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1.
Pm & R ; 18:18, 2022.
Article in English | MEDLINE | ID: covidwho-2034953

ABSTRACT

INTRODUCTION: Limited access to healthcare services and the self-isolation measures due to the COVID-19 pandemic may have had additional unintended negative effects, affecting the health of individuals with spinal cord injury (SCI). OBJECTIVES: We aimed to examine the perceived influence of the COVID-19 pandemic on individuals with SCI. First, this study looked to understand how the pandemic affected the use and perception of telehealth services for these individuals. Second, it investigated the effect of COVID-19 on mental health. DESIGN: Cross-sectional online survey. SETTING: Individuals with SCI living in the community in British Columbia, Canada PATIENTS: This survey was offered to individuals with spinal cord injury and had 71 respondents, with 34% living in a rural setting and 66% in an urban setting. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Telehealth utility, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder scale (GAD-7), Fear of COVID-19 scale (FCV-19S) and Perceived Vulnerability to Disease scale (PVD). RESULTS: Telehealth use in the SCI population has increased from 9.9% to 25.4% over the pandemic, with rates of telehealth use in urban centers nearing those of rural participants. 31.0% of respondents had probable depression and 7.0% had probable generalized anxiety disorder as measured by a score of >=10 on the PHQ-9 and GAD-7 respectively. The mean scores on FCV-19S and PVD were 17.0 (6.6 SD) and 4.29 (1.02 SD) respectively. CONCLUSION: Telehealth use during COVID-19 has more than doubled. It is generally well regarded by respondents, though only a quarter of the SCI population have reported its use. With this in mind, it is important to understand what barriers there are to further adoption. In addition, higher rates of probable depression were seen than those estimated by pre-pandemic studies in other countries. This article is protected by copyright. All rights reserved.

3.
Current Opinion in Ophthalmology ; 25:25, 2022.
Article in English | MEDLINE | ID: covidwho-2018260

ABSTRACT

PURPOSE OF REVIEW: The current article will update and review the clinical and radiological manifestations and management of rhino-orbital mucormycosis (ROM). RECENT FINDINGS: There has been an increase in cases of ROM worldwide, especially in India. Immunosuppression (especially diabetes mellitus) is a known predisposing risk factor for ROM. Delayed diagnosis and treatment of ROM can be vision or life-threatening. This article reviews the clinical and radiologic features, treatment, and prognosis of ROM with special emphasis on new and emerging therapies. SUMMARY: ROM is an angioinvasive fungal infection that affects the sinuses and orbits and may present to ophthalmologists. Clinicians should have a high index of suspicion for ROM, especially in patients with poorly controlled diabetes mellitus or other immunosuppression. Corticosteroid treatment (including the recent COVID-19 pandemic) may be a predisposing risk factor for ROM.

4.
Infection Control & Hospital Epidemiology ; : 1-5, 2022.
Article in English | MEDLINE | ID: covidwho-2016428

ABSTRACT

OBJECTIVE: We aimed to demonstrate the role of real-time, on-site, whole-genome sequencing (WGS) of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in the management of hospital outbreaks of coronavirus disease 2019 (COVID-19). DESIGN: This retrospective study was undertaken at our institutions in Sydney, New South Wales, Australia, between July 2021 and April 2022. We included SARS-CoV-2 outbreaks due to SARS-CoV-2 delta (delta) and omicron (omicron) variants. All unexpected SARS-CoV-2-positive cases identified within the hospital were managed by the infection control team. An outbreak was defined as 2 or more cases acquired on a single ward. We included only outbreaks with 2 or more suspected transmission events in which WGS was utilized to assist with outbreak assessment and management. RESULTS: We studied 8 outbreaks involving 266 patients and 486 staff, of whom 73 (27.4%) and 39 (8.0%), respectively, tested positive for SARS-CoV-2 during the outbreak management. WGS was used to evaluate the source of the outbreak, to establish transmission chains, to highlight deficiencies in infection control practices, and to delineate between community and healthcare acquired infection. CONCLUSIONS: Real-time, on-site WGS combined with epidemiologic assessment is a useful tool to guide management of hospital SARS-CoV-2 outbreaks. WGS allowed us (1) to establish likely transmission events due to personal protective equipment (PPE) breaches;(2) to detect inadequacies in infection control infrastructure including ventilation;and (3) to confirm multiple viral introductions during periods of high community SARS-CoV-2 transmission. Insights gained from WGS-guides outbreak management directly influenced policy including modifying PPE requirements, instituting routine inpatient SARS-CoV-2 surveillance, and confirmatory SARS-CoV-2 testing prior to placing patients in a cohort setting.

