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Background: Treating acute STEMI patients by primary PCI has dramatically fallen globally in covid era as there is chances of potential threat of spreading Covid among the non-Covid patient. Thereby, thrombolysis of acute STEMI patient either by Streptokinase (STK) or Tenecteplase (TNK) in grey zone till Covid RT PCR report to come, was the mode of treatment of acute myocardial infarction patient in our hospital. Post thrombolysis, Covid positive cases were managed conservatively in a Covid dedicated unit. Covid negative cases were treated by rescue PCI of the culprit lesion. Exact data on benefit of thrombolysis either by TNK or STK of STEMI patients in Covid era, is not well addressed in our patient population. Thereby, we have carried out this prospective observational study to see the outcomes of thrombolysis and subsequent intervention. Method(s): STEMI Patient who represented to our ER with chest pain and ECG and hs-TROP-I evidenced acute ST segment elevated myocardial infarction (STEMI), were enrolled in the study. Total 139 patients enrolled (Male:120, Female :19);average age for Male: 54yrs., female was: 56yrs. All patients were admitted in the grey zone of CCU where thrombolysis done either by TNK or STK. Positive for COVID-19, were patients excluded from intervention and managed conservatively in Covid-19 dedicated ward. Covid Negative patients were kept transferred to CCU green zone. Result(s): COVID-19 test was carried out on all studied patients. Among them, Covid-19 positive were 7.9% (11) patients and managed conservatively in dedicated Covid ward, Covid-19 negative were 92.1% (128). Primary PCI was performed in 5.03% (7). Rest was managed by Pharmacoinvasive therapy either by TNK or STK. Thrombolysis by Tenecteplase in 64% (89), Streptokinase in 17.9% (25) patient, 12.9% (18) patient did not receive any thrombolysis due to late presentation and primary PCI done in 5.4% (7). On average 2.1 days after Fibrinolysis, elective PCI carried out. Data analysis from 48 patients;chest pain duration (3.71 +/-2.8 hr., Chest pain to contact time 3.3+/-2.8hr., Chest pain to needle time 7.2 +/-12.7hr., thrombolysis to balloon time 117.5+/-314.8hr., as many of the patient develop LVF post thrombolysis. More than 50% stenosis resolution observed in 41.6% (20) patients, chest pain resolution with one hour of thrombolysis observed in 43.8% (21) patients and development of LVF in 20.8% (10) patients. Door to needle time was 30 min. At presentation of STEMI;Ant Wall MI 46.8% (65), Inferior Wall MI 52.5% (73) and high Lateral 0.7% (1). Average Serum hs Trop-I was 16656 for male and 12109 for female. LVEF were 41% for male and 48% for female. HbA1C were in Male 8.34%: Female 8.05%, SBP for Male 120mmHg: Female 128 mmHg. Total, 88 stents were deployed in 83 territories. CABG recommended for 5.03% (7) patients, PCI in 58.3% (81), remaining were kept on medical management. Stented territory was LAD 45.7% (37) and RCA 39.5% (32) and LCX 14.8% (12). Common stent used;Everolimus 61.4% (54), Sirolimus 25% (22), Progenitor cell with sirolimus 2.3%(2) and Zotarolimus 11.4% (10) Conclusion(s): In the era of COVID-19, in this prospective cohort study, on acute STEMI patient management, we found that Pharmaco therapy by Tenecteplase and Streptokinase, reduced patient symptom and ST resolution partially. Therefore, coronary angiogram and subsequent Rescue PCI by Drug Eluting Stents (DES) are key goals of complete revascularization.Copyright © 2023
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Introduction: In patients presented with hypertensive crises, a fundoscopic assessment is necessary because once hypertensive retinopathy is discovered, a hypertensive emergency is diagnosed, and intravenous antihypertensive medication is recommended. However, direct ophthalmoscopy is relatively underutilized, especially under the social distance regulation, which may result in delayed diagnosis and treatment. The novel method, namely, smartphone-based fundoscopy offers longer working distance and shorter doctor-patient contact time, however, there is limited data regarding its feasibility and effectiveness. Objective: We aimed to gather scientific evidence on the smartphone-based fundoscopy in terms of its effectiveness, accessibility, and trainability in detecting hypertensive