Bullet screen in pre-clinical undergraduate pharmacology education: a survey study.

BACKGROUND: The lack of interaction and communication in pharmacology courses, especially since the onset of the coronavirus disease 2019 (COVID-19) pandemic, which required a fast shift to remote learning at medical schools, leads to an unsatisfactory learning outcome. New interactive teaching approaches are required to improve pharmacology learning attention and interaction in remote education and traditional classrooms. METHODS: We introduced bullet screens to pharmacology teaching. Then, a survey was distributed to first-, second- and third-year pre-clinical undergraduate medical and nursing students at the Shanghai Jiao Tong University School of Medicine from November 2020 to March 2022. We evaluated the essential features, instructional effectiveness, and entertainment value of bullet screens. Responses to structured and open-ended questions about the strengths and weaknesses of the bullet screen and overall thoughts were coded and compared between medical and nursing students. RESULTS: In terms of essential features, bullet screens have a high degree of acceptability among students, and this novel instructional style conveniently increased classroom interaction. Considering instructional effectiveness, bullet screen may stimulate students' in-depth thinking. Meanwhile, students tended to use bullet-screen comments as a way to express their support rather than to make additional comments or to express their different viewpoints. The entertainment value of bullet screen was noteworthy. The lack of ideas might lead to relative differences between medical and nursing students, indicating that guiding the appropriate use of bullet screen is necessary. CONCLUSIONS: The bullet screen may be popularized as an auxiliary teaching approach to promote interaction between teachers and students in the classroom as well as during remote education. It is an interesting and beneficial tool in pharmacology courses, yet there are several aspects of this device that should be improved for popularization.

Characterizing cancer and COVID-19 outcomes using electronic health records.

PURPOSE: Patients with cancer often have compromised immune system which can lead to worse COVID-19 outcomes. The purpose of this study is to assess the association between COVID-19 outcomes and existing cancer-specific characteristics. PATIENTS AND METHODS: Patients aged 18 or older with laboratory-confirmed COVID-19 between June 1, 2020, and December 31, 2020, were identified (n = 314 004) from the Optum® de-identified COVID-19 Electronic Health Record (EHR) derived from more than 700 hospitals and 7000 clinics in the United States. To allow sufficient observational time, patients with less than one year of medical history in the EHR dataset before their COVID-19 tests were excluded (n = 42 365). Assessed COVID-19 outcomes including all-cause 30-day mortality, hospitalization, ICU admission, and ventilator use, which were compared using relative risks (RRs) according to cancer status and treatments. RESULTS: Among 271 639 patients with COVID-19, 18 460 had at least one cancer diagnosis: 8034 with a history of cancer and 10 426 with newly diagnosed cancer within one year of COVID-19 infection. Patients with a cancer diagnosis were older and more likely to be male, white, Medicare beneficiaries, and have higher prevalences of chronic conditions. Cancer patients had higher risks for 30-day mortality (RR 1.07, 95% CI 1.01-1.14, P = 0.028) and hospitalization (RR 1.04, 95% CI 1.01-1.07, P = 0.006) but without significant differences in ICU admission and ventilator use compared to non-cancer patients. Recent cancer diagnoses were associated with higher risks for worse COVID-19 outcomes (RR for mortality 1.17, 95% CI 1.08-1.25, P<0.001 and RR for hospitalization 1.10, 95% CI 1.06-1.14, P<0.001), particularly among recent metastatic (stage IV), hematological, liver and lung cancers compared with the non-cancer group. Among COVID-19 patients with recent cancer diagnosis, mortality was associated with chemotherapy or radiation treatments within 3 months before COVID-19. Age, black patients, Medicare recipients, South geographic region, cardiovascular, diabetes, liver, and renal diseases were also associated with increased mortality. CONCLUSIONS AND RELEVANCE: Individuals with cancer had higher risks for 30-day mortality and hospitalization after SARS-CoV-2 infection compared to patients without cancer. More specifically, patients with a cancer diagnosis within 1 year and those receiving active treatment were more vulnerable to worse COVID-19 outcomes.