5.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009615

ABSTRACT

Background: Immunogenicity and safety of SARS-CoV-2 vaccines have been widely investigated in patients (pts) with cancer. However, their effectiveness against Coronavirus disease 2019 (COVID-19) and the additional protective effect of a booster dose in this population are yet to be defined. Methods: Using OnCovid study data (NCT04393974), a European registry enrolling consecutive pts with cancer and COVID-19, we evaluated morbidity and 14 days case fatality rates (CFR14) from COVID-19 in pts who were unvaccinated, vaccinated (either partially/full vaccinated but not boosted) and those who had received a third dose. Analyses were restricted to pts diagnosed between 17/11/2021 (first breakthrough infection in a boosted pt) and the 31/01/2022. Pts with unknown vaccination status were excluded. Results: By the data lock of 22/02/2022, out of 3820 consecutive pts from 36 institutions, 415 pts from 3 countries (UK, Spain, Italy) were eligible for analysis. Among them, 51 (12.3%) were unvaccinated, 178 (42.9%) were vaccinated and 186 (44.8%) were boosted. Among vaccinated pts, 26 (14.6%) were partially vaccinated (1 dose). Pts with haematological malignancies had more likely received a booster dose prior to infection (25.4% vs 13.6% and 11.8%, p = 0.02). We found no other associations between vaccination status and pts' characteristics including sex, age, comorbidities, smoking history, tumour stage, tumour status and receipt of systemic anticancer therapy. Compared to unvaccinated pts, boosted and vaccinated pts achieved improved CFR14 (6.8% and 7.0% vs 22.4%, p = 0.01), COVID-19-related hospitalization rates (26.1% and 20.6% vs 41.2%, p = 0.01) and COVID-19-related complications rates (14.5% and 15.7% vs 31.4%). Using multivariable Inverse Probability of Treatment Weighting (IPTW) models adjusted for sex, comorbidities, tumour status and country of origin we confirmed that boosted (OR 0.21, 95%CI: 0.05-0.89) and vaccinated pts (OR 0.19, 95%CI: 0.04-0.81) achieved improved CFR14 compared to unvaccinated pts, whilst a significantly reduced risk of COVID-19 complications (OR 0.26, 95%CI: 0.07-0.93) was reported for vaccinated pts only. Conclusions: SARS-CoV-2 vaccines protect from COVID-19 morbidity and mortality in pts with cancer. Accounting for the enrichment of haematologic pts in the boosted group, the observation of comparable mortality outcomes between boosted and vaccinated pts is reassuring and suggests boosting to be associated with reduced mortality in more vulnerable subjects, despite evidence of adverse features in this group.

