Leaving Without Being Seen from the Pediatric Emergency Department: A New Baseline

BACKGROUND Left without being seen (LWBS) rates are an important quality metric for pediatric emergency departments (ED), with high acuity LWBS children representing a patient safety risk. Since 07/2021, our ED experienced a surge in LWBS after the most stringent COVID-19 quarantine restrictions ended. OBJECTIVES We assessed changes in LWBS rates and examined associations of system factors and patient characteristics with LWBS. METHODS We performed a retrospective study in a large, urban pediatric ED, for all arriving patients, comparing three time-periods: before COVID (PRE, 01/2018 – 02/2020), during early-COVID (COVID, 03/2020 – 06/2021), and after the emergence of COVID-19 variants and reemergence of seasonal viruses (POST, 07/2021 – 12/2021). We compared descriptive statistics of daily LWBS rates, patient demographics, and system characteristics. Negative binomial (system factors) and logistic regression (patient characteristics) models were developed to evaluate the associations between system factors and LWBS, and patient characteristics and LWBS, respectively. RESULTS Mean daily LWBS rates changed from 1.8% PRE to 1.4% COVID to 10.7% during POST. Rates increased across every patient demographic and triage level during POST, despite a decrease in daily ED volume compared to PRE. LWBS rates were significantly associated with ESI 2 patients, average ED census, and staff productivity within multiple periods. Patient characteristics associated with LWBS included lower assigned triage levels and arrival between 8PM and 4AM. CONCLUSIONS LWBS rates have shown a large and sustained increase since July 2021, even for high acuity patients. We identified system factors that may provide opportunities to reduce LWBS. Further work should develop strategies to prevent LWBS in at-risk patients.

Uncharted Universe of Educational Technology: Potential Awaits

Educational technological tools are now an integral part of the education industry. Various platforms used for educational purposes were analyzed to find the perception of the learner;however, the major analyzing trends revolve around Zoom, Google meet, Google Classroom, and Institutional LMS, overlooking the evaluation of the perception of Teachly: an Ed-tech application developed by Harvard Kennedy School. The objective of this study is to determine the perception of students at Stamford University (n = 36) who enrolled and completed a semester at Teachly using descriptive statistics. For precision, a slider scale was used to collect data using the Google form in a semi-structured questionnaire. The data were then analyzed using the mean and standard deviation to find the central tendency and the measure of variability. The analysis confirms that the student has a positive perception towards using Teachly covering Walgito's three components of perception, and it also points out some limitations identified by the student which hampers its future implementation. © 2023, North American Business Press. All rights reserved.

An ed-tech organizational transition from a reactive to a proactive change model in client success

The pivotal role Ed-Tech facilitates as an industry is increasing in education. As education evolves, the emergence of Ed-Tech in the classroom, data collection, curriculum, assessment, and student information continues to drive new initiatives, projects, and solutions in the school. The cross-sectional relationship between education and organizational culture during the COVID pandemic identified emerging themes of the increasing reliance on education and the emphasis society and education place on technology. This study analyzes and developed an action plan to address the disconnect between educational stakeholders and client organizational engagement. This qualitative study focuses on the role of the organizational culture of Ed-Tech organizations in improving practices of engagement, user experience, and internal client success practices. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Advancing emergency department-initiated buprenorphine.

Opioids are the main driver of drug overdose deaths in the United States, and there has been a marked increase in opioid-related overdoses during the COVID-19 public health emergency. Many emergency departments (EDs) across the country are implementing ED-initiated buprenorphine programs, and this is a method to address and prevent opioid overdoses. Resources are available to overcome barriers and take action.

Regenerative therapies for erectile dysfunction: the influence of direct-to-consumer marketing on patient interest.

