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Intro: Dexamethasone, a corticosteroid, was recently demonstrated to be the only medication capable of reducing mortality in severe COVID disease in the UK's Recovery Trial. There is a need to compare different steroids because it is well recognised that different corticosteroids have varied pharmacodynamic properties. The aim of our study was to compare outcomes in severe or critical COVID-19 when treated with Dexamethasone versus Methyl prednisolone. Method(s): We conducted a retrospective quasi-experimental, non-randomized study to determine whether intravenous or oral dexamethasone reduces mortality compared with intravenous methylprednisolone in patients with severe or critical COVID-19.The study was conducted on all patients aged 18 and over admitted at a 700-bedded academic medical center.The primary outcome was the mortality. The secondary outcome included length of stay. Finding(s): A total of 706 hospitalized patients with moderate to severe COVID- 19 were included in the study. There were n=217 patients in Dexamethasone group, n= 393 patients in Methylprednisolone group and n=96 patients who did not receive steroids.Among the baseline characteristics between the groups, there was no significant difference in median age (55 years in dexamethsone group vs 57 years in methyl prednisolone group p=0.09). There was male predominance in methylprednisolone group (74% versus 54% p<0.001) and a greater proportion of patients who required invasive mechanical ventilation (13.7% versus 3.2% p<0.001). Mortality was found to be significantly higher in methylprednisolone group compared to dexamethasone group on univariate logistic regression analysis (13.7% versus 3.2% p<0.001) and longer length of stay (7 days versus 4 days p<0.001). In multivariable model, dexamethsone was found to be associated with lower risk of mortality (aOR: 0.24;95% CI: (0.09- 0.62)(p=0.003) and lesser length of stay (aOR: 0.87;95% CI: (0.82-0.92) (p<0.001). Conclusion(s): Dexamethasone was associated with lower mortality and lesser length of stay when compared to Methyl prednisolone in moderate to critical COVID-19.Copyright © 2023
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The COVID-19 pandemic has brought dramatic changes in many business sectors, particularly the commercial vehicle business, which before the COVID-19 pandemic has already experienced a slowdown due to uncertainty in global supply and demand. The introduction of the movement control order (PKP) and several other measures to curb the spread of the COVID-19 epidemic have exacerbated the efforts to recover from the current challenges. This study investigates the effect of COVID-19 disruption on supply chain resilience among commercial vehicle businesses in Malaysia. The results show that all variables significantly influence the supply chain resilience capability in the commercial business sector except for the risk management culture, which requires further validation. In the event of a disruption, the supply chain resilience capability of the organization is critical to absorb and adapt to the changes caused by the interruption and innovatively seek improvement in the operation to become stronger and prepared for any similar disruption in the future. The findings of this study provide valuable information to the business practitioner affected by the COVID-19 pandemic. It also enriches the knowledge of academicians for similar research in supply chain resilience field. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Objective: The objective of this study is to report the frequency and clinical characteristic of IFI in COVID-19 patients. Method(s): This observational study was conducted in Karachi, Pakistan from March 2020-April 2021. Patients with COVID-19 associated aspergillosis (CAPA) were diagnosed using ECMM/ISHAM criteria modified to include tracheal aspirate culture and/or Galactomannan Index (GMI) >4.5 in the possible CAPA category. COVID-19 associated candidemia (CAC) was defined by isolation of Candida species from blood cultures. COVID-19 associated mucormycosis (CAM) was defined as updated EORTC/MSG criteria with inclusion of COVID-19 as host factor. Pneumocystis jirovecii pneumonia (PJP) was defined by consistent clinical and radiological features and PCR positivity. Result(s): During the study period a total of 123 (3.3%) IFI in 3506 hospitalized COVID-19 patients were identified. This included 78 (2.2%) CAPA patients (42 probable;36 possible), 29 (0.8%) CAC (5 C. auris;24 non-C. auris), 10 (0.3%) CAM (7 pulmonary;3 rhinocerebral), 3 (0.08%) PJP and three (0.08%) cases of rare invasive fungal infections (2 C. neoformans;1 Trichosporon asahii). Outcome data was available on 117/123 patients. Of these 117 patients, 78 expired (66.7%). These include 52/74 (70%) CAPA patients, 17/27 (63%) CAC patients, 7/10 (70%) CAM patients and 2/3 (67%) PJP patients. Conclusion(s): We report a rate of 3.3% IFI amongst hospitalized COVID-19 patients at our center. We consider this rate to be an underestimate due to less bronchoscopic procedures and inclusion of only candidemia cases. We also report higher mortality rate with IFI in our patients than global data probably due to delayed diagnosis, co-infections and limited therapeutic options.