retinopathy among hypertensive crisis patients in emergency room settings. Methods: A literature search was conducted on PubMed, Google Scholar, and the Cochrane Library for papers published from January 2010 to November 2021. Keywords including hypertensive crisis, hypertensive retinopathy, target organ damage, fundoscopic optic examination, direct ophthalmoscope, fundus images, smartphone fundoscopy, digital fundus camera, and COVID-19 were used. Full papers published in English and s of non-English publications were all reviewed. Results: Eight studies out of 34 fulfilled our search criteria. Five observational studies confirmed the effectiveness of smartphone-based fundoscopy in obtaining fundus images adequate for interpretation compared with those from commercially available fundus cameras. Also, smartphone-based fundoscopy offers time-saving properties as it allows fundus examination to be effectively completed within 74 seconds compared to 130 seconds with a traditional direct ophthalmoscope. Two studies investigated the accessibility of smartphonebased fundoscopy and discovered that fundus images can be obtained by using 20 diopter condensing lenses with the video mode of the smartphone camera, which can be easily provided even at a primary level hospital due to their low cost. Another study reviewed the trainability of the smartphone-based fundoscopy in 137 undergraduate medical students which concluded that 75% of these students can identify the optic nerve within 20-25 minutes of face-to-face demonstration. Conclusion: With a greater diagnostic capability, accessibility, and trainability of smartphone-based fundoscopy makes it a potentially game-changing technique for detecting hypertensive retinopathy in hypertensive emergency patients, especially during the current COVID-19 pandemic, in which longer working distance and shorter doctor-patient contact time are both required.
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Background: Hematopoietic stem cell preparations are pharmaceuticals that are typically transfused as fresh products. Due to the travel restrictions caused by the Covid-19 pandemic since March 2020, the supply of fresh stem cell preparations to patients became significantly challenging. To maintain global patient supply, a GMP-compliant manufacturing process for cryopreservation of allogeneic stem cell donations was established and validated. Method(s): The donor leukapheresis is transported from the collection center to the manufacturing site at 2-6degreeC using qualified containers. In class D clean rooms, this material is further processed in a completely closed process. If necessary, volume reduction is performed by centrifugation. The suspension is mixed with the cryoprotectant Cryostore CS10 to achieve a final DMSO concentration of 5%. The formulated product is filled into cryobags and cryopreserved under controlled freezing conditions. The frozen products are stored and transported at <= 140 degreeC. The cell counter NC-200 is used to determine the cell count and viability of the product. 97 products in 2020 and 127 products in 2021 were successfully cryopreserved and transported worldwide. Result(s): The mean values of viability of 215 products are 99.3 % (+/- 1.1 % SD) for fresh apheresis products and 93.1 % (+/- 6.2 % SD) for the corresponding cryopreserved final product after thawing. For a good recovery after thawing, the age of the apheresis as well as the DMSO contact time are generally considered to be critical factors. The analysis of the viability of 222 cryopreserved end products after thawing shows a correlation in relation to the age of the apheresis (Fig. 1). As the age of the apheresis increases, the viability decreases. Therefore, care should be taken about the age of the apheresis. A correlation between the DMSO contact time and the viability of the end products after thawing was not observed (Fig. 2). Conclusion(s): GMP-compliant closed system manufacturing of cryopreserved allogeneic stem cell products provides safe and high quality drugs that can be used for transplantation. We have shown that with our manufacturing process, DMSO, which is potentially toxic to cells, has no effect on cell recovery after thawing. Cryopreservation is therefore a suitable and safe method to provide patients with essential therapy worldwide. (Figure Presented).
