Application of PDCA Cycle Management for Postgraduate Medical Students During the COVID-19 Pandemic (preprint)

Background: The COVID-19 outbreak has had an enormous impact on various industries around the world. As postgraduate students in clinical medicine have both student and resident identity characteristics, Peking University Third Hospital (PUTH), as a university-affiliated hospital for cultivating future medical talent, has been facing unprecedented challenges in regard to the management of postgraduate medical students during the COVID-19 pandemic. Therefore, the purpose of this study was to explore the management effect from PDCA cycle management on postgraduate medical students during the COVID-19 outbreak.Methods: The methods of document review, questionnaire surveys and interviews were used to continuously improve the management measures of postgraduate medical students during the COVID-19 pandemic by using the PDCA cycle.Results: Investigations were conducted on the management system, back-to-school arrangements, COVID-19 prevention and control training, online teaching, mentoring, laboratory management, dissertation progress, and emotional state of postgraduate medical students during the COVID-19 pandemic. We found that strengthening public health management knowledge training, increasing infectious-disease-related knowledge training, innovating online teaching methods, improving PDCA management model maps, and formulating improvement programmes are conducive to improving the quality of such management.Conclusion: Aiming at the difficult problems involved in the management of postgraduate medical students during the COVID-19 pandemic, managers need to comprehensively consider and conduct overall planning and use the PDCA management model to improve the management of postgraduate medical students during the COVID-19 pandemic.

Establishment of a pediatric COVID-19 biorepository: unique considerations and opportunities for studying the impact of the COVID-19 pandemic on children.

BACKGROUND: COVID-19, the disease caused by the highly infectious and transmissible coronavirus SARS-CoV-2, has quickly become a morbid global pandemic. Although the impact of SARS-CoV-2 infection in children is less clinically apparent, collecting high-quality biospecimens from infants, children, and adolescents in a standardized manner during the COVID-19 pandemic is essential to establish a biologic understanding of the disease in the pediatric population. This biorepository enables pediatric centers world-wide to collect samples uniformly to drive forward our understanding of COVID-19 by addressing specific pediatric and neonatal COVID-19-related questions. METHODS: A COVID-19 biospecimen collection study was implemented with strategic enrollment guidelines to include patients seen in urgent care clinics and hospital settings, neonates born to SARS-CoV-2 infected mothers, and asymptomatic children. The methodology described here, details the importance of establishing collaborations between the clinical and research teams to harmonize protocols for patient recruitment and sample collection, processing and storage. It also details modifications required for biobanking during a surge of the COVID-19 pandemic. RESULTS: Considerations and challenges facing enrollment of neonatal and pediatric cohorts are described. A roadmap is laid out for successful collection, processing, storage and database management of multiple pediatric samples such as blood, nasopharyngeal and oropharyngeal swabs, sputum, saliva, tracheal aspirates, stool, and urine. Using this methodology, we enrolled 327 participants, who provided a total of 972 biospecimens. CONCLUSIONS: Pediatric biospecimens will be key in answering questions relating to viral transmission by children, differences between pediatric and adult viral susceptibility and immune responses, the impact of maternal SARS-CoV-2 infection on fetal development, and factors driving the Multisystem Inflammatory Syndrome in Children. The specimens in this biorepository will allow necessary comparative studies between children and adults, help determine the accuracy of current pediatric viral testing techniques, in addition to, understanding neonatal exposure to SARS-CoV-2 infection and disease abnormalities. The successful establishment of a pediatric biorepository is critical to provide insight into disease pathogenesis, and subsequently, develop future treatment and vaccination strategies.

Establishment of a Pediatric COVID-19 Biorepository: Unique Considerations and Opportunities for Studying the Impact of the COVID-19 Pandemic on Children.