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COVID pandemic across the world and the emergence of new variants have intensified the need to identify COVID-19 cases quickly and efficiently. In this paper, a novel dual-mode multi-modal approach is presented to detect a covid patient. This has been done using the combination of image of the chest X-ray/CT scan and the clinical notes provided with the scan. Data augmentation techniques are used to extrapolate the dataset. Five different types of image and text models have been employed, including transfer learning. The binary cross entropy loss function and the adam optimizer are used to compile all of these models. The multi-modal is also tried out with existing pre-trained models such as: VGG16, ResNet50, InceptionResNetV2 and MobileNetV2. The final multi-modal gives an accuracy of 97.8% on the testing data. The study provides a different approach to identifying COVID-19 cases using just the scan images and the corresponding notes. © 2022
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Background: Early identification of COVID-19-associated pulmonary aspergillosis (CAPA) is particularly challenging in low- middle-income countries where diagnostic capabilities are limited, and risk factors for CAPA have not been identified. It is also essential to recognise CAPA patients who are likely to have a poorer outcome to decide on aggressive management approaches. Therefore, this study aimed to identify risk factors and outcomes for CAPA among admitted moderate to critical COVID-19 patients at our centre in Pakistan. Methods: An unmatched case–control study with ratio of 1:2 was conducted on hospitalised adult patients with COVID-19 from March 2020–July 2021. Cases were defined according to European Confederation of Medical Mycology and the International Society for Human and Animal Mycology consensus criteria. Controls were defined as patients hospitalised with moderate, severe or critical COVID-19 without CAPA. Results: A total of 100 CAPA cases (27 probable CAPA;73 possible CAPA) were compared with 237 controls. Critical disease at presentation (aOR 5.04;95% CI 2.18–11.63), age ≥ 60 years (aOR 2.00;95% CI 1.20–3.35) and underlying co-morbid of chronic kidney disease (CKD) (aOR 3.78;95% CI 1.57–9.08) were identified as risk factors for CAPA. Patients with CAPA had a significantly greater proportion of complications and longer length of hospital stay (p-value <.001). Mortality was higher in patients with CAPA (48%) as compared to those without CAPA (13.5%) [OR = 6.36(95% CI 3.6–11)]. Conclusions: CAPA was significantly associated with advanced age, CKD and critical illness at presentation, along with a greater frequency of complications and higher mortality. © 2022 Wiley-VCH GmbH.
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Background: Alcohol-based hand sanitizer (ABHS) usage has become one of the COVID-19 pandemic-related adapted responses. Some disulfiram-ethanol reactions are reported in people who use alcohol-based hand rub/sanitizer and take Disulfiram as a treatment for their alcohol use disorders. Aim & Objective: To determine the practice experiences of psychiatrists on disulfiram prescription to alcohol use disorder victims. Methodology: A cross-sectional study on the psychiatrists to find the experiences of disulfiram prescription to their clients with alcohol use disorders during the COVID-19 pandemic. Results: Nearly 84 (51%) were reverted with a completed questionnaire. Among the respondents, 28 (33.3%) of the respondents decreased to prescribe Disulfiram, 48 (57.1%) reported that their patients stopped using ABHS due to fear of Disulfiram-Ethanol Reaction (DER), and 20 (23.8%) responders notified that their patients were expressed their worry on DER with Disulfiram and ABHS. Conclusion: Disulfiram prescribed for alcohol use disorders;treatment got peculiar experiences with the incidences of DER reported with Alcohol-based hand sanitizer. Many practitioners were scared to prescribe disulfiram due to DER with ABHS. The prevailing evidence that there is no possibility of cutaneous application of ABHS producing enough significant DER. Hence using ABHS is not a contraindication for disulfiram prescription. © 2022, Indian Association of Preventive and Social Medicine. All rights reserved.