A Passive Smart Face Mask for Wireless Cough Monitoring: A Harmonic Detection Scheme With Clutter Rejection.

Cough detection has aroused great interest because the assessment of cough frequency may improve diagnosis accuracy for dealing with several diseases, such as chronic obstructive pulmonary disease (COPD) and the recent COVID-19 global pandemic crisis. Here, we propose and experimentally demonstrate a wireless smart face mask based on a passive harmonic tag for real-time cough monitoring and alert. Our results show that the cough events can be successfully monitored through non-contact track of the received signal strength indicator (RSSI) at the harmonic frequency. Owing to the frequency orthogonality between the launched and backscattered radio-frequency (RF) signals, the harmonic tag-based smart mask can well suppress the electromagnetic interferences, such as clutters and crosstalks in noisy environments. We envision that this zero-power and lightweight wireless wearable device may be beneficial for cough monitoring and the public health condition in terms of tracking potential contagious person and virus-transmissive events.

Measurements of Volatile Organic Compounds During the COVID-19 Lockdown in Changzhou, China.

The COVID-19 outbreak in 2020 prompted strict lockdowns, reduced human activity, and reduced emissions of air pollutants. We measured volatile organic compounds (VOCs) using a proton-transfer-reaction mass spectrometry instrument in Changzhou, China from 8 January through 27 March, including periods of pre-lockdown, strict measures (level 1), and more relaxed measures (level 2). We analyze the data using positive matrix factorization and resolve four factors: textile industrial emissions (62 ± 10% average reduction during level 1 relative to pre-lockdown), pharmaceutical industrial emissions (40 ± 20%), traffic emissions (71 ± 10%), and secondary chemistry (20 ± 20%). The two industrial sources showed different responses to the lockdown, so emissions from the industrial sector should not be scaled uniformly. The quantified changes in VOCs due to the lockdowns constrain emission inventories and inform chemistry-transport models, particularly for sectors where activity data are sparse, as the effects of lockdowns on air quality are explored.

Rural-urban disparities in knowledge, behaviors, and mental health during COVID-19 pandemic: A community-based cross-sectional survey.

ABSTRACT: To examine the knowledge level, behaviors, and psychological status of the Chinese population during the COVID-19 pandemic, and to explore the differences between urban and rural areas.We carried out a cross-sectional survey of the knowledge, behaviors related to COVID-19, and mental health in a probability sample of 3001 community residents in 30 provinces or districts across China from February 16-23, 2020. Convenience sampling and a snowball sampling were adopted. We used General Anxiety Disorder (GAD), the 9-item Patient Health Questionnaire (PHQ-9), and knowledge and behaviors questionnaire of community residents regarding COVID-19 designed by us to investigate the psychological status, disease-related knowledge, and the behavior of Chinese urban and rural residents during the pandemic.The average score of anxiety and depression among urban residents was 9.15 and 11.25, respectively, while the figures in rural areas were 8.69 and 10.57, respectively. There was a statistically significant difference in the levels of anxiety (P < .01) and depression (P < .01). Urban participants reported significantly higher levels of knowledge regarding COVID-19 in all aspects (transmission, prevention measures, symptoms of infection, treatment, and prognosis) (P < .01), compared to their rural counterparts. While a majority of respondents in urban areas obtained knowledge through WeChat, other apps, and the Internet (P < .01), residents in rural areas accessed information through interactions with the community (P < .01). Urban residents fared well in exchanging knowledge about COVID-19 and advising others to take preventive measures (P < .01), but fared poorly in advising people to visit a hospital if they displayed symptoms of the disease, compared to rural residents (P < .01). Regression analysis with behavior showed that being female (OR = 2.106, 95%CI = 1.259-3.522), aged 18 ≤ age < 65 (OR = 4.059, 95%CI = 2.166-7.607), being satisfied with the precautions taken by the community (OR = 2.594, 95%CI = 1.485-4.530), disinfecting public facilities in the community (OR = 2.342, 95%CI = 1.206-4.547), having knowledge of transmission modes (OR = 3.987, 95%CI: 2.039, 7.798), symptoms (OR = 2.045, 95%CI = 1.054-4.003), and outcomes (OR = 2.740, 95%CI = 1.513-4.962) of COVID-19, and not having anxiety symptoms (OR = 2.578, 95%CI = 1.127-5.901) were positively associated with affirmative behavior in urban areas. Being married (OR = 4.960, 95%CI = 2.608-9.434), being satisfied with the precautions taken by the community (OR = 2.484, 95%CI = 1.315-4.691), screening to ensure face mask wearing before entering the community (OR = 8.809, 95%CI = 2.649-19.294), and having knowledge about precautions (OR = 4.886, 95%CI = 2.604-9.167) and outcomes (OR = 2.657, 95%CI = 1.309-5.391) were positively associated with acceptable conduct in rural areas.The status of anxiety and depression among urban residents was more severe compared to those living in rural areas. There was a difference in being positively associated with constructive behaviors between rural and urban areas.

