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There is a paucity of information concerning normative reference ranges on standardized measures of profession-wide competencies for the purpose of conducting formative assessments. The present study draws from a convenience sample to provide developmental (first/second half of training year) normative data for use in formative assessments of individual trainees and program-level quality improvement processes. Data reveal the anticipated pattern of competency scores generally improving across any given training year, with the strongest gains in competencies tied to assessment, supervision, and advocacy. A secondary aim, which emerged after study launch, was to evaluate whether training disruptions due an infectious viral pandemic (COVID-19) exerted demonstrable impacts at the aggregate level on trainee competency development. This sample of doctoral trainees evidenced no pandemic-associated suppression of Competency attainment. Rather, this sample of trainees evidenced growth in focal competencies tied to policy creation, systems-change, management structure, and leadership. Training implications are discussed.
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Introduction: The transmission of the etiologic virus of COVID-19 (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) is thought to occur mainly via respiratory droplets even though limited evidence has shown the virus can be found in feces and involve the gastrointestinal (GI) tract. The aim of this study was to assess if patients with COVID-19 present with fecal shedding of SARS-CoV-2, intestinal inflammation or changes in their microbiota. Method(s): This was a prospective cohort study that included outpatients that presented with symptoms of COVID-19 and were tested using a nasopharyngeal PCR test (NPT). Two cohorts were selected: one with a (1) NPT and a control group with a (-) NPT. Stool and a clinical data were collected at baseline and then, days 14, 28 and 42. SARS-CoV-2 viral loads were measured in stool using PCR and stool microbiome was analyzed using 16S rRNA gene sequencing (V3/V4 region). Fecal calprotectin levels were also measured on each sample and used as a surrogate marker of intestinal inflammation. Result(s): 101 patients were recruited (410 total samples). Of those, 55 had a (1) COVID-19 NPT. Most patients with a (1) COVID-19 NPT PCR had a detectable fecal viral load (71%). Among these patients, 23 (55%) had detectable viral stool loads only at baseline, 12 through day 14, 6 through day 28 and 1 through day 42. One patient had a (-) NPT but detectable SARS-CoV-2 in the baseline stool sample. Subjects with (1) NPT presented more commonly with myalgias (p=0.02), dysgeusia (p=0.019) and anosmia (p=0.03) when compared to those with (-) NPT but there were no differences in any other symptoms including GI manifestations.Within the group with a (1) NPT, those patient with detectable SARS-CoV-2 in the stool were younger but no differences were seen in demographic, symptoms, or fecal calprotectin levels (Table). There was no correlation between fecal SARS-CoV-2 loads and fecal calprotectin levels (rho: 0.007 [p=0.95]). Patients with a (1) NPT PCR had higher evenness when compared to those that tested (-) for a NPT PCR. However, no differences were seen in other alpha or beta diversity (Figures 1A and 1B, respectively). Conclusion(s): Even though intestinal viral shedding of SARS-CoV-2 in patients with COVID-19 is common, these patients do not present with evidence of inflammation of the GI tract, a significantly disrupted gut microbiome or a higher incidence of GI symptoms when compared to patients with respiratory symptoms and no COVID-19.
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Multiple sclerosis (MS) is an inflammatory condition affecting the central nervous system. Infection is a major consideration in the MS population due to its relevance to several stages of the disease process: (i) it has been suggested that infective processes may be 'triggering' or aetiological factors for MS, (ii) concurrent infection is known to exacerbate symptoms in MS, (iii) people with MS are at higher risk of infection when compared to the general population, and this risk is exaggerated in those receiving disease modifying therapies (DMTs). This guidance document was developed by specialists in the field of MS, Immunology, Infectious Disease and Pharmacy. A modified Delphi approach was used to develop clinically relevant, evidence-based consensus guidelines to help physicians navigate the complex interaction between DMTs and infectious diseases. We focus on specific risks predisposing people with MS to infection and how to manage these risks. We also provide recommendations on how to screen for, prevent, and manage infection in this population, in particular tuberculosis, progressive multifocal leukoencephalopathy, hepatitis B, human papillomavirus, herpetic and other opportunistic infections. We also discuss vaccination and the COVID-19 pandemic in people on DMTs.