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Due to the general confusion over the mask's efficiency against COVID-19 virus droplets, professionals and the public may find it difficult to stop the disease from spreading. This study intends to investigate the fluid flow across the N95 filtration layer based on the experimental data and create a simulation model based on the analysis. Therefore, the fluid flow across the filtration layer is simulated using ANSYS Fluent, part of Computational Fluid Dynamics (CFD) solver software. This study anticipates the fluid flow across the N95 by using the porous media approach, in which inertial resistance and viscous resistance are introduced in the simulation by obtaining the pressure drop coefficient of the actual 3M N95 filtration. The fluid passed through the filtration layer with some velocity range based on the MS 2323:2010 standard. The pressure and velocity distribution of fluid through the filtration layer are analyzed by simulation illustration of the contour and streamline of the fluid. For most conditions, as fluid flowed across the filter, the flow gradually began to retard and diverge around the filtration layer. Besides, different flow rates across the filtration layer also result in different pressure distributions on the N95 layer. To sum up, this study is beneficial in forecasting the fluid behavior across the filtration layer by applying the porous zone approach in the ANSYS simulation. © 2022,Journal of Advanced Research in Fluid Mechanics and Thermal Sciences. All rights reserved.
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Owing to the various scientific evidence linking smoking to the increased risk of developing severe disease and death from the COVID-19 pandemic, now is a critical time for smokers to cut back or quit. This study aimed to analyze the influence of beliefs about smoking effects in relation to COVID-19 and attempts to quit smoking among university student smokers in Jakarta, Indonesia. This study was conducted in three different universities. As many as 198 respondents who were conveniently selected participated in this study. The health belief model (HBM) was adopted to determine the independent variables in this study. Having had a previous infection of COVID-19 influenced the smoking quitting attempts (AOR: 3.87, 1.49–10.0). Moreover, the belief that smoking increased COVID-19 severity, having a friend who reminded the respondents to not smoke during the pandemic, and having the ability to terminate smoking also increased the possibility for respondents to have a quit smoking attempt. However, perceived barriers such as feeling uncomfortable without smoking (AOR: 0.31, 0.15-0.6) were a protective factor against the attempt to quit smoking. Increasing smokers' confidence to quit smoking and education about the risk of smoking during the pandemic should be intensified to support smokers in successfully quitting the smoking habit. © 2023, Intelektual Pustaka Media Utama. All rights reserved.
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Mucormycosis is a life-threatening infection. Mucormycetes causes a wide range of diseases, including pneumonia, rhinosinusitis, internal organ spread, gastrointestinal tract involvement, and skin and soft tissue infection. It infects predominantly with hematological malignancies, transplantation, immunocompromised, and diabetes mellitus patients. The most severe type of the disease is a disseminated disease, which is linked to significant immunosuppression. Currently, this disease is more prevalent in the COVID-19 pandemic because of erroneous steroid use and untreated diabetes. However, there is a scarcity of study and information on the COVID-19 and mucormycosis connection. According to the latest research, mucormycosis cases are rising in developed and developing nations, and only a few therapies are available. The exact burden of mucormycosis is unclear;however, it is likely to be greater than recorded instances due to mucormycosis epidemiological changes. As a result of the delay in identifying this severe illness, appropriate antifungal medications are delayed, resulting in significant morbidity and death. A few drugs are underclinical trials for their efficacy. Other obstacles to treat patients are lack of reliable diagnostic non-invasive tests. This review article draws the attention of its readers and clinicians towards the agents of mucormycosis and discuss the various cases to manage this fungal infection.
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Aim: Virtual consultations (VC) in breast surgery have been successfully utilised during the COVID pandemic and have potential to reduce the costs of outpatient clinics as well as increase patient satisfaction. We aimed to assess the utility and safety of VC in new patient clinics in women under 30, which are considered a low-risk subgroup. Method: Data was prospectively collected on 118 women aged under 30 who were referred from primary care to the breast clinic between December 2020 and April 2021. Clinicopathological data was collected on referrals, imaging and follow up. Results: Median age was 24 years (range 17-30). The commonest presenting symptoms were a lump (69%), breast pain (16%) and nipple symptoms (14%). The VC was performed via video in 63 (53%) patients and via telephone alone in 55 (47%). Nineteen patients (16%) were reassured and discharged directly from VC. Ninety-four patients (80%) underwent an outpatient ultrasound with a sonographer trained in clinical palpation. Twenty-six (27%) ultrasounds showed benign pathology with the remainder being normal. Six biopsies were performed, all of which were benign. Seventeen (14%) patients required a face-to-face appointment with a breast surgeon after ultrasound or biopsy. Ninety-four (79%) patients were discharged after VC + ultrasound alone. No patients required surgery. Conclusions: Utilising VC, the majority of new referrals in women under 30 did not require face-to-face appointments. VC have potential to reduce burden on new patient clinics whilst improving patient convenience. Early data suggest a low risk of compromising safety in this subgroup.