6.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009604

ABSTRACT

Background: Whilst patients (pts) with cancer are at increased risk of adverse outcome from Coronavirus disease 2019 (COVID-19), no evidence exists as to the natural history of the SARS-CoV-2 B.1.1.529 (Omicron) variant in this population. Methods: Capitalizing on OnCovid study data (NCT04393974), a European registry that collects data on consecutive patients with cancer and COVID-19, we analysed COVID-19 morbidity and case fatality rates at 14 days (CFR14) across 3 phases defined following the evolution of the pandemic in Europe, according to date of COVID-19 diagnosis: “Pre-vaccination” phase (27/02/2020-30/ 11/2020), “Alpha-Delta variant” phase (01/12/2020-14/12/2021), “Omicron variant” phase (15/12/2020-31/01/2022). Results: By the data lock of 04/02/2022, 3820 consecutive pts were enrolled, 3473 of whom were eligible for this analysis. Among them, 2033 (58.6%), 1075 (30.9%) and 365 (10.5%) were diagnosed during the Pre-vaccination, Alpha-Delta and Omicron phases. Pts diagnosed in the Omicron phase were more likely aged < 65 years (48.6% vs 42.5%, 39.4% p = 0.01), had < 2 comorbidities (61.9% vs 55.6%, 52.1% p = 0.01). They had more advanced-stage tumours (62.1% vs 53.3%, 49.0%, p < 0.01) and were more likely receiving systemic anticancer therapy (SACT) at COVID-19 diagnosis (54.9% vs 43.9%, 39.6%, p < 0.01). Proportions of fully vaccinated/boosted pts were higher in the Omicron phase (33.9%-48.1%) compared to the Alpha-Delta phase (16.6%-2.3%, p < 0.01). Pts diagnosed in the Omicron phase had improved CFR14 (9.0% vs 13.9%, 23.1%, p < 0.01) lower hospitalization rates due to COVID-19 (24.4% vs 41.4%, 56.6%, p < 0.01), lower complications rates (15.3% vs 33.6%, 39.4%, p < 0.01) and reduced need for COVID-19 specific therapy (22.4% vs 43.0%, 65.7% p < 0.01) compared to the Alpha-Delta and pre-vaccinal phase. After adjusting for country of origin, sex, age, comorbidities, tumour stage, status and receipt of SACT at COVID-19, patients diagnosed in the Omicron phase displayed the lowest risk of death at 14 days compared to earlier phases. Similarly, rates of hospitalization and complicated COVID-19 were lowest for Omicron phase. Conclusions: This is the first study to portray the evolution of the SARS-CoV-2 Omicron outbreak in Europe, documenting an improvement in all COVID-19 outcomes compared to earlier phases of the pandemic. Enhanced healthcare capacity, improved disease management, immunization campaigns alongside differential virulence of viral strains are likely contributing to improved outcomes across phases.

7.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009570

ABSTRACT

Background: Oral mucositis (OM) is a debilitating side effect of concomitant chemoradiotherapy (CRT) for head and neck cancer (HNC). EC-18 may effectively mitigate OM by minimizing the CRT-induced innate immune response. This Phase II, 2-stage trial evaluated safety, tolerability, and efficacy of EC- 18 in reducing the duration, incidence, and trajectory of severe OM (SOM) in HNC patients. Methods: Patients (n = 105) with pathologically confirmed oral cavity, oropharynx, hypopharynx, or nasopharynx squamous cell cancers who received intensity-modulated radiation therapy (IMRT;with ≥ 55 Gy on ≥ 2 oral sites) and weekly or tri-weekly cisplatin were studied. In Stage 1, 24 patients were randomized (n = 6 per arm) to receive 500, 1000, or 2000 mg of EC-18, or placebo. Following independent Data Safety Monitoring Board review, 81 patients in Stage 2 received EC-18 2000 mg (n = 41) or placebo (n = 40) throughout CRT. WHO OM grade was assessed twice weekly during IMRT and then once weekly for up to 6 weeks post-IMRT. The primary efficacy endpoint was duration of SOM during the active and short-term follow-up (STFU) periods in the compliant per-protocol population (PP). Much of Stage 2 was conducted during peak periods of the COVID-19 pandemic which measurably impacted patient compliance relative to test medication dosing and planned radiation. Consequently, to assess efficacy most accurately, the PP population was analyzed (with at least 4 weeks of study drug dosing, minimum cumulative radiation of 55 Gy, 80% study drug compliance in the first 28 days of dosing, and without using not-allowed-therapy). Results: Patient demographics and baseline characteristics were balanced between groups. Adverse events (AEs) were comparable amongst cohorts without drug-related severe AEs. In the PP, the median duration of SOM from baseline through STFU was 0 day in the EC-18 group (n = 22) v 13.5 days in the placebo group (n = 20). SOM incidence through STFU (45.5% v 70%) and opioid use (time to onset: 32.3 v 26.0 days;and duration: 32.8 v 37.5 days) favored EC-18 v placebo. Results of the covariates analyses suggested that EC-18 favorably impacted SOM incidence in patients who experienced SOM treated with weekly low-dose cisplatin (n = 26;37.5% v placebo 70.0%) and HPV+ tumors (n = 29;35.3% v placebo 66.7%;Table). One-year long-term follow-up for tumor outcomes is ongoing. Conclusions: EC-18 safely mitigated the development and the time course of SOM in CRT-treated HNC patients. In addition, EC-18 may provide substantial benefits to subpopulations of HPV+ HNC patients treated with low dose cisplatin.