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Background/Purpose: Prior to the pandemic, patients with lung cancer commonly experienced stigmatization, high symptom burden, and unmet supportive care needs, placing them at increased risk for psychosocial morbidities during COVID-19. These risks necessitate investigation into how lung cancer patients have been coping during the pandemic. Methods: This study investigated COVID-19-related burden and behavioral coping utilized by 65 lung cancer patients receiving treatment at an NCI-designated Comprehensive Cancer Center between August 2020 and June 2021. Measurements included selfreport demographics, COVID-19 burden (Impact of COVID-19 Pandemic in Cancer Survivors Questionnaire, Penedo et al., 2020), psychosocial well-being (PROMIS Anxiety4a and Depression4a), and coping strategies (Brief COPE, Carver 1997). Results: Most participants identified as female (n = 43), non- Hispanic White (n = 53), partnered (n = 38), and diagnosed with Non-Small Cell Lung Cancer (n = 45);and most reported feeling anxious about contracting COVID-19 (n = 38;58.5%) and concerned that their cancer status increased their risk of dying (n = 47;72.3%). However, average PROMIS T-scores for anxiety (M = 53.59, SD = 9.05) and depression (M = 51.19, SD = 8.30) were similar to normed national averages. Participants primarily endorsed acceptance, active coping, and the use of emotional support coping strategies. Higher total COVID-19 burden was associated with greater use of venting, behavioral disengagement, and self-blame coping strategies. Higher total COVID-19 burden was associated with greater anxiety (r = 0.489;p < 0.001) and depression (r = 0.414;p < 0.001). Greater anxiety was associated with higher use of religion, venting, denial, substance use, and selfblame coping strategies. Greater depression was associated with greater reliance on instrumental support, venting, denial, substance use, and self-blame strategies. Conclusions and Implications: Participants recognized their heightened risks and utilized effective coping strategies during COVID-19. Use of acceptance, active coping, and emotional support may impact lung cancer patients' appraisals of COVID-19 and psychosocial wellbeing.
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What is already known about this topic? The number of reported U.S. tuberculosis (TB) cases decreased sharply in 2020, possibly related to multiple factors associated with the COVID-19 pandemic. What is added by this report? Reported TB incidence (cases per 100,000 persons) increased 9.4%, from 2.2 during 2020 to 2.4 during 2021 but was lower than incidence during 2019 (2.7). Increases occurred among both U.S.-born and non-U.S.-born persons. What are the implications for public health practice? Factors contributing to changes in reported TB during 2020-2021 likely include an actual reduction in TB incidence as well as delayed or missed TB diagnoses. Timely evaluation and treatment of TB and latent tuberculosis infection remain critical to achieving U.S. TB elimination.
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The SARS-CoV-2 virus has infected hundreds of millions of people and caused millions of deaths worldwide. Reports of racial and ethnic disparities regarding both rates of infection of the SARS-CoV-2 virus and morbidity of the coronavirus disease-19 (COVID-19) contain profound differences depending on the population. A previous study found an independent and positive association between the Black/African American race and positive COVID-19 testing results in Milwaukee County, WI, while adjusting for age, sex, socioeconomic status, and comorbidities (Munoz-Price. et al, 2020, JAMA Network). Our previous study revealed that patients with COVID-19 who developed hypertriglyceridemia during their hospitalization were associated with a 2.3 times higher mortality rate, after adjusting for age, gender, body mass index, history of hypertension and diabetes (Dai. et al, 2021, manuscript accepted by Journal of Clinical Lipidology). Additionally, adverse blood clotting events is one of the major causes of death for patients with COVID-19. In this study, we investigated the correlation between racial/ethnic groups and mortality, along with potential correlations between hypertriglyceridemia and adverse blood clotting events in hospitalized patients with COVID-19 (ICD10CM:U07.1). De-identified data from 1,441 hospitalized patients diagnosed with COVID-19 between March 2020 and June 2021 were extracted using the Medical College of Wisconsin Clinical Research Data Warehouse. Vital, demographic, and diagnostic information were used for the statistical analysis, specifically: age, gender, body mass index (BMI), race/ethnicity, thrombosis diagnosis and laboratory test results for triglyceride. The thrombotic events included were presence of disseminated intravascular coagulopathy, deep vein thrombosis, myocardial infarction, pulmonary embolism, and stroke diagnosed during their hospitalization. Hypertriglyceridemia was characterized as triglyceride levels greater than 150 mg/dL, with a baseline variable being the first occurrence of hypertriglyceridemia (baseline), and the peak variable being the highest manifestation of hypertriglyceridemia during hospitalization (peak). A binary logistic regression model showed that non-white Hispanic and Asian patients both had a higher correlation with mortality than white patients, with odds ratios (OR) of 4.1 [95% CI (2.2-7.9), p < 0.001] and 4.2 [95% CI (1.8-9.8), p < 0.001], respectively, after adjusting for age, BMI, and sex (Figure A). Additionally, the regression analysis showed that peak hypertriglyceridemia developed during hospitalization was correlated with a 1.8 times higher mortality in the entire inpatient cohort [95% CI (1.2-2.9), p < 0.01], after adjusting for age, sex, and BMI and independent of obesity. Furthermore, myocardial infarction [OR = 1.5, 95% CI (1.-2.5), p < 0.05] and pulmonary embolism [OR = 2.0, 95% CI (1.1-4.1), p < 0.05] were also correlated with a higher mortality, after adjusting for age, BMI, and sex (Figure B). The peak hypertriglyceridemia developed during hospitalization correlates with the incidence of thrombotic events with a borderline significance [OR= 1.5, 95% CI (0.9-2.1), p = 0.05] after adjusting for BMI, age, and sex. Further analysis revealed that non-white Hispanic patients had the highest frequencies of peak hypertriglyceridemia (triglyceride > 150 mg/dL) occurrence during hospitalization than the other race/ethnicity groups (Figure C). On the other hand, 22% of non-white Hispanics had at least one diagnosis of thrombotic event during hospitalization, which was the lowest incidence of thrombosis among all race/ethnicity groups (Figure D). In our current retrospective study of inpatients with COVID-19, race/ethnicity, peak hypertriglyceridemia developed during hospitalization, and thrombosis are independently associated with mortality. The peak hypertriglyceridemia developed during hospitalization is positively correlated with the incidence of thrombosis. [Formula presented] Disclosures: No relevant conflicts of interest to declare.