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Background and Aim: In this study, the relationship of revascularization via percutaneous coronary intervention (PCI) with 1-month mortality in non-ST-elevation myocardial infarction (NSTEMI) patients with active COVID-19 infection, coronary angiography (CAG) and PCI application preferences of cardiologists to COVID-19 patients, and the infection rates of the personel working in the angio of the active COVID-19 patient will be investigated. Method(s): The study included 101 consecutive patients who were admitted to our clinic with the diagnosis of NSTEMI while they had active COVID-19 infection between 03/2020 and 02/2021. Patients were divided into two groups as those who were revascularized by PCI and those who were not. The angio records of the patients who underwent CAG but did not undergo PCI were re-evaluated by two cardiologists blinded to the study, and the patients who were deemed to need PCI by both cardiologists were determined. On the other hand, cardiologists, nurses and angio technicians who entered the procedure of patients who underwent CAG were identified from the hospital records and the results of those who gave the COVID-19 test within 14days after the procedure were recorded. Result(s): CAG was performed in 62.4% of the patients included in the study. The rates of performing CAG were significantly lower in patients in the severe-critical COVID-19 category. Only 46.0% of the patients who underwent CAG were revascularized with PCI. The 1-month mortality rate in our study was 24.8%. In the regression analysis, revascularization with PCI was associated with 1-month mortality, independent of age and COVID-19 category, while the absence of revascularization increased mortality by approximately 5times. When 34 patients who underwent CAG and did not undergo PCI were evaluated retrospectively, 5 (14.7%) patients were found to be suitable for PCI. A total of 48 personnel took part in 63CAG operations. 13 COVID-19 tests were performed by the personnel in charge within 14 days after the procedure, but none of the tests were positive. Conclusion(s): When compared to the studies in the literature in the similar period, it was seen that CAG was applied to patients at a higher rate. Despite this, most of the patients, especially in the advanced COVID-19 category, were deprived of this opportunity. In addition, although they did not have a large rate, it was observed that some of the patients who underwent CAG could be treated with PCI, but not. We think that the fear of prolonged contact time with a COVID-19 patient may play a role in this situation. In our study, it was determined that revascularization with PCI was associated with 1-month mortality regardless of age and COVID-19 category. On the other hand, no healthcare personnel were infected due to being in the process of the COVID-19 patient. Considering these two results together, we think that the approach to COVID-19 patients diagnosed with NSTEMI should not be different from other patients, provided that necessary precautions are taken. .
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Background: In 2020 the COVID-19 pandemic spread due to the coronavirus SARS-CoV-2. Vaccination is crucial to fight the COVID-19 pandemic. Initial reports of anaphylaxis after vaccination caused concern and fear of the population and consequently a high demand for allergy testing. Method(s): The need and reasons for allergy testing were recorded via questionnaires and the patients' medical history. To study the possibility of higher-throughput allergy evaluation, additional new skin test appointment slots were created for patients concentrated during the Christmas week 2021 and the amount of material, time required, as well as the organization and the tolerability of subsequent vaccination were analyzed. Result(s): The demand for testing greatly exceeded the number of available standard appointment slots. Test indications were mostly the patients' fear of an allergic reaction to the vaccine when a polyethylene glycol (PEG) allergy could not be unequivocally excluded in the patients' history. Forty-one patients (38 females, 3 men, age 51 +/- 17.7) were tested on 3 days. The average contact time needed per patients for the nurse was 30 minutes and for the physician 25 minutes. One patient could not be tested due to antihistamine use. After testing, in 36 cases routine vaccination was recommended;of those 35 patients got vaccinated. In four patients, an indication for inpatient PEG provocation or inpatient vaccination was given. Two thirds (27/41 patients, 65.9%) of all who were initially refusing vaccination got vaccinated shortly after allergy tests and tolerated this vaccination without major complications, an additional 9.8% intended future vaccination. Only four patients (9.8%) persistently refused vaccination after testing. Conclusion(s): In this pilot study, we show a useful and effective option to triage patients requesting COVID-19 vaccine allergy testing and generally how to process allergy appointments in a more time effective manner. Optimizing intraclinical processes leads to a substantially higher number of patients that can be allergy tested and vaccinated. Copyright © 2022 Dustri-Verlag Dr. K. Feistle.
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Introduction: Collection media of clinical samples with the capacity to denature viruses reduce the risk of contagion during transportation and processing. Objective(s): To use the nucleic acids transport media (NATM) in nasopharyngeal swab samples collected for the diagnosis of SARS-CoV-2. Method(s): An experimental study was conducted to demonstrate the medium capacity to inactivate viral infectivity. Zika virus (ZIKV), of biosafety level 2, was used as an enveloped virus model. The clinical performance of the NATM for the diagnosis of SARS-CoV-2 was evaluated. A ZIKV strain propagated in the Vero cell line was used and, prior to cells infection, ZIKV was in contact at different intervals (2;15, and 30 min) with pure NATM;subsequently, serial dilutions (10-1-10-4) were performed. Viral inactivation was evaluated by RT-PCR in the supernatant and the collected cells when the propagation period was completed. CITOSWAB VTM was used as reference to estimate the clinical performance of the NATM in 30 nasopharyngeal swabs collected for the diagnosis of SARS-CoV-2 infection. Result(s): ZIKV remained infectious at inoculum dilutions of >= 10-2, regardless of contact time. Clinical specificity and sensitivity of the NATM for the diagnosis of SARS-CoV-2 were 100%, respectively. Conclusion(s): Results suggest that ZIKV positive clinical samples at dilutions <= 10-1 of the NATM can be safely handled, which could potentially be applied to the molecular diagnosis of SARS-CoV-2. Copyright © 2022, Editorial Ciencias Medicas. All rights reserved.