Background: Despite a lack of evidence, a number of "regenerative" therapies have become popularized treatments for erectile dysfunction (ED). Platelet-rich plasma (PRP) injections and shockwave therapy have received significant attention through direct-to-consumer marketing and are advertised as viable alternatives to guideline-backed therapies. Additionally, focused low-intensity shock wave therapy (LiSWT) has become conflated with acoustic or radial wave therapy (rWT), although their mechanism of wave generation and tissue penetration is distinct. GAINSWave, a marketing platform for acoustic wave therapy, has also pervaded the marketplace. We aim to evaluate the relative impact of direct-to-consumer marketing of shockwave therapy and PRP by analyzing the quantity of Google internet search queries for selected regenerative and guideline-backed non-regenerative therapies for ED. Methods: National Google Search trends in the United States (www.google.com/trends) were analyzed to characterize interest in different forms of therapy for ED. Search trends for PRP, LiSWT (and various iterations), intracavernosal injections (ICI), intraurethral injections (IU), vacuum erectile device (VED), and GAINSWave were analyzed. Monthly search data were compiled over multiple years, ending at 2/28/2020, just before the COVID-19 pandemic and state of emergency in the United States. Macro-level changes in public interest were quantified using yearly averages. Results: Patterns in Google Search interest in PRP and LiSWT increased respectively by 3-fold and 275-fold over the decade, representing a larger share of Google Searches by 2020. Trends in Google Search interest in selected types of shockwave therapy for ED also show that queries for GAINSWave commanded public interest, increasing by 219-fold from 2016 to 2020. Conclusions: Regenerative therapies for ED have produced interest surpassing other adjunct guideline-backed therapies, despite receiving the designation of "experimental" or "investigational" therapies. The establishment of GAINSWave also constitutes an inflection point for the whole shockwave market: searches for shockwave therapy increased by 782% between 2016 and 2020. Direct-to-consumer marketing of PRP and shockwave therapy has upturned the customary role of physicians in counseling patients about evidence-based therapies for ED. This increase in public interest in GAINSWave emphasizes its success as a marketing platform. The urological community should consider strategies to address misinformation, such as search-engine optimization, social media, and educational outreach.

Adapting the Use of Mask Ed™ Simulation in Nursing Programmes During the COVID- 19 Pandemic.

The onset of the COVID-19 pandemic toppled education delivery worldwide. Nursing education was no exception. The pandemic required nurse educators to quickly shift from face-to-face learning environments to remote and more virtual interactions. Educators were compelled to create and employ strategies to support nursing learners as they assimilated critical and complex knowledge, and skills from their homes, instead of classrooms and simulation laboratories. One modality of simulation which maintained engagement and connection with learners in the online environment was Mask-Ed™ Simulation. This paper presents a snapshot of Mask-Ed™ simulation activities across four higher education institutions globally during the COVID-19 pandemic.

Challenges of Digital Transformation in Education in India

Online learning has been present since the 1960s and has risen in popularity over time. World-class universities have been using online teaching-learning methodologies to fulfill the needs of students who reside far away from academic institutions for more than a decade. Many people predicted that online education would be the way of the future, but with the arrival of COVID-19, online education was imposed upon stakeholders far sooner and more suddenly than expected. When the COVID-19 pandemic broke out, educational institutions began to explore digital ways to keep students studying even when they couldn't be together in person as governments enacted legislation prohibiting large groups of people from gathering for any reason, including education. The future of such a transition looks promising. However, transitioning from one mode of education to another is not easy. Historically, when educators adopt new tools, learning still continues in the conventional manner. Based on the responses of 176 students, this paper studies the challenges of Digital transformation in the Education sector. The research is extremely beneficial in evaluating the scope of societal opposition to change. © 2022 IEEE.

Virtual Technology in Radiologic Technology Classrooms: Educational Effect of the COVID-19 Pandemic

PURPOSE: To investigate the educational effect of the COVID-19 pandemic on virtual technology use in the radiologic technology classroom by comparing virtual technology use and perceived barriers for use from before the COVID-19 pandemic through the spring 2021 semester. METHODS: An explanatory mixed-method, cross-sectional survey design was used to evaluate radiologic technology educators' integration of virtual technology and continuance intention to use (CITU) virtual technology in the radiologic technology classroom. A pseudoqualitative component also was used to add meaning to the quantitative data. RESULTS: A total of 255 educators completed the survey. Educators with associate degrees scored significantly lower in CITU compared with participants with master's degrees (P = .04) and doctoral or professional degrees (P = .01). Virtual technology use significantly increased from before COVID-19 to spring 2021 (P < .001). Educators' perceptions of barriers to technology integration significantly decreased from before COVID-19 to spring 2021 (P < .001). In this report, radiologic technology educators indicated intentions for increased virtual technology use in the future compared with their use during the spring 2021 semester (P = .001). DISCUSSION: Virtual technology use was low before COVID-19, and although it increased during the spring 2021 semester, it remained relatively low. Future intentions for virtual technology use indicate an increase from spring 2021, suggesting a change in future delivery of radiologic science education. Instructors' levels of education had a significant effect on CITU scores. Cost and funding was consistently the highest reported barrier to virtual technology use, whereas student resistance to technology was consistently the lowest reported barrier. Narratives of participants' challenges, current and future use, and rewards related to virtual technology also added pseudoqualitative meaning to the quantitative findings. CONCLUSION: The educators in this study demonstrated low virtual technology use before the COVID-19 pandemic, increased virtual technology use because of the pandemic, and significantly positive CITU scores. Radiologic science educators' responses regarding their challenges, current and future use, and rewards might be helpful in facilitating more effective technology integration. Copyright © 2023 American Society of Radiologic Technologists.