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AIMS: Glioblastoma Multiforme (GBM) is one of the most aggressive primary brain tumors with poor prognosis (median survival 18 months) and no cure. Management strategies often involve maximum safe resection followed by chemoradiotherapy. There has been a move from managing such patients electively rather than the traditional model of treating them as an emergency. While this may have advantages, this can delay the time from presentation to operation. This delay has recently been further compounded by the current COVID-19 pandemic. There is no data available as to whether the surgical delays that are currently occurring have an impact on patient care, and may outweigh the benefits of elective management on health services. We aimed to conduct a single centre observational study to assess how long patients should be waiting prior to surgery. We hypothesised that the longer the wait, the higher the pre-operative complication rate and worse the outcomes. METHOD: 698 patients in a GBM database over a 5-year period (29/10/14-8/11/19) were studied. All patient data was accessed via electronic patient records Surgical delay was defined as the interval between date of being put on the waiting list (the date seen in the neuro-oncology clinic) to date of surgery. Primary outcome measure was preoperative complications, which was categorised into transient neurological decline, stroke, seizures, diabetes/erratic blood sugars, emergency admission, others (e.g., cardiovascular compromise, steroid complications, blood disorders) Inclusion criteria included: First presentation supratentorial WHO Grade 4 GBM confirmed on histology (this included histological variants such as Gliosarcoma and Epithelioid Glioblastoma), and all patients who had been seen in the neurooncology clinic prior to surgery. Exclusion criteria included all patients who were not thought to have a GBM or high-grade glioma on initial imaging, those admitted as an emergency without being seen in a neuro-oncology clinic, recurrent or secondary GBRESULTS: 460 patients met the inclusion criteria in this study. There was a pre-operative complication rate of 14.6% (67/460). 55% of complications were due to a transient neurological decline (37/67) with 16.4 % (11/67) of patients presenting with seizures. For those with surgical delays =7 days pre-operative complication rates were 2.2 % vs 15.9% in those with delays >7 days, p value 0.012, Odds ratio 8.53 (95% CI 1.48-88.09). Results were statistically significant in those with delays greater than 10 and 14 days (p values 0.0026 and 0.0004 respectively) ROC Curve analysis revealed an AUC of 0.66 with sensitivities of 99%, 90% and 76% at surgical delays of 7,10 and 14 days respectively. The median length of hospital admission in both groups of patients was 5 days (p= 0.2065) All statistical analysis was carried out using Prism 9 and SPSS CONCLUSION: In spite of unchanged length of hospital stay, we note a significant increase in pre-operative complication rates as a result of surgical delays greater than 7,10 and 14 days, which introduces an interesting debate in the merit of delaying operations for further assessment in clinic. Our objectives would be to minimize complication rate, therefore a high sensitivity i.e. true positive rate would be most desirable. The 99% levels achieved at 7 days In the ROC analysis lends weight to introducing policy to fast-track admissions for primary GBM patients. Further directions could include assessing the impact reduced surgical services and redeployment might have had on complications rates and length of hospital stay on patients admitted over the COVID 19 pandemic.
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COVID-19 dramatically changed the way Texas' students and residents learn medicine.
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COVID-19 prompted a partnership among North Texas medical societies to serve their communities.
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The new mRNA vaccines for COVID-19 are highly effective at giving people immunity against the disease. But as with all other vaccines, that immunity is not 100% for everyone who receives them.
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The uneven rollout of COVID-19 vaccines in December created at least one bright spot for Texas physicians: It highlighted how the state could make vaccination more efficient.
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Texas grapples with a medical staffing shortage amid a renewed COVID-19 surge.
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The rise of telemedicine during the COVID-19 pandemic has spurred a change in state law that will not only help make certain telemedicine services permanent but also give out-of-state physicians an easier pathway to join the Texas workforce.
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Before March 2020, remote patient monitoring (RPM) was a tool endocrinologist Thomas Blevins, MD, used to help patients with diabetes track and regulate blood sugar levels and report the results back to him. But when the COVID-19 pandemic forced many doctors to turn to telemedicine, Dr. Blevins and the nine other physicians on staff at Austin Diabetes and Endocrinology had to rev up their RPM use.
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What if Texas lawmakers created a mental health service that physicians asked for but then not many physicians used it? So far, that is what's happening with the Child Psychiatric Access Network (CPAN), which gives pediatricians and family physicians across Texas free telemedicine-based consultation and training on community psychiatry.