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Background: Safety of front-line health care workers dealing with critically ill patients is of prime importance during COVID-19 pandemic. We have limited skilled workforce and intensive care units (ICU). Aim(s): To determine the frequency of COVID 19 among ICU staff and find association with contact time and procedure performed. Method(s): A comparative cross-sectional study was conducted on 95 subjects working in ICU settings of tertiary care hospitals of Lahore. Data was collected about COVID-19 infection, prevention practices, contact time & procedures performed through google forms. Data was entered & analyzed by SPSS v23 while performing descriptive statistics, T Test, Chi square test & binary logistic regression. Result(s): Among 95(100%) subjects 25(26.31%) had covid-19 infection whereas 70(73.68%) did not had infection. Age> 30(p=.041), female gender (p=.022), use of re-useable personal protective equipment PPE(p=.009), contact time (p=.020), performing procedures: Nebulization(p=.023) & non-invasive positive pressure ventilation (p=.011) were significantly associated with COVID-19 infection among ICU staff. Conclusion(s): There was high frequency of COVID-19 infection among ICU staff. Age> 30, female gender, re-useable PPE, contact time, performing procedures: Nebulization & non-invasive positive pressure ventilation were significantly associated with COVID-19 infection among ICU staff. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.
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National and state science standards emphasize student understanding of and engagement in engineering. However, many teachers do not have robust understandings of engineering and their students may not have opportunities to engage in engineering. The COVID-19 Pandemic has likely further decreased opportunities for elementary students to engage in engineering as their teachers grappled with reduced contact time, integration of new technologies and pedagogical approaches, and remote/virtual learning. The purpose of this qualitative case study was to describe how an elementary teacher attended to engineering instruction during virtual learning despite the barriers presented by the pandemic. Aleshia was purposefully selected from a larger sample of 22 grade K-6 teachers because she included engineering in her virtual instruction. Data sources, including interviews, surveys, observations, and lesson artifacts were analyzed using an inductive approach in which the teacher's data corpus was holistically analyzed and interpreted to make meaning and answer the research question (Merriam, 1998). Aleshia's case demonstrates how an elementary teacher leveraged the affordances of digital technology to engage students in engineering design tasks despite the barriers presented by the pandemic. Aleshia's high baseline confidence and beliefs about technology integration may explain why she was able to implement technology-enhanced engineering instruction during virtual instruction. The results have implications for the design and development of PD to support engineering integration into elementary science teaching and the importance of developing elementary teachers' confidence integrating technology into instruction. Ultimately, Aleshia's case demonstrates the resilience, resourcefulness, and creativity of an elementary teacher integrating engineering instruction during the COVID-19 Pandemic when supported through PD initiatives that include a coaching component. © American Society for Engineering Education, 2022.
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COVID-19 is a continuing global pandemic causing significant changes and modifications in the ways we teach and learn here in the U.S as well as around the world. Most universities, faculty members, and students modified their learning system by incorporating significant online or mixed learning methods/modes to reduce in person contact time and to reduce the spread of the virus. Universities, faculty and students were challenged as they adapted to new learning modules, strategies and approaches. This adaption started in the Spring of 2020 and has continued to date through the Spring of 2022. The main objective of this project was to investigate faculty perception of STEM student experiences and behavior during the Fall 2020 semester as compared to the Spring 2020 semester as COVID-19 impacts were prolonged. Through a qualitative methodology of zoom interviews administered to 32 STEM faculty members across six U.S. Universities nationwide and a theming scheme, the opinion and narratives of these faculty members were garnered in a round one and round two sets of interviews, in Summer 2020 and then in Spring 2021 (following the semesters of interest). Some of the main new themes that were detected in faculty interviews during the Fall 2020 semester and which reflect faculty perceptions are represented as follow: COVID-19 impact on student and faculty motivation, COVID-19 impacts on labs and experiential learning, COVID-19 impact on mental health, COVID-19 impact on STEM students' involvement in STEM experiential learning opportunities and research. Other previous themes detected and which are revisited to analyze major differences with those themes obtained during the Spring 2020 are presented and not limited to: extra efforts from professors, student cheating behavior, cheating factors and prevention, student behavioral and performance changes, student struggles and challenges, University response and efforts to the COVID-19 pandemic. We explored the differences in these themes between the semesters to look at noticed adaptations and modifications. Presented will also be recommendations to improve student and faculty motivation along with strategies to enhance the student learning experience during the COVID-19 pandemic. We report on common findings and suggest future strategies. © American Society for Engineering Education, 2022.