8.
BMC pediatrics ; 22(1):515, 2022.
Article in English | MEDLINE | ID: covidwho-2009368

ABSTRACT

BACKGROUND: Dysferlinopathy refers to a heterogenous group of autosomal recessive disorders that affect a skeletal muscle protein called dysferlin. These mutations are associated with limb-girdle muscular dystrophy type 2B, Miyoshi myopathy, asymptomatic hyperCKemia, and distal myopathy with anterior tibial onset. CASE PRESENTATION: A 16 year old female presented with myalgia, weakness and dark urine one week after her second BNT162b2 mRNA (Pfizer) vaccine. Initial serum creatine kinase (CK) was measured at 153,000 IU/L, eventually up-trending to over 200,000 IU/L. However, stable renal function precluded hemodialysis allowing discharge after 10 days of intravenous (IV) hydration and alkaline diuresis. Just two years prior to the current presentation, the patient was hospitalized following Group A Streptococcal pharyngitis infection complicated by rhabdomyolysis. She presented with fatigue, lower extremity weakness, and dark oliguria with CK measuring 984,800 IU/L. IV hydration was attempted however hemodialysis was ultimately required throughout her 24-day hospital stay. Her episode was presumed to be idiopathic and no further work-up was performed at that time. During the patient's current hospitalization, she reported similar symptomology (myalgias and weakness) following her first quadrivalent Gardasil vaccine at age 11. No hospitalization was required at that time. A comprehensive workup was now initiated while the patient was being treated for her suspected second or third non-exertional, non-traumatic rhabdomyolysis. Rheumatologic, metabolic, infectious, and endocrinologic workup were all unremarkable. Patient eventually had whole exome sequencing performed which revealed a heterozygous pathogenic variant in the DYSF gene (DYSF c.2643 + 1G > A) encoding dysferlin. No clinically significant sequelae occurred thus far. CONCLUSIONS: While there have been reports of symptomatic heterozygote carriers of dysferlinopathies, to our knowledge none have been associated with recurrent rhabdomyolysis after immunogenic stimuli. This unique case presentation highlights the importance of a multi-disciplinary care team, the utility of modern whole-exome gene sequencing, and the future challenges of balancing vaccine risk vs benefit.

9.
11.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003415

ABSTRACT

Background: Patient safety adverse events are a significant concern in pediatric healthcare in the US. Learning how to identify and report identified errors and near misses enables mitigation of current and future harm. An interactive in-person simulation activity at our institution has been successful in enhancing medical students and trainees' ability to identify and report patient safety hazards. Infection prevention precautions during the COVID-19 pandemic necessitated the rapid development of a virtual simulation training in 2020-2021. Our objectives were to assess the feasibility and effectiveness of a virtual simulation training to enhance medical students and trainees' awareness of and confidence in identifying and reporting patient safety hazards. Methods: Learners were 102 second year medical students starting clinical clerkships. Brief orientation videos reviewed learning objectives, instructions on navigating the 360-video virtual interface, and the simulated case - a 5 y/o boy in the emergency department with an acute asthma exacerbation. Learners then explored a 360 video in a virtual simulation environment to identify hazards that fell into the broad themes of falls, allergies, protected health information, personal protective equipment, hand hygiene, choking, medication administration, privacy, electronic health records, and infections. Learners then viewed brief instructional videos on these hazards, the importance of situational awareness, and how to report near misses and errors using our hospital incident reporting system. Effectiveness and learners experience was assessed through pre and post simulation questionnaires and learner interviews. Results: Key outcomes were frequency of safety issues identified and confidence in identifying and reporting hazards, errors and near misses. Scores of learner confidence in identifying and reporting patient safety hazards significantly increased (see Figure). Learners rated their overall satisfaction on a 0-10 scale (0= Not at all Satisfied, 10= Very Satisfied). Median learner satisfaction scores were 7. Learners reported that the virtual simulation was a good alternative to in-person training. Specific positive aspects identified were the short instructional videos with a variety of speakers, the concise nature of the activity, and learning to how to file incident reports. The increase in confidence in identifying and reporting patient safety hazards were lower in the virtual simulation compared to the in-person version. However, learners identified several strategies to enhance the experience in future years. Specific areas for improvement were zooming in capabilities on mobile devices and variation in experience depending on internet speed and device used. Conclusion: This brief interactive simulation activity was successful in enhancing learners' awareness of and confidence in identifying and reporting patient safety hazards. Our next steps include improving the immersive nature of the simulation experience, integrating more authentic components, replicating a team approach, and identifying platforms that are suited to a variety of mobile devices and internet speeds.

