Post COVID-19 trends in simulation use within diagnostic radiography and radiation therapy education

PURPOSE Simulation is used within medical radiation science training. Recent global events and simulation resource uptake has led to significant changes. The aim of this study was to capture post COVID-19 trends and activity of simulation-based education (SBE) in diagnostic radiography and radiation therapy. METHODS An online survey was designed to investigate the role of simulation within diagnostic radiography and radiation therapy education. Survey design was based on literature and experience within the research team. Questions were based around access and use of simulation, future trends and the effects of COVID-19. Participants were diagnostic radiography and/or radiation therapy educators. Data captured in this study was undertaken in March 2022 and compared with previous data from Bridge and colleagues (2021). RESULTS Sixty-seven responses were received across five continents (two from North/South America), Europe was the most widely represented (n=58, 87%). Fifty-three (79%) of participants reported that they use simulation as part of their teaching and learning. Twenty-seven (51%) respondents reported that they had increased their use of simulation because of COVID-19. Sixteen (30%) respondents stated that they were now able to enrol more students because of the pandemic. Fixed models and immersive environments were the two most common simulation activities. Participants reported, to different degrees, that simulation was used across all parts of the curriculum. CONCLUSIONS Simulation is deeply embedded into diagnostic radiography and radiation therapy education. Evidence suggests that the growth of simulation may be slowing. Opportunities exist for the development of guidance, training and best practice resources around simulation. IMPLICATIONS FOR PRACTICE Simulation is a key pedagogical approach for diagnostic radiography and radiation therapy education. Key stakeholders now need to work collaboratively to define standards and best practices.

Granulomatous Pleuritis in a Previously Covid-19-Infected Patient

INTRODUCTION: The most common setting for granulomatous pleuritis is usually in the presence of Mycobacterium tuberculosis. This pathology draws interest due to its potential of long-term injury to lung pleura, as well as, the potential to harm the lung parenchyma by association. We present a rare presentation of granulomatous pleuritis following COVID19 infection. DESCRIPTION: The patient is a 28-year-old female who presents to the hospital with fever and malaise for one week. She reports having an outpatient CT which showed a large right pleural effusion so her pulmonologist instructed her to come in. She denies recent exposure to any sick contacts. She does note a history of COVID-19 a year ago which resulted in shortness of breath but did not require hospitalization. She has worked at a gun shooting range for the last two years, for which she assembles bullets. She notes that she is required to wear a particulate protection mask and has worn this consistently to limit exposure. Thoracic surgery was consulted and initially completed a thoracentesis with 500 mL of exudative fluid. Patient remained intermittently febrile with worsening right sided chest pain. Culture and gram stain were unremarkable. She subsequently underwent a bronchoscopy with bronchial washing, biopsy, and decortication. Pathology demonstrated non-necrotic granulomatous pleuritis with a small area of central fibrinoid necrosis. Repeat chest x-rays demonstrated a minimal pleural effusion, much improved from prior. Fevers had also subsided at this time. Patient was discharged home with instructions to follow-up with thoracic surgery regarding further management of steroids. DISCUSSION: The findings of non-tuberculosis-related granulomatous pleuritis are unique in that they frame the need to look for different perspectives and potentiators for pleural pathology. This case is also important given the unique presentation of the post-covid inflammatory response. Since COVID-19 is still so new, the field of post covid syndromes remains largely unknown.

Consulting with Children and Parents to Cocreate Resources About Receiving Paediatric Outpatient Parenteral Antimicrobial Therapy (Opat)

Aims We aim to showcase how we engaged with children and their parents via a teleconferencing platform (Zoom) using the power of illustration to trigger their recall of going home on outpatient parenteral antimicrobial therapy (OPAT). This co-creative consultation work was conducted to address the need, identified by children and parents in a previous research study, for enhanced preparation and information about OPAT. Methods Children (n=4) who had received OPAT and their parents (n=4) were invited to participate by clinicians in the OPAT team at the children's tertiary centre. The children were sent specifically designed activity sheets asking them about their experiences in advance of an online activity consultation via Zoom. There was no set schedule for the online activity, instead conversation was triggered by the researchers asking the children about their drawings and responses in their completed activity sheets. Meanwhile, the illustrator listened, shared their screen, utilised the children's drawings and words and created new images that brought to life, in realtime, the experiences children and their parents shared. Children and their parents were in control of the process as they could direct, confirm or alter the drawings that appeared on the screen and ask for text to be added. Results The freely available, co-developed resources include a 3-minute long animation (figure 1) and an information leaflet (figure 2), has been designed by and for children and their parents. Although remote engagement with children has become more commonplace, the use of real-time, co-creation based on children's illustrations and augmented by professional illustration and animation during the online activity is novel. The strengths (e.g. children enjoyed the approach) and limitations (e.g. reliance on stable Wi-Fi) of this approach have been explored. The findings from this consultation aligned with and added depth to understanding the experiences of children and parents about being at home on OPAT. Link to animation: https://www.youtube.com/watch? v=JERVuqmLLDM Link to information leaflet: https://figshare.edgehill.ac.uk/ articles/figure/Things-you-might-like-to-know-about-having- your-medicine-at-home-information-leaflet-OPAT-/ 19180895/1 872 Figure 1 872 Figure 2 Conclusion The COVID-19 pandemic has had a profound impact on the way consultation activities are conducted. This illustration driven, virtual consultation method with children receiving OPAT and their parents was successful and allowed the co-creation of free resources for other children and parents to use. Rather than constrain what was done, using virtual methods meant that children and their parents were able to engage with and co-create ideas for resources from the comfort of their own homes.

