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
Background and aims: Managing patients in a specialist cirrhosis clinic improves survival. The COVID-19 pandemic necessitated the transition to virtual clinics (VC). We aimed to evaluate the clinical impact of VC on survival, admission and decompensation rates in cirrhotic patients managed in a specialist service. Method: We retrospectively analysed cirrhotic patients who had a specialised VC from March to June 2020. Clinical parameters were collected at baseline and 6 months and compared with a cohort of patients reviewed face to face (F2F) in the same specialist cirrhosis clinics from March to June 2019. Patients with COVID-19 were excluded. Results: 143 patients attended for VC, 129 for F2F review. Groups were matched for age, sex, aetiology, and Child Pugh grade (CP). There was no difference at 6 months in survival, change in MELD/UKELD, decompensation or need for ambulatory reviewin all cirrhosis grades combined or CP BandC subgroup alone (p > 0.05) (Table 1). Fewer patients were admitted in the VC vs the F2F group (p = 0.01) but this was not validated in CP BandC subgroup (p = 0.28). Fewer blood tests were ordered for the VC group (p = 0.0001). The VC group had longer delays for ultrasound HCC surveillance (<0.0001) without an increase in new HCC cases.Table: Baseline Patient Demographics and 6 months’ outcome (*p < 0.05, **p < 0.01)(Table Presented)Conclusion: VC have not resulted in poorer clinical outcomes, even in patients with decompensated cirrhosis. Access to ambulatory care was still required. Fewer blood tests ordered and completed in the VC group did not result in adverse outcomes and this raises the possibility of cost-saving. urther studies need to confirm the longterm clinical impact and cost-effectiveness of specialist VC in management of cirrhotic patients.
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.