12.
Br J Cancer ; 2022.
Article in English | PubMed | ID: covidwho-2000874

ABSTRACT

BACKGROUND: Consolidated evidence suggests spontaneous immunity from SARS-CoV-2 is not durable, leading to the risk of reinfection, especially in the context of newly emerging viral strains. In patients with cancer who survive COVID-19 prevalence and severity of SARS-CoV-2 reinfections are unknown. METHODS: We aimed to document natural history and outcome from SARS-CoV-2 reinfection in patients recruited to OnCovid (NCT04393974), an active European registry enrolling consecutive patients with a history of solid or haematologic malignancy diagnosed with COVID-19. RESULTS: As of December 2021, out of 3108 eligible participants, 1806 COVID-19 survivors were subsequently followed at participating institutions. Among them, 34 reinfections (1.9%) were reported after a median time of 152 days (range: 40-620) from the first COVID-19 diagnosis, and with a median observation period from the second infection of 115 days (95% CI: 27-196). Most of the first infections were diagnosed in 2020 (27, 79.4%), while most of reinfections in 2021 (25, 73.5%). Haematological malignancies were the most frequent primary tumour (12, 35%). Compared to first infections, second infections had lower prevalence of COVID-19 symptoms (52.9% vs 91.2%, P = 0.0008) and required less COVID-19-specific therapy (11.8% vs 50%, P = 0.0013). Overall, 11 patients (32.4%) and 3 (8.8%) were fully and partially vaccinated against SARS-CoV-2 before the second infection, respectively. The 14-day case fatality rate was 11.8%, with four death events, none of which among fully vaccinated patients. CONCLUSION: This study shows that reinfections in COVID-19 survivors with cancer are possible and more common in patients with haematological malignancies. Reinfections carry a 11% risk of mortality, which rises to 15% among unvaccinated patients, highlighting the importance of universal vaccination of patients with cancer.

13.
mBio ; : e0214122, 2022.
Article in English | MEDLINE | ID: covidwho-2001782

ABSTRACT

Examining the neutralizing capacity of monoclonal antibodies (MAbs) used to treat COVID-19, as well as antibodies recovered from unvaccinated, previously vaccinated, and infected individuals, against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) remains critical to study. Here, we report on a SARS-CoV-2 nosocomial outbreak caused by the SARS-CoV-2 R.1 variant harboring the E484K mutation in a 281-bed psychiatric facility in New Jersey among unvaccinated inpatients and health care professionals (HCPs). A total of 81 inpatients and HCPs tested positive for SARS-Cov-2 by reverse transcription (RT)-PCR from 29 October 9 to 30 November 2020. The R.1 variant exhibits partial or complete resistance to two MAbs in clinical use, as well as 2 receptor binding domain MAbs and 4 N-terminal domain (NTD) MAbs. NTD MAbs against pseudovirus harboring single characteristic R.1 mutations highlight the role of S255F in loss of activity. Additionally, we note dampened neutralization capacity by plasma from individuals with previous SARS-CoV-2 infection or sera from vaccinated individuals. The relative resistance of the R.1 variant is likely lower than that of B.1.351 and closer to that of P.1 and B.1.526. The R.1 lineage has been reported in 47 states in the United States and 40 countries. Although high proportions exhibited symptoms (26% and 61% among patients and HCPs, respectively) and relative antibody resistance, we detected only 10 R.1 variants from over 2,900 samples (~0.34%) collected from January to October 2021. Among 3 vaccinated individuals previously infected with R.1, we observed robust neutralizing antibody responses against SARS-CoV-2 wild type and VOCs. IMPORTANCE The neutralizing capacities of monoclonal antibodies used to treat COVID-19 and of those recovered from previously infected and vaccinated individuals against SARS-CoV-2 variants of concern (VOCs) remain important questions. We report on a nosocomial outbreak caused by a SARS-CoV-2 R.1 variant harboring an E484K mutation among 81 unvaccinated inpatients and health care professionals. We note high attack rates with symptoms in nearly 50% of infected individuals, in sharp contrast to an unrelated institutional outbreak caused by the R.1 variant among a vaccinated population. We found little evidence of significant community spillover. This variant exhibits partial or complete resistance to two monoclonal antibodies in clinical use and dampened the neutralization capacity of convalescent-phase plasma from individuals with previous infection or sera from vaccinated individuals. Among three vaccinated individuals previously infected with R.1, we observed robust neutralizing antibody responses against SARS-CoV-2 wild type and VOCs. These findings underscore the importance of vaccination for prevention of symptomatic COVID-19 disease.