Clinical Features and Duration of Viral Shedding in Individuals With SARS-CoV-2 Omicron Variant Infection.

We analyzed the duration of infectivity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant by viral culture of respiratory samples collected daily from isolated patients with SARS-CoV-2 infection. The culture positivity rate of the Omicron variant was higher than that of the Delta variant within 8 days after symptom onset.

Estimating the Impact of School Classroom Sizes on the Probability of Severe Acute Respiratory Syndrome Coronavirus-2 Infectivity or Exposure

Background. Despite schools reopening across the United States in communities with low and high Coronavirus disease 2019 (COVID-19) prevalence, data remain scarce about the effect of classroom size on the transmission of severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) within schools. This study estimates the effect of classroom size on the risk of COVID-19 infection in a closed classroom cohort for varying age groups locally in Durham, North Carolina. Total number of Coronavirus Disease 2019 (COVID-19) infections over a 28-day follow-up period for varying classroom reproduction number (R0) and varying classroom cohort sizes of 15 students, 30 students and 100 students in Durham County, North Carolina. Methods. Using publicly available population and COVID-19 case count data from Durham County, we calculated a weekly average number of new confirmed COVID-19 cases per week between May 3, 2020 and August 22, 2020 according to age categories: < 5 years, 5-9 years, 10-14 years, and 15-19 years. We collated average classroom cohort sizes and enrollment data for each age group by grade level of education for the first month of the 2019-2020 academic school year. Then, using a SEIR compartmental model, we calculated the number of susceptible (S), exposed (E), infectious (I) and recovered (R) students in a cohort size of 15, 30 and 100 students, modelling for classroom reproduction number (R0) of 0.5, 1.5 and 2.5 within a closed classroom cohort over a 14-day and 28-day follow-up period using age group-specific COVID-19 prevalence rates. Results. The SEIR model estimated that the increase in cohort size resulted in up to 5 new COVID-19 infections per 10,000 students whereas the classroom R0 had a stronger effect, with up to 88 new infections per 10,000 students in a closed classroom cohort over time. When comparing different follow-up periods in a closed cohort with R0 of 0.5, we estimated 12 more infected students per 10,000 students over 28 days as compared to 14 days irrespective of cohort size. With a R0 of 2.5, there were 49 more infected students per 10,000 students over 28 days as compared to 14 days. Conclusion. Classroom R0 had a stronger impact in reducing school-based COVID-19 transmission events as compared to cohort size. Additionally, earlier isolation of newly infected students in a closed cohort resulted in fewer new COVID-19 infections within that group. Mitigation strategies should target promoting safe practices within the school setting including early quarantine of newly identified contacts and minimizing COVID-19 community prevalence.

Quality of care and in-hospital outcomes of patients hospitalized for heart failure with reduced ejection fraction during the COVID-19 pandemic: Findings from the get with the guidelines-heart failure registry