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Background: The Covid-19 pandemic has meant a modifcation of the patterns of the doctor-patient relationship, favoring online visits and reducing face-to-face visits. Likewise, the implementation of Patient-Reported Outcomes (PROs) that do not require the intervention of the doctor in our clinical practice and that given their close relationship with the clinical activity of chronic infammatory joint diseases (CIJD) has favored an empowerment of patients and can allow the development of the online visit. Objectives: Know the use and acceptance of patients with CIJD: rheumatoid arthritis (RA), psoriatic arthritis (PsA) and spondyloarthropathies (SpA) of a non-face-to-face online visit, through a digital environment. Methods: Patients were included in a platform called Rheumanet for access by username and passwords (https://www.laconsultacercadetI.com/). At the time of inclusion, demographic variables were collected: date of birth, sex, level of education (primary education, secondary education, vocational training, further education and higher education), distance from the hospital to the patient's home, and clinical variables such as diagnosis: RA, PsA or SpA, as well as the duration of the disease. Prior to the appointment, patients were encouraged to complete a PRO survey to assess their clinical situation: Routine Assessment of Patient Index Data 3 (RAPID3) for RA, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for SpA and RAPID3 and/or BASDAI for the PsA. Both the RAPID3 and BASDAI were scored for the patient's knowledge and assigned to a color scale based on disease activity in green (remission or low activity), orange (moderate activity) or red (severe activity). Likewise, they were ordered to express through a free text what they would tell us as if they were in a face-to-face consultation. Complementary tests (analytical, radiological studies and others) are obtained simultaneously from the medical records and a joint assessment of the visit is carried out. Results: Between September 1, 2020 and January 31, 2022, a total of 248 patients (113 RA, 53 SpA and 82 PsA) were included in the platform. 172 (69.3%) patients used the digital platform and made at least one non-face-to-face visit during follow-up. The number of online visits made by each patient ranged from 1 to a maximum of 13 visits. 80 patients (70.7%) suffered from RA, 40 (75.4%) from SpA and 52 (63.4%) from PsA. The number of patients who made non-face-to-face visits was 38 (72.3%) for a disease duration of <5 years and 137 (64.5%) for >5 years. When the ages of the patients were analyzed, the number of patients who made visits was 75 (73.5%) between 18 and 30 years old, 50 (67.7%) between 30 and 50 and 47 (66.4 %) from 50 years. According to the degree of activity of the disease, 75 patients were in remission or low activity at some point during the visits, 63 patients with moderate activity and 34 with severe activity. The distribution according to level of education was: 11 (6.3%) primary education, 21 (12.2%) secondary education, 37 (21.5%) vocational training, 63 (36.6%) further education and 40 (23.2%)higher education. The number of online visits was higher in patients who lived at a distance of 50 km or more from the hospital, reaching 100% of the visits in this subgroup of patients. Conclusion: The online visit through a digital platform through PROs is well accepted by our population with CIJD, especially in the young population, with a higher cultural level and whose home is far from the hospital. The online visit was made by patients regardless of the severity of their disease activity. Speed and ease of use using PROs already known to the patient and clinician is an important consideration for rheumatolo-gists working in healthcare systems where patient contact time is limited. It would be interesting to obtain this information in non-pandemic situations such as COVID-19, which would make it possible to assess actual acceptance and its use in this type of patient in circumstances in which fear of contagion is not a variabl to consider.