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BACKGROUND: Early identification of COVID-19 associated pulmonary aspergillosis (CAPA) is particularly challenging in low-middle income countries where diagnostic capabilities are limited and risk factors for CAPA have not been identified. It is also essential to recognise CAPA patients who are likely to have a poorer outcome to decide on aggressive management approaches. Therefore, this study aimed to identify risk factors and outcomes for CAPA amongst admitted moderate to critical COVID-19 patients at our center in Pakistan. METHODS: An unmatched case-control study with ratio of 1:2 was conducted on hospitalized adult patients with COVID-19 from March 2020-July 2021. Cases were defined according to European Confederation of Medical Mycology (ECMM) and the International Society for Human and Animal Mycology (ISHAM) consensus criteria. Controls were defined as patients hospitalized with moderate, severe, or critical COVID-19 without CAPA. RESULTS: A total of 100 CAPA cases (27 probable CAPA;73 possible CAPA) were compared with 237 controls. Critical disease at presentation (aOR 5.04;95% CI 2.18-11.63), age greater than or equal to 60 years (aOR 2.00;95% CI 1.20-3.35), and underlying co-morbid of chronic kidney disease (CKD) (aOR 3.78;95% CI 1.57-9.08) were identified as risk factors for CAPA. Patients with CAPA had a significantly greater proportion of complications and longer length of hospital stay (p-value <0.001). Mortality was higher in patients with CAPA (48%) as compared to those without CAPA (13.5%) [OR=6.36(95%CI 3.6-11)]. CONCLUSIONS: CAPA was significantly associated with advanced age, chronic kidney disease, and critical illness at presentation, along with a greater frequency of complications and higher mortality.
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It is evident that the impacts of COVID-19 crisis on education inevitably require a myriad of innovations on the delivery of conventional financial management courses in higher-educational institutions. The Future-Ready Financial Management Course (FRFMC) was one of a plethora of innovations that was developed to uncover the gap in the current curriculums. It also aims to cultivate and expand the abilities of students by enriching teaching contents and optimizing teaching methods through the Future-Ready Curriculum using a modified Attracting, Informing, Positioning and Delivering model. The development of FRFMC is extremely important as it can be used a means to attract non-finance students background to show interest in studying finance. Furthermore, the FRFMC dramatically changed the way higher-educational institutions, specifically educators in a financial management course to engage more efficiently and effectively with their new batches of digitally native and technologically savvy students. The reality is, many students are now on remote learning mode, highly depending on technology especially during the COVID-19 pandemic. While many students are considered sophisticated users of technology, few non-finance students are found struggling to learn the basics of finance for entrepreneurs. The FRFMC intends to cater to both groups of students. A number of 431 questionnaire surveys were collected among the non-finance student of Universiti Malaysia Kelantan and observations was adopted as the mechanisms to examine the students’ experience during the FRFMC implementation. The findings show that financial management courses can indeed be taught in a more innovative and effective way in order to draw the interest of non-finance students to take up more technical courses in the future. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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The Indonesian Government has launched PeduliLindungi (PL) mobile apps as a COVID-19 preventive tool. This study aimed to describe the PL utilization and determine the factors influencing its successful use among college students. This study used a cross-sectional design and a total population sampling at a university in the Special Capital Region of Jakarta, Indonesia. The Delone and Mclean Information System Success Model was adopted to measure the use of the apps. The Spearman's rank correlation test was performed to determine the relationship between two variables. Furthermore, 354 respondents participated in this study. The respondents used the apps mostly to display the vaccination certificate and check in/out from public facilities. The overall user satisfaction value towards the application was 3.83 +/- 0.76. The system quality (rho = 0.621, p-value<0.001) and information quality (rho = 0.626, p-value<0.001) were associated with the user satisfaction while the user satisfaction (rho = 0.471, p-value<0.001), was correlated to the perceived benefit. In brief, perceived benefit was positively correlated with the user's satisfaction, whereas user satisfaction was positively correlated with self-efficacy, system quality, and information quality.