Introduction: COVID-19's impact on in-hospital care quality and outcomes of patients hospitalized with acute heart failure (HF) has not been systematically evaluated nationally. Methods: Patients hospitalized with HF with ejection fraction (EF) <40% in the AHA GWTG-HF registry during the pandemic (3/1/2020 - 4/1/ 2021) and pre-pandemic (2/1/2019 - 2/29/2020) periods were included. Adherence to HF process of care measures, in-hospital mortality, and length of stay (LOS) were compared in the pre-pandemic vs pandemic period and among hospitalized HF patients with vs without COVID-19 across both periods. Results: 40,005 pre-pandemic and 35,561 pandemic period patients admitted across 346 centers (median age 68, 33% women, 58% White) were included. There were no differences in clinical characteristics, comorbidities, presentation vital signs, or EF during the pandemic vs pre-pandemic periods. Among process of care measures, utilization of guideline-directed medical therapy at discharge was comparable across both periods. In contrast, rates of ICD placement or prescription and blood pressure control at discharge were lower during the pandemic (vs pre-pandemic period) (Table). In-hospital death (2.5% vs. 3.0%, p<0.001) and LOS (mean 5.4 vs. 5.7 days, p=0.008) were higher during the pandemic vs pre-pandemic. Substantial geographic variation was seen in the inhospital death rates during the pandemic, with highest rates among patients hospitalized in the Northeast region (3.36%). Among HF patients hospitalized during the pandemic with COVID-19 (N = 527 [1.5%]), adherence to ICD placement or prescription at discharge and prescription of aldosterone antagonist or ACE/ARB/ARNi were lower, and risk of in-hospital death and length of stay were significantly higher than those without COVID-19. Conclusion: In-hospital mortality and adherence to certain quality measures worsened during COVID-19 pandemic among patients admitted for acute decompensated HFrEF.

Evaluating student attitudes and learning at remote collegiate soil judging events

As with many aspects of teaching, the COVID-19 pandemic forced soil judging teams to attempt new strategies towards achieving student learning outcomes. Soil judging Regions IV and V hosted remote regional contests in October 2020 in place of traditional, in-person contests typically held each fall. We conducted pre- and post-contest surveys to assess student learning outcomes, attitudes, and reflections on the remote contest experience compared to past, in-person contest experiences. We received 108 total responses from students who participated in the Region IV and Region V remote soil judging contests (>80% response rate). In self-reported learning outcomes, there were no significant gains post-contest and there were minimal differences between students in Regions IV and V. Female students, students with more soil judging experience, and students who had taken more soil science courses agreed more strongly that soil science is important, that they planned to pursue careers in soil science, and that they gained important skills from soil judging. Finally, students who previously participated in contests reported that they gained more knowledge and enjoyed in-person contests more than the remote contests held in Fall 2020. Thus, while it is possible to replicate some aspects of the soil judging experience in a remote contest, other aspects that are critical to student engagement are lost when teams are unable to gather at the contest location and examine soils in the field. © 2021 The Authors. Natural Sciences Education published by Wiley Periodicals LLC on behalf of American Society of Agronomy

Initial routine laboratory tests can be used to predict clinical course in patients hospitalised with COVID-19

BackgroundPrevious work has related demographic and clinical characteristics to clinical course and outcome of patients hospitalised with COVID-19.1 We sought to evaluate if initial routine laboratory test results could be utilised to predict length of inpatient stay (LOS), need for non-invasive (NIV)/invasive mechanical ventilation (IMV) and admission to an intensive care unit (ICU). We also sought to establish if C-reactive protein levels related to radiographic disease severity.MethodsA retrospective analysis was carried out on a cohort of 567 patients with a laboratory confirmed diagnosis of COVID-19 admitted during the second wave of the pandemic between April 2020 and May 2021 including descriptive statistics and multivariate and regression analysis. Radiological severity was based upon previously proposed scoring systems.2ResultsOf the 567 patients included, 342 (60%) were male, mean age 61 years, 318 (56%) were Caucasian, 143 (25%) Asian and 35 (6%) Black. Raised admission d-dimer and urea levels correlated with longer LOS (r= 0.17 and 0.16 respectively, p<0.01). Rising C-reactive protein and d-dimer correlated with increased risk of requirement for admission to ICU (r= 0.27 and 0.19 respectively, p<0.001), need for NIV (Pearson’s correlation 0.26 and 0.15 respectively, P<0.01) and progression to IMV (r=0.15 and 0.14, p<0.05). A correlation between initial routine blood results and death was not detected. C-reactive protein correlated with radiographic disease severity (r=0.32, p<0.001).ConclusionsAbnormalities in initial laboratory test results may be utilised to risk stratify patients presenting to secondary and tertiary care with COVID-19, may help predict clinical course and in doing so facilitate more efficient and streamlined delivery of care and resource utilisation with likely significant impact on patient outcomes.ReferencesCheng D, Calderwood C, Skyllberg E, et al. Clinical characteristics and outcomes of adult patients admitted with COVID-19 in East London: a retrospective cohort analysis. BMJ Open Respiratory Research 2021;8:e000813.Monaco CG, Zaottini F, Schiaffino S, et al. Chest x-ray severity score in COVID-19 patients on emergency department admission: a two-centre study. Eur Radiol Exp. 2020;4(1):68.