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Hypofractionation has shown to be beneficial in the management of a wide range of cancers1,2 including other advantages such as cost savings3. Trials over the last decade4,5,6 have demonstrated the advantages of hypofractionation compared with a standard radiotherapy regimen3. Covid-19 significantly impacted the way in which cancer patients7 are managed and even though the use of hypofractionation is well established in some cancer types;the application thereof during the pandemic has been widely expanded to minimise treatment time8. Even though the treatment outcomes have been well defined, there is limited evidence to suggest changes in patient care. Some oncology centres advocated for a reduced contact time between patient and staff9. Hypofractionation in an ageing population is particularly advantageous in allowing people to receive treatment in a shorter time demonstrating treatment outcomes similar to younger age groups10 however;greater consideration should be given to performance status and comorbidities associated with these treatment outcomes11. Fractionation schedules which allow delivery in less fractions, can be highly effective with limited treatment-related toxicity. Studies have shown that the late consequences of radiotherapy in these patient groups are seldom an issue even with larger fraction s12. However more recent studies suggest that a reduction in treatment time should not be the only reason for selecting this approach. Moderate hypofractionation should therefore be considered for those patient who are younger and who might experience long terms effects13. More studies are now investigating the tolerability of ultra-hypofractionated radiotherapy in an attempt to improve the therapeutic gain, suggesting that these approaches are well-tolerated and showed no statistical difference in toxicity14. Hypofractionation in radiotherapy may be a good alternative to conventional fractionation however patience care remains paramount in the management of all toxicities related the radiotherapy delivery. There is no evidence to suggest the patient care of these patients have changed, however the tolerability and outcomes of this method of delivery requires constant review. Patient care needs to consider the site of treatment, age of the patient, performance status, and tolerability. A model of shared decision making in managing care is advocated with greater emphasis on selfcare.
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Background: Nowadays, the COVID-19 pandemic has become a global problem that new methods must be used to prevent it. The virus is highly contagious and is mainly transmitted through the air. Ozone is a powerful oxidant that can be used to inactivate a wide range of viruses that may be resistant to other disinfectants. The purpose of this study was to review the use and effect of ozone in inactivating indoor viruses. Methods: To conduct this review study, the keywords such as ozone, virus and air were used to search the PubMed and Scopus databases. Articles were searched from 2010 to 2020. As a result of the search, 57 articles in this field were selected and their content and results were used in this review study. Results: This review study showed that ozone has been successfully used to prevent several viral diseases such as COVED-19. In addition, some viruses, such as coronaviruses, contain sulfhydryl functional groups containing cysteine and tryptophan that react better with ozone gas. The infected person's sneezing may result in the formation of 40,000 droplets in the air. The droplets can be transferred to the nearest surface up to approximately 2 meters before falling and also may remain in the air for 30 hours. Conclusion: The use of ozone gas has many potential applications in inactivating viruses in enclosed spaces. Given the importance of virus-containing aerosols in the transmission of COVED-19, ozone can be a promising way to prevent the disease. The degree of inactivation of viruses by ozone gas depends on the gas concentration, contact time, temperature, humidity and type of virus. In general, studies in this field have shown the use of ozone gas in preventing the spread of viral diseases such as COVED-19. Necessary safety measures and precautions are also recommended in using this gas.
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Background/Aims Since the last UK wide survey of undergraduate (UG) education in rheumatology in 2000 (1), the landscape of both university teaching and clinical services has altered significantly. There has been an increase in the number of medical schools (26 to 37), rise in student numbers, curricula expansions, plus the impact of Covid-19. This survey evaluates the current status of rheumatology teaching in the UK and highlights areas for the Rheumatology community to consider when planning future training. Methods In early 2021, a 'Survey Monkey' was emailed to named MSK leads representing all 37 UK schools. This included open and closed questions and explored themes from previous published surveys. Reminders were sent after 2 and 4 weeks. Results Responses were received from 34/37 (92%) schools. There is wide variation in what, when and how teaching is delivered, but the vast majority deliver rheumatology specific teaching spread across years 1- 5. Overall length of clinical rheumatology exposure varied from 3 days to 7 weeks, delivered either as separate days (e.g. in integrated placements or PBL), as formal blocks (often with orthopaedics) or within a student selected component. Approximately 25% of teaching is delivered in primary care. Most is delivered in Year 4. Most schools have a designated rheumatology lead: a clinical academic or clinician. Teaching is acknowledged in most job plans with educational roles discussed at appraisals. Small group teaching remains the most common method of delivering formal teaching, followed by on-line learning and lectures. The majority of teaching is delivered by consultants, trainees and research fellows. A wide range of barriers were noted including competing pressures from clinical work, lack of physical space for teaching and the volume of medical students. Due to COVID-19, 50% of medical schools suspended placements at some point during the pandemic. 70% of schools reported a 50-75% reduction in patient contact time for students reflecting the national data re: 20% of rheumatology departments functioning at less than 50% during the pandemic (2). Many schools reported designing new innovative (often online) resources to support learning during the pandemic. Available resources such as the Versus Arthritis patient examination videos (available on YouTube) and flipbook were noted to be particularly useful learning resources. Conclusion Over the past 20 years, rheumatology UG teaching has remained strong but time for dedicated rheumatology training has reduced in some centres. Remote learning has become more common, which coupled with Covid, has raised concerns amongst teachers that students are not getting sufficient clinical exposure. There is interest for a rheumatology UG community to create and share online resources and act as a source of support.