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Reports of COVID-19-associated mucormycosis have been increasing in frequency since early 2021, particularly among patients with uncontrolled diabetes. Patients with diabetes and hyperglycaemia often have an inflammatory state that could be potentiated by the activation of antiviral immunity to SARS-CoV2, which might favour secondary infections. In this Review, we analysed 80 published and unpublished cases of COVID-19-associated mucormycosis. Uncontrolled diabetes, as well as systemic corticosteroid treatment, were present in most patients with COVID-19-associated mucormycosis, and rhino-orbital cerebral mucormycosis was the most frequent disease. Mortality was high at 49%, which was particularly due to patients with pulmonary or disseminated mucormycosis or cerebral involvement. Furthermore, a substantial proportion of patients who survived had life-changing morbidities (eg, loss of vision in 46% of survivors). Our Review indicates that COVID-19-associated mucormycosis is associated with high morbidity and mortality. Diagnosis of pulmonary mucormycosis is particularly challenging, and might be frequently missed in India.
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The impact of the Covid-19 pandemic has had a far-reaching effect on higher education institutions, and individual student assessments have garnered much attention during the pandemic. This study aimed to validate Science, Technology, Engineering, and Mathematics (STEM) application instruments using the Rasch analysis employing Winsteps version 3.73. A survey was conducted with 201 respondents from two provinces in Indonesia. The students were selected by convenience sampling and answered the adopted STEM application instrument. The STEM application instruments were adapted, and these were divided into seven sub-constructs derived from STEM disciplines. Rasch Modelling was employed for data analysis using Winsteps version 3.7.3 to analyse reliability, separation, item fit statistics, unidimensionality, and rating scale calibration. Each sub-construct fulfilled a minimum of 0.65 for Cronbach alpha, item, and person reliability, and most of them had more than 1.5 person and item separation. In general, each item had a good score of the mean square, Z-tolerated standard, and point measure correlation, indicating fulfilment of the Rasch measurement model. The analysis also showed unidimensionality assumption and an excellent rating scale. This study contributed to the body of STEM knowledge by using Rasch Modelling to test the validity and reliability of STEM application instruments. © 2022 Society for Research and Knowledge Management. All rights reserved.
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Inventive Problem-Solving Skills (IPSS) is the ability to solve difficulties efficiently and without hindrance. The aim of this study is to identify issues, importance, and solutions in identifying the causes of inventive design problems among students and teachers of Invention. In addition, there are two objectives of the study (1) to identify the differences in the importance and issues of IPSS among students and teachers of Invention, and (2) to identify the importance, issues and proposed solutions of IPSS by Invention’s teachers. This study has a used mixed-method an approach that includes quantitative and qualitative methods. For the first objective quantitative will be used by making a questionnaire while for the second objective, the mixed method was used by using questionnaires and semi-structured interviews. The survey covered a total of 133 students and 30 Invention teachers from a secondary school in Johor. In this study, SPSS software was used to obtain the data. As a result, there was no significant difference in significance [t (133) = 2.915;p = .194, (p > .05)] or problem [t (133) = .142;p = .09, (p > .05)] for gender, according to t-test findings. The level of significance was then determined using a two-way ANOVA test. Subsequently, two-way ANOVA tests revealed that importance (F (30) = 2.874, p = .061) and problem (F (30) = 6.846, p = .112) abilities were not influenced by teacher gender or teaching experience. To identify the root cause of inventive problems, the majority of teachers prefer to use Functional Analysis to apply the Theory of Inventive Problem-Solving Skills (TRIZ). As a result, the creation of self-learning modules is offered as a teaching resource to help students use their abilities in the Invention course. Thus, the objective has been well achieved to (1) identify the differences in importance and issues of IPSS among students and teachers of Invention, and (2) identify the importance, issues and proposed solutions of IPSS by Invention’s teachers. Among the challenges faced in this study was that communication between students and teachers was done virtually on deck due to the Covid-19 issue that struck. © 2022, author.