14.
Journal of General Internal Medicine ; 37:S611, 2022.
Article in English | EMBASE | ID: covidwho-1995723

ABSTRACT

SETTING AND PARTICIPANTS: Methods A survey was distributed to medical students of the Rutgers Robert Wood Johnson Medical School or New Jersey Medical School in March to July 2021. Self-reported frequency and quality of exposure to telemedicine-based clinical activities were compared across the four years. Knowledge-based questions to evaluate general telehealth knowledge and self-assessment questions were created based on the AAMC Telehealth Competencies guidelines. The responses were compared along different levels of education and exposure to clinical telehealth activities. DESCRIPTION: Background Telehealth services are an essential part of healthcare delivery, but only 42% of medical schools have a formal telehealth curriculum. During the SARS-CoV-2 pandemic, medical students have been exposed to more telehealth- based clinical activities. The purpose of this study is to investigate the effect of exposure to telehealth activities on medical students' telehealth-based knowledge and self-assessed competencies based on the AAMC telehealth-based competencies. EVALUATION: Results Of the 82 respondents, 89% had experience with standardized patients via telemedicine, with MS2 and MS4 students having almost double the exposure compared to the MS1 and MS3 students. 78% of students had exposure to actual patients via telemedicine with MS3 and MS4 students having triple the exposure compared to MS1 and MS2 students. During these experiences, 65% of students observed physicians conducting a patient interview while only 31% observed a physician performing a physical exam using telehealth modalities. In assessing their telemedicine knowledge, all years performed relatively equally, with higher performance in the Equity and Assessment domains and lower in the Technology and Safety domains. Self-reported confidence across several telehealth competencies domains increased from MS1 to MS4 students. Overall, MS4s demonstrated the highest confidence in their skills and had the most exposure to patients. 87% of students gave feedback that more telehealth services should be provided by physicians, and 63% felt telehealth increased patient satisfaction. DISCUSSION / REFLECTION / LESSONS LEARNED: Conclusion The results highlight the increased confidence in telehealth topics that have clinical parallels to in-person training, such as Equity and Assessment, but telehealth-specific topics like Communication and Ethics of telemedicine require more targeted education. The study advocates for integration of telehealth education into the medical school curriculum in order to foster student telehealth competencies and promote telemedicine in future stages of training.