Erectile dysfunction among Thai patients with COVID-19 infection.

BACKGROUND: Erectile dysfunction (ED) is suspected to be the symptom manifestation of COVID-19. However, scarce data was presented this day. Our study was conducted to determine the prevalence of ED and its associated factors among Thai patients with COVID-19. METHODS: Sexually active males with COVID-19, hospitalized between May and July 2021 at one university hospital in Bangkok, were screened for erectile dysfunction by the International Index of Erectile Function 5 (IIEF-5). Demographic data and COVID-19 treatment history were collected. Mental health status, including depression and anxiety, was evaluated with the Thai Patient Health Questionnaire 9 (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7), respectively. The sample size was calculated, and logistic regression was used to analyze the association. RESULTS: One hundred fifty-three men with COVID-19 were recruited. ED prevalence was 64.7%, of which severity was mostly mild. Logistic regression, adjusted for age, BMI, and medical comorbidities, portrayed a significant association between ED and mental health status. Higher risk of ED was found in participants with major depression [adjusted OR 8.45, 95% CI: 1.01-70.96, P=0.049] and higher GAD-7 total score [adjusted OR 1.15, 95% CI: 1.01-1.31, P=0.039]. CONCLUSIONS: Thai patients with COVID-19 had high prevalence of ED, which was associated with mental disorders. Thus, screening for mental problems is recommended in individuals with COVID-19 and ED.

Trends in STI testing and diagnosis rates during the COVID-19 pandemic at a large urban tertiary care center, and the role of the emergency department in STI care.

Introduction: The COVID-19 pandemic has had profound effects on access to care, including outpatient sexually transmitted infection (STI) testing and treatment. Many vulnerable populations already relied on the emergency department (ED) for much of their care prior to the pandemic. This study examines trends in STI testing and positivity before and during the pandemic at a large urban medical center and evaluates the role of the ED in providing STI care. Methods: This is a retrospective review of all gonorrhea, chlamydia, and trichomonas tests from November 1, 2018, through July 31, 2021. Demographic information and location and results of STI testing were extracted from the electronic medical record. Trends in STI testing and positivity were examined for 16 month periods before and after the COVID-19 pandemic started (March 15, 2020), with the latter divided into the early pandemic period (EPP: March 15 -July 31, 2020) and late pandemic period (LPP: August 1, 2020 - July 31, 2021). Results: Tests per month decreased by 42.4% during the EPP, but rebounded by July 2020. During the EPP, the proportion of all STI testing originating in the ED increased from 21.4% pre-pandemic to 29.3%, and among pregnant women from 45.2% to 51.5%. Overall STI positivity rate increased from 4.4% pre-pandemic to 6.2% in the EPP. Parallel trends were observed for gonorrhea and chlamydia individually. The ED represented 50.5% of overall positive tests, and as much as 63.1% of positive testing during the EPP. The ED was the source of 73.4% of positive tests among pregnant women, which increased to 82.1% during the EPP. Conclusions: STI trends from this large urban medical center paralleled national trends, with an early decrease in positive cases followed by a rebound by the end of May 2020. The ED represented an important source of testing for all patients, and especially for pregnant patients, throughout the study period, but even more so early in the pandemic. This suggests that more resources should be directed towards STI testing, education, and prevention in the ED, as well as to support linkage to outpatient primary and obstetric care during the ED visit.

A rare case of newly diagnosed diabetes mellitus following COVID-19 infection.

Several reports showed the likelihood of a relationship between COVID-19 infection and the onset and prognosis of diabetes mellitus (DM) of all types. A 73-year-old female patient who presented to the clinic with respiratory symptoms and was tested positive for COVID-19 and treated for the next three days. Despite having neither a known history of hyperglycemia nor a family history of diabetes, she was unconscious and suffering from polyuria and polydipsia when she was brought to the emergency department. Once her condition was successfully stabilized, she was sent home with COVID-19 medications and oral anti-diabetic therapy. After subsequent viral recovery and continued anti-diabetic medication, the patient was monitored for the following seven months. DM might be linked to the SARS-CoV-2 infection. Further research is necessary to prove a relationship between COVID-19 and newly-onset diabetes.

