ABSTRACT
Despite the upheavals in health care systems related to the onset of the COVID-19 pandemic, cardiac rehabilitation (CR) needs to continue for inpatients experiencing recent cardiac surgery or severe heart failure because CR improves patient outcomes, reduces readmissions and lowers long-term costs. Our aim is to share the strategies implemented in our facility to minimize the risk of COVID-19 transmission and thus ensure safe and efficient CR for the inpatients. We describe the guidelines that were applied in our cardiac rehabilitation unit (CRU) during the containment phase in France, from March 17 to May 11, 2020. We report the incidence of COVID-19 confirmed cases by RT-PCR testing among symptomatic inpatients and health care workers (HCWs) within the same timeframe. Our strategy was focused on isolation of all inpatients and protection of the professionals. The main measures were systematically placing admitted patients in a single room, generalizing the use of surgical masks for HCWs and inpatients, suspending day hospital activity. The CR program was based on individual exercise and education, plus collective activities involving 2 or 3 patients with respect of enhanced barrier measures. From March 17, to May 11, 2020, 97 patients have been hospitalized in the CRU. The average length of stay was 24 days. Five members of the health care staff (5/205, 2.4%) were suspected cases and all tested negative for COVID-19. Eighteen inpatients (18/97, 18%) tested for COVID-19 and 2 (2/18, 11%) tested positive. Patient No. 1 had a positive test 10 days after her admission to the CRU. Patient No. 2 tested positive on the day of his admission. Both had recent cardiac surgery. They were transferred back to the hospital. No secondary case was detected in the CRU. CR can be performed in a safe way for both inpatients and HCWs during the COVID-19 pandemic era. In our experience, strict isolating and protecting measures are efficient to avoid nosocomial SARS-CoV-2 spread in CRUs.
ABSTRACT
The SARS-CoV-2 pandemic has necessitated significant adaptation to medical education. A significant proportion of teaching has moved online, and innovative approaches have been required in all areas, including assessment. Provision of the clinical examination has presented a particular challenge. This year it was considered impractical and unsafe to carry out clinical examinations in person due to the SARS-CoV-2 pandemic. Therefore, in our institution, clinical examinations in paediatrics were moved online. Prior to summative assessment, teaching was provided using a similar format to the examination in order to improve assessment literacy. The summative clinical assessment was held using Zoom software and included history-taking, knowledge of paediatric clinical examination and communication. Retrospective analysis showed a significant correlation between students’ performance in the online clinical examination, other methods of assessment and their overall grade. In the absence of a traditional clinical examination, this method appears to be an acceptable alternative.
ABSTRACT
Coronavirus (SARS-CoV-2 - COVID-19) disease causes severe acute respiratory syndrome. During infection, activation of macrophages and pro-inflammatory granulocytes produces cell damage, inducing lung inflammation that leads to the characteristic symptoms of fever, cough, fibrosis, and high increase in pro-inflammatory cytokine levels. In general, during the inflammatory process and infection by coronavirus, cytokines are elevated, particularly IL-1, 6 and 12, TNF-α, and TGF-β. In addition, patients with complications and lethal prognosis present increased serum levels of IF-I and γ compared to healthy individuals or patients with moderate symptoms. On the other hand, it is known that physical activity favours an adaptation of the immune system function. In this context, we suggest that appropriate exercise programs could improve recovery of people who have suffered from COVID-19 disease, improving the quality of life and reinforcing the protection against future infections. The immunomodulatory properties of exercise and physical activity could act as prevention tools for different chronic diseases in healthy individuals and complement therapeutic tools in sick patients. Nevertheless, exercise must be adequate b © Faculty of Education. University of Alicante