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BACKGROUND: COVID-19 affects healthcare resource allocation, which could lead to treatment delay and poor outcomes in patients with acute myocardial infarction (AMI). We assessed the impact of the COVID-19 pandemic on AMI outcomes. METHODS: We compared outcomes of patients admitted for acute ST-elevation MI (STEMI) and non-STEMI (NSTEMI) during a non-COVID-19 pandemic period (January-February 2019; Group 1, n = 254) and a COVID-19 pandemic period (January-February 2020; Group 2, n = 124). RESULTS: For STEMI patients, the median of first medical contact (FMC) time, door-to-balloon time, and total myocardial ischemia time were significantly longer in Group 2 patients (all p < 0.05). Primary percutaneous intervention was performed significantly more often in Group 1 patients than in Group 2 patients, whereas thrombolytic therapy was used significantly more often in Group 2 patients than in Group 1 patients (all p < 0.05). However, the rates of and all-cause 30-day mortality and major adverse cardiac event (MACE) were not significantly different in the two periods (all p > 0.05). For NSTEMI patients, Group 2 patients had a higher rate of conservative therapy, a lower rate of reperfusion therapy, and longer FMC times (all p < 0.05). All-cause 30-day mortality and MACE were only higher in NSTEMI patients during the COVID-19 pandemic period (p < 0.001). CONCLUSIONS: COVID-19 pandemic causes treatment delay in AMI patients and potentially leads to poor clinical outcome in NSTEMI patients. Thrombolytic therapy should be initiated without delay for STEMI when coronary intervention is not readily available; for NSTEMI patients, outcomes of invasive reperfusion were better than medical treatment.
Subject(s)
COVID-19 , Myocardial Infarction , Non-ST Elevated Myocardial Infarction , ST Elevation Myocardial Infarction , Humans , Myocardial Infarction/diagnosis , Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Non-ST Elevated Myocardial Infarction/diagnosis , Non-ST Elevated Myocardial Infarction/therapy , Pandemics , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/therapy , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: The influence of the early COVID-19 pandemic on non-COVID-19 emergencies is uncertain. We conducted a systematic review and a meta-analysis to evaluate the impact of the first months of the COVID-19 pandemic on the presentation, management, and prognosis of patients presenting with ST-segment elevation myocardial infarction (STEMI). METHODS: We searched the PubMed, Scopus, and Embase databases from January to August 2020. A meta-analysis of studies comparing the profile, STEMI severity at presentation, reperfusion delay, and in-hospital mortality for patients presenting before and during the early COVID-19 pandemic was conducted. Fifteen cross-sectional observational studies including 20,528 STEMI patients from the pre-COVID period and 2190 patients diagnosed and treated during the first months of the COVID-19 pandemic met the inclusion criteria. RESULTS: Patients presenting with STEMI during the pandemic were younger and had a higher comorbidity burden. The time interval between symptoms and first medical contact increased from 93.22 ± 137.37 min to 142 ± 281.60 min (p < 0.001). Door-to-balloon time did not differ significantly between the two periods (p = 0.293). The pooled odds ratio (OR) for low left ventricular ejection fraction at presentation during the pandemic was 2.24 (95% confidence interval (CI) 1.54-3.26) and for a presentation delay >24 h was 2.9 (95% CI 1.54-5.45) relative to before the pandemic. In-hospital mortality did not increase significantly during the outbreak (p = 0.97). CONCLUSION: During the first months of the COVID-19 pandemic, patients presenting with STEMI were addressed later in the course of the disease with more severe left ventricular impairment. In-hospital emergency circuits and care functioned properly with no increase in door-to-balloon time and early mortality.
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In a multimodal world the contact time between the teacher and the students is not always sufficient to ensure the effectiveness of the learning process. For the assimilation of concepts, students often endeavor on a search for the materials that best suit their learning needs. With the application of new technologies in teaching, study materials and support platforms are increasingly abundant and diverse. Additionally, recommendation algorithms overwhelm students with several options, sometimes hard to resist and select, especially after the COVID-19 restrictions, where the amount of connected time as increased. In this context, it is important for the teacher, to know which methods and materials the students use when they are autonomously developing their knowledge and skills. A survey was conducted within a group of engineering students at a Portuguese higher education institution with the main goal of characterizing the study habits and the materials that students. The obtained results are here reported and analyzed and compared with previous results from pre-pandemic study. © 2021 IEEE.
