ABSTRACT
Aims Northern Irish paediatric trainees are accustomed to moving to a new trust every 6 months, and in turn having to re-learn management of common conditions based on local guidelines. Following feedback and audit evidence of significant variation in management of common paediatric conditions throughout Northern Ireland (NI), the trainee-led NI Paediatric Education Audit and Research network (NI PEAR) have successfully produced regionally approved guidelines to help standardise care across trusts. The NI PEAR committee recognised there were no resources available for trainees to facilitate easy access to this material and set about creating and launching our own website (www.nipear.squarespace.com). We wanted to create a NI paediatrics trainee hub where guidelines, educational resources, course information and event reminders can be easily accessed. Methods The NI PEAR committee developed a website using the platform 'Squarespace'. The website was designed to be easily navigable with a home page linking to the most frequently used content, a section outlining our aims as a group and a dedicated guidelines page. Regional NI guidelines and links to external guidelines are available whilst we continue to develop our guideline portfolio. Multiple education sections advertise ongoing learning opportunities available to trainees. There are numerous areas for those visiting the website to submit their request for a guideline to be uploaded and to suggest or show interest in audit and research opportunities. Results The NI PEAR website went 'live' in December 2021 and has proved to be extremely popular with NI Trainees to date. The site received over 500 hits within the first few weeks of launch and has been supported by consultants in the region. We conducted an online survey which showed 100% of trainees who responded previously having difficulties locating guidelines in a timely manner, 100% stating a regional hub for guidelines and training information is useful and 82% finding that the website has enhanced their experience as a trainee in its first version. Conclusion Modern Technology is becoming increasingly integrated into the trainee experience. We have all witnessed a shift in approaches to teaching, meetings and how we receive our information since the beginning of the COVID 19 pandemic. Yet, harnessing this technology to improve the trainee experience is something we receive no formal training on. We, as a group of trainees, have taken the initiative to build a platform tailored to our needs. It is designed to be the one stop hub for paediatrics in NI, whether that's checking when the next PICU telelink is, or at 3am when you have a sick child and need to access a guideline. Through this project, we will be able to improve the standard of care delivered to our paediatric population in NI with regional guidance and improve the experience of our trainees by giving everyone access to the same resources. Most importantly, this is a resource created by trainees, for trainees, giving us somewhere to interact with each other's work, to collaborate and build a robust network of paediatricians in NI.
ABSTRACT
Alcohol misuse is associated with the development of respiratory failure, including the acute respiratory distress syndrome (ARDS), with attendant poorer outcomes. Epidemiologic data suggest that alcohol consumption increased during the COVID-19 pandemic;however, consumption habits among critically ill patients are not well-described. We hypothesized that the prevalence of alcohol consumption and misuse among patients with respiratory failure would be greater during the pandemic relative to years prior. Patients with respiratory failure requiring mechanical ventilation in a single academic hospital were enrolled from 2015-19 (pre-pandemic) and 2020-21 (pandemic). Data regarding demographics and alcohol use were obtained from the medical record. Phosphatidylethanol (PEth) was measured in a subset of patients in red blood cells collected within 48 hours of intubation. Patients were characterized as follows: (1) likely drinking: patient or proxy endorsed any drinking on the Alcohol Use Disorders Identification Test (AUDIT) or in social history;or patient was admitted for an alcohol-related diagnosis;or patient had detectable blood alcohol or PEth;(2) likely alcohol misuse: PEth ≥ 250;or AUDIT-C ≥3 (women) or ≥4 (men);or AUDIT ≥5 (women) or ≥ 8 (men);or patient was admitted for an alcohol-related diagnosis;(3) likely severe alcohol misuse: PEth ≥400. Univariable statistics were utilized as appropriate (Fisher's Exact Test, Kruskal- Wallis Test). The prevalence of likely drinking in the study population (n = 195) varied over time (p <0.0001). When pandemic (n = 67) and pre-pandemic patients (n = 128) were compared, the prevalence of likely drinking (93% vs 58%, p <0.0001), likely alcohol misuse (49% vs 33%, p <0.03) and likely severe alcohol misuse (32% vs 10%, p <0.003) were all greater during the pandemic. Among likely drinking patients with available PEth data (n = 97), median PEth was significantly higher during the pandemic compared to pre-pandemic years (251 [135-702] versus 87 [16-374], p = 0.002). Among the subset of patients enrolled during the pandemic, the prevalence of likely current drinking was 100% in those with COVID-19 compared to 76% among non-COVID patients (p = 0.002), but alcohol misuse did not differ. We conclude that alcohol consumption, and alcohol misuse, have increased during the pandemic in this patient cohort. These changes in drinking patterns are concerning and warrant additional research regarding their impact on susceptibility and outcomes for respiratory failure.
ABSTRACT
Introduction: Rome IV irritable bowel syndrome (IBS) is characterized by abdominal pain and altered bowel habits, and meta-analysis reveals a global prevalence of 3.8%. Using data from the “National GI Survey II”—a nationwide audit of gastrointestinal (GI) symptoms in nearly 90,000 adult Americans—we aimed to determine the prevalence, burden of illness, and healthcare seeking behavior of those who met Rome IV IBS criteria. Methods: We conducted the National GI Survey II from 5/3-6/24/20, a period coinciding with the peak of the initial COVID-19 wave in the U.S. A representative adult sample based on U.S. Census age, sex, and region data was recruited. The self-administered survey guided participants through the Rome IV IBS questionnaire, NIH GI PROMIS symptom scales, and questions on comorbidities and demographics. A primary outcome was prevalence of IBS based on Rome IV criteria;we also determined the presence and severity of non-cardinal IBS symptoms and healthcare seeking for abdominal pain, constipation, or diarrhea in those with IBS. We used multivariable logistic regression to adjust for confounding variables. Results: Of the 88,969 individuals who completed the survey, 6,543 (7.4%) met Rome IV IBS criteria: mixed IBS (IBS-M), 34.0%;IBS with constipation (IBS-C), 32.1%;IBS with diarrhea (IBS-D), 29.6%;unsubtyped IBS, 4.4%. Females, non-Hispanic Whites, and those 30-49yo and with comorbidities (e.g., prior gastroenteritis, fibromyalgia, inflammatory bowel disease) had statistically higher odds for meeting Rome IV IBS criteria (all p<.001). Differences in pain severity, as measured by PROMIS, were not evident among the subtypes (p>.05). Table 1 presents the presence and severity of symptoms beyond the cardinal IBS symptoms;those with IBS-D or IBS-M were more likely to report excess gas, heartburn, regurgitation, nausea/vomiting, pelvic pain, or bowel incontinence vs. those with IBS-C, but symptom severity scores were largely similar among groups. Those with IBS reported the following healthcare seeking behaviors for their cardinal IBS symptoms: ever sought care, 73.8%;ever sought care via telehealth, 19.4%;sought care in past 12 months, 59.7%. Table 2 presents the healthcare seeking data stratified by subtype;those with IBS-D and IBS-M were less likely to have sought care vs. those with IBS-C. Discussion: In this nationwide U.S. survey, we found that Rome IV-positive IBS is more prevalent (7.4%) vs. prior estimates. Additional research is needed to understand if this higher prevalence is in part due to the COVID-19 pandemic, as social distancing may have levied a psychological toll on many individuals, leading to alterations in the gut-brain axis and a propensity to develop IBS or gain greater awareness of symptoms. We also noted that people with IBS commonly experience other symptoms on top of their cardinal IBS symptoms.(Table presented) (Table presented)