Impact of COVID-19 on the Healthcare of Patients With Inflammatory Bowel Disease: A Comparison Between Epicenter vs. Non-epicenter Areas.

Background and Aims: The COVID-19 pandemic poses a great challenge to healthcare. We aimed to investigate the impact of COVID-19 on the healthcare of patients with inflammatory bowel disease (IBD) in epicenter and non-epicenter areas. Methods: Patients with IBD from Hubei province (the epicenter of COVID-19) and Guangdong province (a non-epicenter area), China were surveyed during the pandemic. The questionnaire included change of medications (steroids, immunomodulators, and biologics), procedures (lab tests, endoscopy, and elective surgery), and healthcare mode (standard healthcare vs. telemedicine) during 1 month before and after the outbreak of COVID-19. Results: In total, 324 IBD patients from Guangdong province (non-epicenter) and 149 from Hubei province (epicenter) completed the questionnaire with comparable demographic characteristics. Compared to patients in Guangdong province (non-epicenter), significantly more patients in Hubei (epicenter) had delayed lab tests/endoscopy procedures [61.1% (91/149) vs. 25.3% (82/324), p < 0.001], drug withdrawal [28.6% (43/149) vs. 9.3% (30/324), p < 0.001], delayed biologics infusions [60.4% (90/149) vs. 19.1% (62/324), p < 0.001], and postponed elective surgery [16.1% (24/149) vs. 3.7% (12/324), p < 0.001]. There was an increased use of telemedicine after the outbreak compared to before the outbreak in Hubei province [38.9% (58/149) vs. 15.4% (23/149), p < 0.001], while such a significant increase was not observed in Guangdong province [21.9% (71/324) vs. 18.8% (61/324), p = 0.38]. Approximately two-thirds of IBD patients from both sites agreed that telemedicine should be increasingly used in future medical care. Conclusions: Our patient-based survey study in a real-world setting showed that COVID-19 resulted in a great impact on the healthcare of patients with IBD, and such an impact was more obvious in the epicenter compared to the non-epicenter area of COVID-19. Telemedicine offers a good solution to counteract the challenges in an unprecedented situation such as COVID-19.

Impact of COVID-19 outbreak on the care of patients with inflammatory bowel disease: A comparison before and after the outbreak in South China.