15.
Journal of General Internal Medicine ; 37:S209, 2022.
Article in English | EMBASE | ID: covidwho-1995722

ABSTRACT

BACKGROUND: Teaching methods can impact achievement emotions and cognitive load in learners. Due to COVID19, the University of Central Florida College of Medicine (UCF) adopted some online clinical-skills training for their first-year medical students (M1s) while the University of Florida College of Medicine (UF) was able to continue with limited in-person instruction. We hypothesized online learning could increase cognitive load, negatively impact self efficacy, and lead to increased levels of imposter syndrome associated with learning clinical skills. METHODS: M1s from UCF and UF from the 20-21 academic year were given an online survey during the Summer of 2021measuring Medical Student Wellbeing Index (WBI), Clance Imposter Phenomenon Scale (CIPS). Cognitive load and achievement emotions were measured using previously validated instruments on a 5-point Likert scale. Demographic data was collected, and IRB approval obtained. Descriptive statistics were obtained with SPSS 27 and reported as frequencies and percent response. Spearman correlation analysis was performed on all variables. T-tests were conducted to compare variables between UF and UCF. Overall response rate was 54% (44% and 61% for UCF and UF, respectively). RESULTS: Analyzing combined data from both schools for history and physical exam components, several statistically significant correlations were found (see Table 1). For both history and physical exam components UF learners had higher task value (4.66, 4.26 p<.001;4.70, 4.52 p=.042), enjoyment (4.34, 3.70 p<.001;4.28, 3.86 p=.001) and self-efficacy (4.43, 4.10 p=.004;4.36, 4.02 p=.007) and lower anxiety (2.32, 2.84, p=.003;2.32, 3.03 p<.001) and extrinsic load (1.88, 3.14 p<.001;2.07, 3.35 p=.001) compared to UCF learners, respectively. UF learners had lower WBI scores than UCF learners (250.74, 279.90 p=.024), but no differences in CIPS scores were found. Higher scores on CIPS and WBI scores indicate greater severity of imposter syndrome and reduced well-being, respectively. CONCLUSIONS: Teaching methods appear to have an impact on learners' achievement emotions, cognitive load, and well-being. Increased task value may mitigate a learners' extrinsic load with implications on how educators apply teaching methods. Further studies are needed to identify long-term impacts of online teaching methods.

16.
Heart Lung and Circulation ; 31:S137, 2022.
Article in English | EMBASE | ID: covidwho-1977296

ABSTRACT

Aim: We investigated the use of intravenous digoxin for atrial fibrillation on ISLHD’s Wollongong Hospital’s general wards. The primary aim was to inform the design of a new drug guideline. Methods: All results for e-meds use of intravenous digoxin in 2020 for ISLHD were accessed. They were filtered to Wollongong Hospital. Whilst the emergency department and intensive care unit were excluded as critical care areas, other key units with cardiac monitoring capacity (Coronary Care Unit, Neuro-high Intensity Unit and COVID-19 ward) were included. Results: 45 patients received intravenous digoxin on inpatients’ wards in Wollongong Hospital in 2020. The average age was 77 years, with 28 (62%) having known AF. 23 patients (51%) were on cardiac monitoring. 5 patients (11%) were haemodynamically unstable. 10 patients (22%) were not prescribed rate control when intravenous digoxin was initiated, and 4 patients (9%) were not taking their rate control due to swallowing issues or hypotension. 31 patients (69%) had a rapid response and cardiology was involved in 22 (49%) of the patients. Only one patient had a documented bradyarrhythmia. Conclusion: The above data informed a new drug guideline for intravenous digoxin on general wards. It specifically addressed low rates of cardiology involvement and earlier involvement in uncontrolled AF. It also included an emphasis on the utilisation of cardiac monitoring for haemodynamically unstable patients requiring intravenous digoxin.

