ABSTRACT
Introduction: The emerging complications of thromboembolism (TE) in COVID-19 patients have led to severe consequences such as death. Nonetheless, the prevalence of TE complications among COVID-19 patients in the Intensive Care Unit (ICU) in Malaysia is unknown. The aim of this study is to investigate the prevalence of thromboembolic (TE) complications including venous deep vein thrombosis (DVT), pulmonary embolism (PE), and line related thrombosis] and arterial [stroke, peripheral arterial disease and myocardial infarction (MI)] thrombosis and mortality among COVID-19 patients admitted to an ICU in Hospital Sungai Buloh. Material(s) and Method(s): In this retrospective Malaysian cohort study, patients admitted to a single centre ICU with polymerase chain reaction (PCR) confirmed of SARS-CoV-2 virus and received adequate thromboprophylaxis within February 2020-2021 were included. Thromboembolic (TE) event is a combination of venous and arterial thrombosis. Result(s): Mean (SD) age 56.6 (13.7), 63.5% were male, 61.6% Malays, median (IQR) 7 (3-14) days of ICU admission, 64.2%, 53.2 % and 20.9% had underlying hypertension, diabetes and obesity respectively. Of 534 patients, 4 (0.7%) developed DVT, 198 (37.1%) PE and 2 (0.4%) line related thrombosis. Meanwhile, 21 (3.9%) developed stroke, 39 (7.3%) MI, 1(0.2%) PAD and 22.8% died despite adequate thromboprophylaxis. In total, 240 (44.9%) developed TE event during their ICU admission. Significantly higher proportions of COVID-19 patients who developed complications of DVT (2.5% vs. 0.2%;p=0.013), PE (47.5% vs 34.0%;p=0.006), stroke (12.3% vs. 1.5;p<0.001) and MI (16.4% vs. 4.6%;p<0.001) died. Age, duration of ICU admission, obesity, white cell count (WCC), troponin, D-Dimer and corticosteroid use were significantly greater among those with TE events. Demographics, comorbidities, other laboratory parameters and inflammatory markers were similar in COVID-19 patients with and without TE events. Predictors of TE events on multivariate logistic regression analysis were age [OR 1.02 (95% CI 1.00-1.03)], obesity [OR 2.84 (95% CI 1.93-4.18)], WCC [OR 1.04 (95% CI 1.00-1.07)], and duration of ICU admission [OR 1.04 (95% CI 1.02-1.06)]. Conclusion(s): In this cohort of severely ill COVID-19 patients, the overall prevalence of TE complication was high (44.9%) with the overall mortality of 22.8% despite adequate thromboprophylaxis. Key predictors of TE events included age, obesity, white cell count, and duration of ICU admission. Perhaps a more aggressive treatment (combination of thromboprophylaxis and enhanced anti-inflammatory treatment) may be needed among COVID-19 patients admitted to ICU with high risk factors to prevent further increase in the incidence of thromboembolism and death.
ABSTRACT
In response to the inability to conduct conventional face-to-face objective structured clinical examination (OSCE) due to the COVID-19 lockdown, this study explored options to design virtual OSCE (vOSCE) that meets the objectives and standards of effective competency-based assessment for a large cohort of pharmacy students. The vOSCE required advanced planning of the actual assessment and technical conduct. The development of a master plan consisting of the types of competencies to test, topics and number of cases, and assessment rubrics, guided the team members to develop an adequate OSCE assessment module. Technical aspects included recruitment of examiners, simulated patients (SP), technical support, and a platform for vOSCE. The main challenges were to ensure well-ordered vOSCE and a stable internet connection for examiners, SP, and students. Google Meet was utilised due to its functionality, familiarity, and low internet consumption to all parties involved. Feedback was obtained from stakeholders to improve future OSCE conduct.