BACKGROUND AND AIMS: Epidemics pose a great challenge to health care of patients. However, the impact of unprecedented situation of COVID-19 outbreak on health care of inflammatory bowel disease (IBD) patients in real-world setting has seldom been investigated. METHODS: We performed an observational study in a tertiary referral IBD center in China. The mode of health care and medication use was compared before and after COVID-19 outbreak. Electronic questionnaire surveys were performed among gastroenterologists and IBD patients to investigate the impact of COVID-19 outbreak on their attitudes towards telemedicine. RESULTS: COVID-19 outbreak resulted in substantial decrease of patients participating in standard face-to-face visit during 1 month post-outbreak (n = 51) than pre-outbreak (n = 249), whereas the participation in telemedicine was significantly higher than comparable period in 2019 (414 vs 93). During the 1 month after COVID-19 outbreak, 39 (39/56, 69.6%) patients had their infliximab infusion postponed with the mean delay of 3 weeks. The immunomodulator use was similar between pre-outbreak and post-outbreak. Six elective surgeries were postponed for a median of 43 days. In post-outbreak period, 193 (193/297, 64.98%) of the surveyed physicians have used telemedicine with an increase of 18.9% compared with 46.13% (137/292) in the pre-outbreak period (P < 0.001); 331 (331/505, 65.54%) of the surveyed IBD patients supported that the use of telemedicine should be increased in future health care. CONCLUSION: COVID-19 outbreak resulted in a great change in health-care access among IBD patients including decrease in standard face-to-face visit and delay of biologics use. There was an increased use and need of telemedicine after COVID-19 outbreak.

Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis.

BACKGROUND: The prevalence and prognosis of digestive system involvement, including gastrointestinal symptoms and liver injury, in patients with COVID-19 remains largely unknown. We aimed to quantify the effects of COVID-19 on the digestive system. METHODS: In this systematic review and meta-analysis, we systematically searched PubMed, Embase, and Web of Science for studies published between Jan 1, 2020, and April 4, 2020. The websites of WHO, CDC, and major journals were also searched. We included studies that reported the epidemiological and clinical features of COVID-19 and the prevalence of gastrointestinal findings in infected patients, and excluded preprints, duplicate publications, reviews, editorials, single case reports, studies pertaining to other coronavirus-related illnesses, and small case series (<10 cases). Extracted data included author; date; study design; country; patient demographics; number of participants in severe and non-severe disease groups; prevalence of clinical gastrointestinal symptoms such as vomiting, nausea, diarrhoea, loss of appetite, abdominal pain, and belching; and digestive system comorbidities including liver disease and gastrointestinal diseases. Raw data from studies were pooled to determine effect estimates. FINDINGS: We analysed findings from 35 studies, including 6686 patients with COVID-19, that met inclusion criteria. 29 studies (n=6064) reported gastrointestinal symptoms in patients with COVID-19 at diagnosis, and the pooled prevalence of digestive system comorbidities was 4% (95% CI 2-5; range 0-15; I2=74%). The pooled prevalence of digestive symptoms was 15% (10-21; range: 2-57; I2=96%) with nausea or vomiting, diarrhoea, and loss of appetite being the three most common symptoms. The pooled prevalence of abnormal liver functions (12 studies, n=1267) was 19% (9-32; range 1-53; I2=96%). Subgroup analysis showed patients with severe COVID-19 had higher rates of abdominal pain (odds ratio [OR] 7·10 [95% CI 1·93-26·07]; p=0·003; I2=0%) and abnormal liver function including increased ALT (1·89 [1·30-2·76]; p=0·0009; I2=10%) and increased AST (3·08 [2·14-4·42]; p<0·00001; I2=0%) compared with those with non-severe disease. Patients in Hubei province, where the initial COVID-19 outbreak occurred, were more likely to present with abnormal liver functions (p<0·0001) compared with those outside of Hubei. Paediatric patients with COVID-19 had a similar prevalence of gastrointestinal symptoms to those of adult patients. 10% (95% CI 4-19; range 3-23; I2=97%) of patients presented with gastrointestinal symptoms alone without respiratory features. Patients who presented with gastrointestinal system involvement had delayed diagnosis (standardised mean difference 2·85 [95% CI 0·22-5·48]; p=0·030; I2=73%). Patients with gastrointestinal involvement tended to have a poorer disease course (eg, acute respiratory distress syndrome OR 2·96 [95% CI 1·17-7·48]; p=0·02; I2=0%). INTERPRETATION: Our study showed that digestive symptoms and liver injury are not uncommon in patients with COVID-19. Increased attention should be paid to the care of this unique group of patients. FUNDING: None.