ABSTRACT
Background: The Breaking Bad News OSCE assesses fellow counselling/ communication skills in 20-minute simulation scenarios: kidney replacement therapy (KRT) in ESKD, urgent KRT in AKI, and kidney biopsy. In-person simulation was impractical during the COVID epidemic, so we adapted the OSCE to a virtual platform. Methods: The AKI scenario was audio only. Fellows called a simulated patient (SP) surrogate for urgent KRT consent. The ESKD and kidney biopsy scenarios were video encounters between fellows and SPs. Faculty observed while muted/video off. After each scenario, fellows received feedback from SPs and faculty (unmuted/video on). Fellows from 3 programs at 2 centers completed the OSCE in May 2021. Post-OSCE, fellows were anonymously surveyed about each scenario, the OSCE overall, and their estimate of the percent of outpatient encounters and inpatient KRT counseling they had done virtually in the past year. Results: 15 fellows did the OSCE;14 completed the survey (93% response rate). 93% rated the OSCE overall as a good/very good approximation of a telemedicine experience. 100% were satisfied/very satisfied with the AKI scenario, 79% with the ESKD, and 77% with the kidney biopsy scenarios. Several commented that the AKI scenario was most realistic-they often counseled surrogates by telephone for urgent KRT. Fellows estimated that about 25% (median 27.5%;IQR 16-50%) of counseling for acute inpatient KRT was done virtually in the past year. They estimated about 50% (median 52.5%;IQR 36-70%) of outpatient encounters were done virtually in the past year, but several (dissatisfied with the ESKD and kidney biopsy scenarios) indicated they would not have counseled similar outpatients using telemedicine. Conclusions: Overall, fellows felt the OSCE well-approximated virtual encounters. All were satisfied with the AKI scenario. The majority were satisfied with the ESKD and Kidney Biopsy scenarios, but some did not feel they were consistent with normal practice. The OSCE allows fellows to practice telemedicine communication skills that will remain relevant post-pandemic. The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Defense or U.S. Government.
ABSTRACT
Background: The coronavirus disease 2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Assessment of newly developed anti-SARS-CoV-2 antibody tests in hemodialysis patients is needed. Methods: As part of a quality improvement (QI) initiative, nasopharyngeal swabs and predialysis blood samples were collected on the same day from adults receiving routine dialysis care at clinics managed by a large dialysis organization in the Miami, Florida, region (April 23-30, 2020). Polymerase chain reaction (PCR) tests for SARS-CoV-2 (Fulgent Genetics, Temple City, California) and chemiluminescence immunoassays (Diazyme Laboratories, Inc, Poway, California) were performed according to manufacturer protocols. For antibody tests (IgM and IgG), a reading of >;1 arbitrary unit/ mL was scored as positive. Results: Of 715 participants in the QI initiative, 38 had symptoms consistent with COVID-19 prior to or during the initiative. Among these, COVID-19 was confirmed in 14 and ruled out in 20, with 4 being inconclusive. Among the 34 patients with known COVID-19 status, the sensitivity and specificity of the antibody test were 57.1% and 85.0%, respectively, when both IgM and IgG were considered. The remaining 677 patients had no record of symptoms consistent with COVID-19 or any known exposure. Of these, 38 (5.6%) tested positive for anti-SARS-CoV-2 antibodies;none of the antibody-positive patients with available PCR results (N=33) tested positive for SARS-CoV-2. Conclusions: The operational characteristics of the laboratory-based antibody test make it sufficient to rule in, but not rule out, SARS-CoV-2 infection in the appropriate clinical circumstance. A substantial proportion of dialysis patients may have had asymptomatic SARS-CoV-2 infection.