Status Asthmaticus Gravidus: Emergency and Critical Care Management of Acute Severe Asthma During Pregnancy.

One-third of women with asthma have deterioration of their asthma during pregnancy, and one-fourth of pregnant women with asthma will experience severe exacerbations necessitating emergency department (ED) visits or hospitalizations. Early recognition of acute severe asthma, including life-threatening status asthmaticus, and aggressive medical interventions with ß2-agonists, anticholinergic agents, and systemic corticosteroids are necessary to treat maternal airway bronchoconstriction, support maternal and fetal oxygenation, and avoid adverse fetal outcomes. This review describes management of acute severe asthma in pregnancy, including status asthmaticus, in the ED and intensive care unit.

A Collaborative Metaverse based A-La-Carte Framework for Tertiary Education (CO-MATE).

The paper aims to propose a futuristic educational and learning framework called CO-MATE (Collaborative Metaverse-based A-La-Carte Framework for Tertiary Education). The architectural framework of CO-MATE was conceptualized in a four-layered approach which depicts various infrastructure and service layer functionalities. CO-MATE is a technologically driven educational metaverse environment involving loosely coupled building blocks to provide an a-la-carte model for platform designers. For this, the authors had undertaken a systematic mapping study of the pre/post-COVID period to review the application of various emerging technologies. Further, the paper also discusses the core attributes and component offerings of CO-MATE for a technology-driven and automated immersive-learning environment and exemplifies the same through various use cases.

ENT Referral From Emergency Department During COVID-19: A Single-Center Experience.

PURPOSE: COVID-19 pandemic transformed the health system response worldwide. The aim of this study is to report changes about numbers and reason for ENT consultations in emergency department (ED) during COVID-19 pandemic comparing with those occurred the previous year (2019). METHODS: Data about patients admitted to adult and pediatric ED were collected from March 1 to May 31, 2019 and 2020. Patients referred for urgency from general practitioners were excluded from the study. RESULTS: Global ED admission (except for dyspnea or COVID-19-related symptoms) dramatically decreased during pandemic (-50.9% among adults and -71.4% among pediatrics). At the same time, ENT consultancy significantly reduced too, by 71.5% (P < .01) among adults and 45.1% (P < .01) for pediatrics. Among adults, it was reported a statistically significant decrease in consultation for ear problems (-88.5%, P = .0146). Reduction in ENT referral for bone fracture (-40%, P = .059), vertigo (-77.8%, P = .637), and tonsillitis (-87.5%, P = .688) was consistent, but not significant. Among pediatric patients, it was observed an increase by 25% about foreign bodies (12 vs 15, P < .01). A reduction in numbers of consults for ear problem (-90.8%; P = .045), epistaxis (-80%; P = .196), and nasal fracture (-70%; P = .36) was also observed. CONCLUSION: Fear of infection and the forced lock down caused a significant decrease in the number of ED accesses and in ENT consultancy. These data may suggest that some ED referral usually could be deferred, but on the other hand, pandemic will cause a great diagnostic delay.

An unusual site of a pericardial cyst in a child: A case report.

Pericardial cysts are rare congenital anomalies, often clinically silent and incidentally found on imaging. However, patients with pericardial cysts may present with chest pain, tachypnea, and, rarely, symptoms secondary to cardiac tamponade. Echocardiography (transthoracic or transesophageal) and chest computed tomography (CT) scan with contrast are diagnostic modalities of choice in patients with pericardial cysts. Conservative management is justified in asymptomatic patients, while a surgical approach is recommended in symptomatic patients. Here, we describe the case of a 12-year-old boy who underwent imaging during the coronavirus disease 2019 (COVID-19) pandemic and was incidentally found to have a pericardial cyst.

Safety and tolerability of Evusheld in patients with CVID: The Mayo Clinic experience.