Canadian Greenhouse Operations and Their Potential to Enhance Domestic Food Security

Food security is a growing societal challenge. The pressure to feed a projected global population of 9.6 billion by 2050 will continue to be limited by decreasing arable land. The recent disruptions in international trade resulting from responses to the COVID-19 pandemic have highlighted the importance of regional self-reliance in food production. While Canada is highly self-reliant in food categories such as meat and dairy, the nation relies heavily on international imports to fulfill fresh vegetable demands. In potential future scenarios where international trade faces disruptions, Canadian food security could be at risk. By providing local sources of fresh foods year-round, the greenhouse vegetable industry holds strong potential to overcome future food supply shortages and could become a critical contributor to self-sustainable food production in Canada. Many challenges, however, surround the Canadian greenhouse industry. Some challenges include the persistence and spread of infectious plant pathogens and forecasted labour shortages. Opportunities to alleviate such challenges include introducing more diverse commodity groups and integrating innovative technologies to accelerate efficiency within the industry. In this commentary, we examine the current state of the Canadian greenhouse industry, explore potential challenges, and highlight opportunities that could promote food security across the nation.

Postal set up of cpap: A positive innovation during the covid 19 pandemic

Introduction and Objectives Traditionally at this unit, patients diagnosed with OSA have been initiated on CPAP at a face to face (F2F) appointment. Patients are followed up via telephone consultation at 4 weeks Abstract P23 Figure 1 with a virtual review of CPAP usage. During the Covid-19 pandemic this department adapted their practices to reduce F2F interactions. Patients were sent a CPAP machine via the post and a YouTube video link of how to use the CPAP. The aim of this study is to compare outcomes in symptoms and compliance between the patient groups to evaluate the effectiveness of a postal CPAP service. Methods Patients initiated on CPAP between September and November 2019 (F2F CPAP) were compared to patients initiated on CPAP between April and June 2020 (Postal CPAP). Data was obtained from the electronic records. Patients were only included in the study if all data regarding symptoms, Epworth score and compliance was complete. Results 346 patients were initiated on F2F CPAP between and 185 were sent postal CPAP during the said period. Of these, 191 (55%) and 59 (32%) respectively had full data recorded. Table 1 compares outcomes in symptom improvement and compliance between both groups. Common causes of missing data were unable to contact patient or extended trial. The majority of patients felt their symptoms were better on CPAP. There was no significant difference between the groups in terms of ESS improvement, hours used per night and percentage of nights used. Conclusions Overall, symptom improvement and compliance were similar in both groups. While it is possible that the outcomes were exaggerated as patients who did not respond well or were non-compliant were excluded as they were not contactable, however that is applicable to both groups & hence comparable. This study has huge implications for how the OSA CPAP service is run in future and supports a case that the initiation of CPAP can be done remotely via postal CPAP without impacting on patient outcomes, with fewer hospital visits, PPE use & clinic room utilization. Future studies should look at long term compliance in this group.

Reducing plastic waste in paeds ED

Aims/Objectives/Background Venepuncture and PVC insertion are common procedures in Children's ED and often include blood cultures. Opening a universal dressing pack (udp) including a plastic tray, sterile swabs, gloves and 2 plastic sterile field drapes (sfd) is common practice. Our department was making a huge spend on udp's. We aimed to determine if this was necessary and if we could reduce our plastic waste. Methods/Design A sample of 8 doctors across all grades demonstrated their set up for both procedures. We replaced udp in the IV trollies with x2 sfd pack (sfdp). Information was disseminated via weekly staff brief. Trollies are restocked each night using attached flashcards which were updated appropriately. The use and costs of dressing packs in ED was determined for April-June 2019. We planned to compare this for April-June 2020. Results/Conclusions All clinicians were opening a dressing pack for procedures but 87.5% only used the sfd and swabs. 100% discarded gloves due to inappropriate size and 100% discarded the tray. All staff adopted the new equipment with no problems identified. 3500 udps were being used in dept in 3 months. Udp v sfdp per item costs 32p v 8p, weight 65 g v 30 g. Due to CoVID-19 pandemic the number of ED attendances significantly reduced therefore costs were based on 2019 usage. In 3 months switching from udp to sfd would save £840 and 122.5 kg of refuse weight. Volumes of stocks were reduced from 0.05 m2 to 0.01 m2 for 50 udp v 50 sfdp which aids storage and restocking of IV trollies releasing staff time. We demonstrated a significant reduction in unnecessary plastic waste while also reducing costs and need for storage and restocking whilst maintaining safe practice. This has been rolled out in the neighbouring Clinical Decision Unit with anticipation of being a permanent change in both areas.