Background : COVID-19, the disease caused by the highly infectious and transmissible coronavirus SARS-CoV-2, has quickly become a morbid global pandemic. Although the impact of SARS-CoV-2 infection in children is less clinically apparent, collecting high-quality biospecimens from infants, children and adolescents in a standardized manner during the COVID-19 pandemic is essential to establish a biologic understanding of the disease in the pediatric population. This biorepository enables pediatric centers world-wide to collect samples in a standardized manner to drive forward our understanding of COVID-19 by addressing specific pediatric and neonatal COVID-19-related questions. Methods : A broad study was implemented with strategic enrollment guidelines to include patients seen in urgent care clinics and hospital settings, neonates born to SARS-CoV-2 infected mothers, and asymptomatic children. The methodology described here, details the importance of establishing collaborations between the clinical and research teams to harmonize protocols for patient recruitment and sample collection, processing and storage. Results : Considerations and challenges facing enrollment of neonatal and pediatric cohorts are described. A roadmap is laid out for successful collection, processing, storage and database management of multiple pediatric samples such as blood, nasopharyngeal and oropharyngeal swabs, sputum, saliva, tracheal aspirates, stool, and urine. Using this methodology, we enrolled 327 participants, who provided a total of 972 biospecimens. Conclusions : Pediatric biospecimens will be key in answering questions relating to viral transmission by children, differences between pediatric and adult viral susceptibility, and, immune responses, the impact of maternal SARS-CoV-2 infection on fetal development, and factors driving the Multisystem Inflammatory Syndrome in Children. The specimens in this biorepository will allow necessary comparative studies between children and adults, help determine the accuracy of current pediatric viral testing techniques, in addition to, understanding neonatal exposure to SARS-CoV-2 infection and disease abnormalities. The successful establishment of a pediatric biorepository is critical to provide insight into disease pathogenesis, and subsequently, develop future treatment and vaccination strategies.

Effect of Ribavirin on Recovery Time in COVID-19 Patients: A Real-world Retrospective Cohort Study (preprint)

Background: Up to now, there is still no specific drug against COVID-19. However, Ribavirin may bring clinical benefits to COVID-19 patients.Methods: This study was designed as a real-world retrospective cohort study based on electronic medical record (EMR), and linear regression model was used to evaluate the effect of Ribavirin on recovery time.Results: 342 patients were enrolled in this study. Both unadjusted and unadjusted models showed that interferon or Lopinavir-Ritonavir combined with Ribavirin could shorten the recovery time of patients, which was evident in all subgroups considered except the severe subgroup and after fine adjustments.Conclusion: This study shows that interferon or Lopinavir-Ritonavir combined with Ribavirin can shorten the recovery time of patients with non-severe COVID-19.

Clinical characteristics and prognostic factors in elderly patients with COVID-19 (preprint)

Background: The COVID-19 pandemic posed tremendous threats to the world. Elderly patients were among the high-risk population, and apt to experience worse outcomes.Methods: Elderly patients (age ≥60 years old) were enrolled from January 28 to February 29, 2020, in Tongji Hospital, one of designated COVID-19 medical centers in Wuhan, China. A retrospective study was performed to describe clinical characteristics and outcomes of elderly COVID-19 patients. COX regression was used to analyze predictors for 28-day mortality. Linear regression models were constructed to analyze factors associated with length of hospital stay (LOS).Result: A total of 186 elderly patients (aged 70.4 ± 7.1 years, 95 males (51.6%)) were enrolled, 120 patients (64.5%) were severe or critical type, and mortality rate was 16.1%. Patients in non-survival group had a higher smoking rate, more symptoms of dyspnea, lab results indicative of poorer health. Age (HR 1.128, 95% CI 1.066-1.194), lymphocyte count (HR 0.261, 95% CI 0.073-0.930), LDH (HR 1.003, 95% CI 1.002-1.005), procalcitonin (HR 1.061, 95% CI 1.002-1.125), and qSOFA (HR 3.162, 95% CI 1.646-6.072) were independently associated with 28-day mortality. CURB-65 plus LDH on admission were predictors of mortality by ROC analysis (AUROC=0.891). Among surviving patients, consolidation on CTs, elevated ferritin level and neutrophil count were associated with increased LOS.Conclusion: High incidence of comorbidities and mortality were observed in elderly patients. Decreased lymphocyte, older age, higher qSOFA score, procalcitonin and LDH levels were independent factors associated with mortality, CURB-65 plus LDH could be a predictive model of fatal outcome. Consolidation on CTs, elevated ferritin and neutrophil level correlated with increased LOS. Further prospective studies should be performed to test our findings and explore potential treatments.