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Background: Introduction: The ABS recommends that gynaecomastia in secondary care does not require all aspects of triple assessment. The COVID pandemic altered pathways for care delivery and triggered a review of practice. The audit is designed to assess the compliance of clinical practice with the ABS guidelines. Materials and Methods: Methods: Retrospective data collection of all male patients referred to a DGH Breast service from 1st August 2019 to 1st August 2020 using hospital data system. The cohort represents patients referred 6 months prior to COVID pandemic and 6 months after. The proforma design was based on ABS guidelines. Results: Results: Sample size 233. Clinical contact time increased due to the COVID pandemic, however there were less patient facing episodes. No patient referred was under 25 with a P3+ lesion in the breast. Just under 25% of the patients aged <25 with a clinical grade of P2 had no imaging. 44% of these were impacted by the COVID pandemic. Only 17% of patients presenting with bilateral benign gynaecomastia graded <P2 met the audit standard. Of these, only one patient had a face to face clinic appointment. 8 patients had P3+,M3+ or U3+ lesions, only 1 patient was not biopsied. Conclusions: Conclusion: Results demonstrate overprovision of care in two of the four standards assessed. The COVID pandemic has demonstrated that alterations can be made to the delivery of care in line with guidelines without compromising the quality of care. Some changes were implemented during the second lockdown based on these outcomes and will be re-audited.
ABSTRACT
Keywords: Education, Technology, Qualitative Purpose: At the level of frontline service delivery, a key healthcare impact of the COVID-19 pandemic in the UK has been the increasingly widespread usage of virtual platforms. Even physiotherapy, which is traditionally strongly associated with face-to-face delivery, has embraced online working to ensure safe and sustained patient contact during viable assessments and treatments. Allied to such change has been the development of Virtual Placement (VP) schemes for physiotherapy students, designed to provide experience of such remote working, given that it will very likely remain a feature of physiotherapeutic work in the longer term. Given this, the research reported herein explores the experiences of Clinical Educators (CEs) working on a nationwide ConnectHealth physiotherapy VP scheme that ran during 2020 and 2021. This is done with a view to (a) highlighting how future VPs might be refined for greatest efficacy, while (b) providing needs-sensitive assistance to CEs in their practical roles. Methods: The research team contacted all ConnectHealth CEs who had worked with at least two full six-week VP student cohort, inviting them to take part in an online semi-structured interview addressing their experiences of the VP scheme itself. The first N = 10 to register interest in participating were formally recruited. Interviews (with a mean duration of 33 min) were provided by all invited CEs and were transcribed verbatim, though necessary redactions were made to protect participants’ identities. Investigation of the transcripts, using Reflexive Thematic Analysis, was undertaken by the full research team. Results: Analysis revealed four global data themes. 1. Supervision and Oversight;while reduced direct contact time with students lessened some of the background working pressures on the participants themselves, they all expressed concerns that it might have increased those pressures on their students. This was, however, widely taken to be counterbalanced by the students’ access to a much broader range of clinicians. 2. Technology and Independence;all participants saw design and delivery of Facebook Live sessions as powerful independent learning experiences for the students, although they were patient engagement with them was sometimes inconsistent. These sessions also contributed a bank of online resources that would help ‘lighten the load’ for both students and CEs in the future. 3. Patient Contact;it was widely held that the VP environment had improved students’ subjective assessment capacities. The students’ ability to work directly with patients was limited by GDPR concerns regarding sharing those patients’ contact details, however, and meetings including a CE were harder to arrange with increased chances of technical glitches. 4. Assessment;it was much more difficult for participants to effectively observe students’ clinical work in a virtual environment, with existing assessment schemes being particularly awkward to apply remotely. Conclusion(s): Findings indicate that the present VP scheme, although deemed highly effective in some areas, involved some legacy structures that made its delivery difficult for CEs, not least around practical assessment. Impact: These findings ideally give some provisional direction on how prospective physiotherapy VPs might be shaped to help CEs more effectively help themselves and students. Funding acknowledgements: The work was supported by a small grant from the University of Cumbria's Internal Research Fund.