialysis attendance, by their dialysis team of nurses and nephrologists. Results: Of 674 responses, 476 (71%) patients reported willingness to accept the vaccine. However only 41% of the 232 patients of Black ethnicity stated that they would accept the vaccine with 59% undecided or declined, compared to acceptance of 77% and 82% of the Asian and White patients respectively (p<0.0001). The actual acceptance rate was significantly higher in all ethnic groups than that predicted by the survey (82.2% uptake in total), with 71.5%, 86.0% and 89.3% in Black, Asian and White cohorts respectively (p<0.0001). In total, 59.1% of patients who responded 'no' in the initial survey, accepted the vaccine when offered on the unit. Conclusions: Though vaccine hesitancy remains a concern, even in this particularly vulnerable patient group, our data show that uptake can be improved by offering Covid-19 vaccination in a familiar environment by a trusted healthcare team.

Impact of early fluid administration on inpatient mortality and acute kidney injury in patients with COVID-19 disease

BACKGROUND AND AIMS: Initial WHO guidance advised cautious fluid administration for patients with COVID-19 due to concern about the development of acute respiratory distress syndrome (ARDS). However, as the pandemic unfolded it became apparent that patients who were admitted to hospital had high rates of AKI and this initiated a change in local clinical guidelines during early April 2020. We aimed to ascertain the impact of judicious intravenous fluid use on mortality, length of hospitalisation and AKI. METHOD: An observational cohort study of 158 adults admitted with confirmed SARS-Cov-2 between 18th March and 9th May 2020 was conducted in a teaching hospital and designated centre for infectious diseases, London, UK. Key clinical and demographic data collected included clinical severity markers on admission, biochemical and haematological parameters as well as radiological findings. Primary outcomes were inpatient mortality, mortality at 6-weeks post discharge, length of hospitalisation and intensive care (ICU) admission. We also measured requirement for kidney replacement therapy (KRT) and AKI recovery rate at discharge. Using tests of difference, we compared key outcomes between patients treated with varying fluid regimens and then identified risk factors for AKI and mortality using multivariate logistic regression with results expressed as odds ratios (OR) with corresponding 95% confidence interval (CI). RESULTS: The median age was 74.4 (IQR 59.90 - 84.35) years, 66% were male, 53% white with hypertension and diabetes being the commonest co-morbidities. The median duration of illness prior to admission was 7 days (IQR 2 - 10) with respiratory symptoms and fever most prevalent. The people who presented with AKI on admission were more likely to receive fluids (34% vs 15%, p=0.02). 118 patients (75%) received fluids within 24-hours of admission with no difference in volume administered after local guidance change (p=0.78). Comparing patients receiving fluids with those who did not, we observed no difference in mortality (p=0.97), duration of hospital stays (p=0.26) or requirement for ICU admission (p=0.70). 18% died as an inpatient, and 52 patients were either admitted with or developed AKI. Of these 52 patients, 43 received fluids and 9 did not with no difference in KRT requirement (p=0.34), mortality (p=0.50) or AKI recovery (p=0.63). Peak AKI stage was greater among participants who received fluids though stage of AKI at presentation was also greater (p=0.04). Mortality rate in patients with an AKI is higher compared to overall inpatient mortality (31% vs 18%). Of the 36 patients with AKI (Figure Presnted) who were discharged home, 25 patients (69.4%) had renal recovery by the time of discharge. Increasing age and clinical severity on admission were associated with higher mortality (see Figure 1). Older age was associated with 34 - 53 times higher risk of death compared with those aged ≥ 65 years (age 76 - 85 years: OR 34.26, 95% CI: 3.94 - 297.48, p=0.001;age > 85 years: OR 53.07, 95% CI: 5.23 - 539.03, p=0.001). Patients with NEWS2 >4 on admission has 5-fold increased risk of death than those with a score ≥4 (OR 5.26, 95% CI: 1.32 - 20.92). Black ethnicity was associated with a 16-fold increased risk of developing AKI (OR 15.86, 95% CI: 1.67 - 150.99). CONCLUSION: To our knowledge, this is the first study to examine the impact of fluid management on inpatient mortality as well as on renal-associated outcomes of COVID-19 admission. Fluid administration regimen did not have an impact on mortality, length of hospitalisation or ICU admission, nor did it affect renal outcomes. Given the high rates of AKI and KRT in COVID-19 disease, early fluid administration is likely to be an important cornerstone of future management. Further adequately powered prospective studies are required to identify whether early fluid administration can reduce renal injury.

Frailty score before admission as risk factor for mortality of renal patients during the first wave of the COVID pandemic in London

Background: Frailty is a known predictor of mortality and poor outcomes during hospital admission. In this large renal retrospective cohort study, we investigated whether frailer COVID-19 positive renal patients had worse outcomes. Design: All SARS-Cov-2 positive renal patients aged >=18 years who presented to the emergency department at the Royal Free Hospital or at the satellite dialysis centres from 10th of March until the 10th of May 2020, with recent data on frailty, were included. The follow up was until 26th of May 2020. Age, gender, ethnicity, body mass index, chronic kidney disease stage, modality of renal replacement therapy, co-morbidities, Rockwood clinical frailty score (CFS), C reactive protein and the neutrophil-to-lymphocyte count were collected at presentation. The primary outcome was the overall mortality rate following COVID-19 diagnosis. Secondary outcomes included the need for hospital admission.