Background: The past 2 years of the COVID-19 pandemic brought with it many unknowns for patients with immunodeficiency. Because of the concern for severe infection in those with immunocompromise, patients have been eager for effective prevention, vaccination, and treatment strategies. Preexposure prophylaxis provides another means of prevention in those with immunocompromise. A combination of tixagevimab and cilgavimab (Evusheld [AstraZeneca Cambridge, United Kingdom]) was granted emergency use authorization for preexposure prophylaxis at the end of 2021, but questions remained regarding how this would be tolerated and the side effects associated with its use. Objectives: Our aim was to evaluate the safety and tolerability of Evusheld in patients with CVID from our tri-site institution. Methods: We performed an institutional review board-approved, retrospective chart review of patients with common variable immunodeficiency (CVID) who received Evusheld before March 26, 2022. Results: Of the 45 patients with CVID who received Evusheld, 41 (91%) received the recommended full dose of 600 mg. The majority of patients (39 of 45 [87%]) tolerated Evusheld without adverse events. The adverse events reported included immediate injection site pain, fatigue and cough, an episode of shingles, and chest pain. Conclusions: This is an initial report on the safety and tolerability of Evusheld injections in patients with CVID. The majority of patients tolerated the injections without adverse events. For patients with reported chest pain, the results of a subsequent cardiac workup were negative. The efficacy of Evusheld could not be evaluated owing to the short median follow-up of this study (19 days).

Effect of 2021-2022 vaccination on the seroprevalence of antibodies to Influenza A and B strains in kidney transplant recipients and health-care workers*

Background: Since the beginning of the coronavirus 2 pandemic in 2019, incidence of influenza infections has significantly decreased mainly due to the COVID-19-related protective measures. We aimed to evaluate the prevalence of serum antibodies against Influenza A and B in kidney transplant recipients (KTRs) and health-care workers (HCWs) before and after receiving the 2021-2022 season vaccine. Methods or Case description: In prospectively collected preand postvaccination sera from KTRs (n = 75) and HCWs (n = 28), vaccinated with Fluarix tetra, IgG antibodies against influenza hemagglutinins of the strains included in the 2021-2022 vaccine (A/Victoria/H1N1;A/Cambodia/H3N2;B/Washington;B/PHUKET) were measured by ELISA. Same measurements were performed in the sera from unvaccinated KTRs (n = 28) and HCWs (n = 11) at 3-month interval during the same season. The half maximal effective dilution (ED50) was measured for all sera and fold-change variation of ED50 values before and after vaccination were calculated. Results or Learning points: ED50 values of IgG against each strain from the serially collected sera are shown in Figure 1. Almost all study participants showed antibodies to all four strains prior to vaccination, whereby the ED50 values were mostly higher in the HCWs. There was no significant increase of ED50 values after vaccination in both KTRs and HCWs, and the increase was comparable in KTRs and HCWs. Unvaccinated subjects, especially HCWs, showed a slight increase of ED50 values over a 3-month interval, although this variation was not significant. During the study period no influenza infection was selfreported or diagnosed in all the enrolled subjects. Conclusion(s): In our cohorts of KTRs and HCWs, we were able to show a wide prevalence of pre-vaccination antibodies against influenza vaccine strains of 2021-2022 season. IgG levels were significantly higher in HCWs compared to KTRs. There was no significant increase of antibodies after vaccination in both KTRs and HCWs.

Whose future? Whose facts?: A critical case study of news literacy education in the United States

In the wake of the 2016 and 2020 U.S. presidential elections and the COVID-19 pandemic, increasing public attention has been paid to the ability of citizens to use and understand news media, information, and digital technology. Conversations about media literacy-the ability to critically engage with media-are ongoing in the press, schools, and state and federal governments. Most media literacy scholars agree that media literacy is an integral part of an informed and healthy democracy. Yet not all media literacy approaches are the same, and some scholars suggest that mainstream approaches may re-create antidemocratic systems and ideologies. What does it mean when the tools intended to support a healthy democracy reinforce systems of oppression?A case study of the News Literacy Project (NLP), a nonpartisan, nonprofit education organization, was used to explore this question by examining how ideologies of racism and neoliberal capitalism are perpetuated or challenged in the resources and curriculum created and disseminated by NLP, which positions itself as a leader in news literacy education. Within a theoretical framework of critical political economy of communication, curriculum theory, and Critical Race Theory, NLP as an organization and its Checkology curriculum were analyzed to understand how ideologies of racism and neoliberal capitalism are replicated or rejected in this curriculum. NLP depends on corporate and philanthropic funding from both media and nonmedia industries and uses the standards of the professional news industry to define its approach to news literacy education. The Checkology 101 curriculum, a default set of news literacy lessons available through an online portal, reflects ideologies of neoliberal capitalism through its atomized and individualistic structure, limited critiques of the news industry's economic structures, and language centered on individualism and consumerism. The curriculum also reflects ideologies of racism, which appear to be the unintentional result of reliance on liberal ideals such as aspirations for neutrality, universality, objectivity, and unbiased truth, that manifest in stereotyping, decontextualized information, and incomplete storytelling. (PsycInfo Database Record (c) 2023 APA, all rights reserved)