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This study aims to examine the long-term relationship between the unemployment rate and the growth of domestic product (GDP) in Malaysia, thereby revealing unemployment's impact on GDP. In this COVID-19 pandemic situation, numerous people have lost their jobs. That indirectly increases the unemployment rate which later has a variety of negative consequences on the government, society, and individuals. The Malaysian government has taken a big step in announcing the Movement Control Order (MCO) to slow down the spread of infections. Such decisions have affected the unemployment rate, as some businesses have to reduce their employees and some high-risk companies temporarily closed to stop the spreading of COVID cases. The cointegration test is employed to identify the relationship between the unemployment rate and GDP and then validate it by analyzing the error. Quarterly unemployment rate and GDP data were obtained from the Department of Statistics Malaysia (DOSM) website from the first quarter of 2010 to the fourth quarter of 2020. The study found that the variables were stationary at first differencing and long-run relationships existed among them. According to the empirical findings in this study, long-run and short-run unemployment rates have a high influence on the GDP rate. However, the result contradicted one work in literature that claimed a negative association between GDP and unemployment for the past fifty years. This could have occurred as a result of the worldwide COVID-19 pandemic. © 2022 The Authors.
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Aim: Virtual consultations (VC) in breast surgery have been successfully utilised during the COVID pandemic and have potential to reduce the costs of outpatient clinics as well as increase patient satisfaction. We aimed to assess the utility and safety of VC in new patient clinics in women under 30, which is considered a low-risk subgroup. Methods: Data was prospectively collected on 118 women aged under 30 who were referred from primary care to the breast clinic between December 2020 and April 2021. Clinicopathological data was collected on referrals, imaging and follow up. Results: Median age was 24 years (range 17-30). The commonest presenting symptoms were a lump (69%), breast pain (16%) and nipple symptoms (14%). The VC was performed via video in 63 (53%) patients and via telephone alone in 55 (47%). Nineteen patients (16%) were reassured and discharged directly from VC. Ninety-four patients (80%) underwent an outpatient ultrasound with a sonographer trained in clinical palpation. Twenty-six (27%) ultrasounds showed benign pathology with the remainder being normal. Six biopsies were performed, all of which were benign. Seventeen (14%) patients required a face-to-face appointment with a breast surgeon after ultrasound or biopsy. Ninety-four (79%) patients were discharged after VC + ultrasound alone. No patients required surgery. Conclusion: Utilising VC, the majority of new referrals in women under 30 did not require face-to-face appointments. VC have potential to reduce burden on new patient clinics whilst improving patient convenience. Early data suggest a low risk of compromising safety in this subgroup.
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Coronaviruses are a large viral family that attacks key organs, particularly the lungs. The infection spread is growing by the day, affecting almost every industry. Various Artificial Intelligence studies have been proposed, to learn the measurable information of people who have been affected with COVID-19 and those who have recovered, as well as the death rate. Various data samples like chest images, lung images, swab results, blood samples, and CT scans are used to predict the COVID-19. The paper gives an in-depth look at how AI and machine learning techniques can be used to accurately predict COVID-19. The proposed review is centered around investigating the different AI methods, models, and logical registering procedures used in foreseeing the COVID-19 sickness. The study also summarizes the difficulties associated with current methods and future exploration works.
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Aim: Virtual consultations (VC) in Breast Surgery have become wellestablished during the COVID pandemic. They are successfully utilised in routine follow ups and low-risk new referrals. We aimed to assess the utility of VC in more complex clinical discussions. Methods: We collected feedback anonymously via electronic link from 20 consecutive patients who specifically had more challenging video- VC including: 12 diagnostic MDT results (10 patients received bad news of new cancer diagnosis, 2 had benign results);6 post-operative wound checks with therapeutic MDT outcomes;2 new consultations for chest wall reconstruction. Results: The time saved by patients was between 1 and 3 hours (median=2). All patients felt that booking and joining a VC was either very easy (12) or easy (8). 18 patients were satisfied with the quality of sound and picture and all 18 felt they were able to communicate everything to the clinician during their VCs. Compared to a face-to-face consultation, 14 patients felt that VC was better (70%), 4 felt it was similar (20%) and 2 thought it was worse (10%). Most received comments were themed around VC had allowed patients to get their results, discuss their management plans and ask questions while they were safely at home with other family members, at times when COVID restrictions applied to outpatient clinical settings. Conclusion: VC may be utilised selectively to provide complex consultations including discussing results, breaking bad news and wound inspections. Qualitative studies in this field can be beneficial.