18.
Gastroenterology ; 162(7):S-1222, 2022.
Article in English | EMBASE | ID: covidwho-1967424

ABSTRACT

Background: Data have shown an increase in alcohol use during the COVID-19 pandemic in North America. While the total number of emergency department (ED) visits decreased during the early pandemic, some studies show that the proportion of alcohol-associated visits increased during this time. There is otherwise a paucity of data on how potentially increased alcohol use during the pandemic has affected healthcare utilization and patient outcomes, especially in patients with liver disease. Methods: Clinical records from a tertiary hospital in Ontario, Canada were reviewed for all adult patients encounters in the ED, urgent care, or inpatient setting for alcohol-associated reasons between April 2019 and October 2019 (pre-pandemic cohort) and between April 2020 and October 2020 (pandemic cohort). Data collected included: age, sex, marital status, rurality and socioeconomic status (by postal code-linked national census data), medical history, alcohol consumption habits, use of medications for alcohol use disorder, alcohol-associated diagnosis (based on ICD-10 code), need for intensive care unit admission, consultations made, discharge disposition, and laboratory results. Bivariate chi-squared analysis was performed to compare data from the pre-pandemic and pandemic cohorts. Results: 528 records in the pre-pandemic cohort and 490 records in the pandemic cohort were ed and summarized (Tables 1 and 2). As compared with the pre-pandemic cohort, patients during the pandemic presenting with alcohol-associated diagnoses were older (43 years, IQR 31-57 vs. 38 years, IQR 24-55;p<.001), more likely to be male (66% vs. 55%;p=.001), have a prior history of habitual heavy alcohol use or alcohol use disorder (77% vs. 63%;p<.001), have a history of a psychiatric disorder (56% vs 46%;p=.003), and to have been previously prescribed medication for alcohol use disorder (18% vs. 5%;p<.001). In the pandemic cohort, there was a greater proportion of encounters for alcohol withdrawal (32% vs. 22%;p=.001), a lower proportion of encounters for alcohol intoxication (46% vs. 56%;p<.001), and a similar proportion of encounters for alcohol-associated liver disease (8% vs. 7%;p=.651) compared to the pre-pandemic cohort. Conclusion: Our data show differences in patient characteristics for patients presenting to hospital for alcohol-associated reasons during the COVID-19 pandemic. As compared with the year before the pandemic, patients were older, more often male, and more likely to have history of psychiatric disorders or heavy alcohol use. One concerning finding was a significant rise in alcohol withdrawal, which could potentially be due to increased consumption of alcohol during the pandemic. These data raise concern for an increase in prevalence of alcohol-associated liver disease in the future, highlighting the need for enhanced alcohol addiction services. (Table Presented)

19.
Gastroenterology ; 162(7):S-676-S-677, 2022.
Article in English | EMBASE | ID: covidwho-1967362

ABSTRACT

Background: Celiac disease (CeD) is an autoimmune disorder characterized by an inflammatory immune response against gluten and increased susceptibility to bacterial and viral infections. After the coronavirus disease 2019 (COVID-19) pandemic began, several studies showed no difference in infections rates of SARS-CoV-2 between patients with CeD and the general population. However, all studies were based on diagnosed CeD patients who are likely on a gluten-free diet;the immune system of these patients is similar to the general population, which is not likely to show an increased risk of COVID-19. On the contrary, individuals with undiagnosed CeD are likely to be susceptible to viral infections due to abnormally overactivity of the immune system. We aimed to evaluate the frequency of SARSCoV- 2 positivity and related to hospitalization in hidden CeD patients and diagnosed CeD and compare the vaccination rate in these groups. Methods: Based on the previous community cohort of subjects who were tested for CeD serology, we categorized them into three groups: hidden CeD, diagnosed CeD, and seronegative controls. Data of COVID-19 were obtained from January 2020 through September 2021, utilizing polymerase chain reaction (PCR) test results for SARS-CoV-2 and corresponding hospitalization records. Results: A total of 207 hidden celiac disease, 68 diagnosed CeD, and 22,213 seronegative controls were included in the study. Table 1 summarizes the COVID-19 PCR tests, positivity rate, hospitalization, and vaccination rate. Remarkably, about two thirds of the community in the study population were tested for SARS-CoV-2. SARS-CoV-2 PCR tests were more frequently conducted in the diagnosed CeD group (78%), compared to the undiagnosed CeD (68%) or seronegative group (63%) (p=0.01). The positivity rate among subjects tested for SARSCoV- 2 was higher in the seronegative group (15.3%) than that of undiagnosed CeD (14.3%) or diagnosed CeD (7.5%), but it was not statistically significant. Of 2,125 subjects with positive SARS-CoV-2 results in the seronegative group, about 8.1% (n=172) were hospitalized, while only one patient with undiagnosed CeD (out of 20 positive cases) was hospitalized. Interestingly, vaccination rates among the three groups were similar (48% in the seronegative group, 49% in the undiagnosed CeD, and 53% in the diagnosed CeD). Conclusions: This study demonstrated no difference in susceptibility to SARS-CoV-2 infection in undiagnosed or diagnosed CeD. Testing rate is higher in diagnosed CeD, which is likely to be related to health-seeking behavior. (Table Presented)

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