Simulation in Urological Training: The Hybrid Model of Institute of Kidney Diseases Peshawar A Comparative Study

Background:"I fear the man who has practised one kick 10,000 times." Lee Bruce This aphorism highlights the growing importance of simulation in postgraduate urology training, especially during the COVID 19 pandemic, when all teaching and training activities were stopped, jeopardising postgraduate residents' education. Postgraduate residents must perform hours of surgical training to overcome urological learning curves. According to study, residents educated on simulators boost their summative scores. By introducing simulation to urology training in a way comparable to the well-known Halsted apprenticeship model, the current study emphasises the hybrid model of IKD. Objective(s): to compare the formative assessment results between residents taught on simulators and residents in the conventional apprenticeship model on factors of communication skills, technical competence, and overall capacity to conduct procedure on OSAT and DOPS. Material(s) and Method(s): from 2019 to 2021 this comparative study was conducted in the Department of Urology by Team C at the Institute of Kidney Diseases Peshawar. Group A (10 residents) and Group B (10 residents, 5 from the second and third years) received STEPS method OT instruction in the first phase. These simulators were used to impart knowledge to Group "B" Harvey for counseling and medical examinations Simulator for PCNL The second phase included a six-month training assignment swap between the two groups. A standard QSAT and DOPS proforma was used to evaluate each resident. Data analysis was done using SPSS 24.0. Result(s): Residents in Group A, who were originally exposed to the conventional technique, considerably outperformed Group B on Harvey (mean: 50.5;standard deviation: 2.21.1) in terms of communication skills, professionalism, and ethical concern during the first phase (p 0.001). However, the Group p0.05 shown considerably higher technical proficiency and overall process performance capacity. The mean technical skill and overall capacity to finish the process had a somewhat positive association in phase 1 in favour of group B (r=0.630, p 0.01). All QSAT and DOPS metrics significantly improved in the second phase. However, both groups did not vary significantly (p> 0.05). According to Pearson coefficient correlation, both groups considerably overcame their gaps in technical proficiency, communication skills, and procedural competence. (P= 0.001) Results are shown in Figures 1 through 06 and Tables 1 through 2. Conclusion(s): To improve the standard of urology residency in Pakistan, a hybrid paradigm that includes both simulation and actual performance is necessary. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

Simulation of Aerosol Dispersion During Medical Examinations

The main route of transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) virus is airborne. The objective of this study is to analyze the aerosol dispersion and potential exposure to medical staff within a typical medical examination room during classical airway procedures. The multiphase simulation of the aerosol particles in the airflow is based on a Lagrangian-Eulerian approach. All simulation cases with surgical mask show partially but significantly reduced maximum dispersion distances of the aerosol particles compared to the cases without a surgical mask. The simulations have shown that medical examiners are exposed to a large amount of aerosol particles, especially during procedures such as laryngoscopy where the examiner's head is directly in front of the patient's face. However, exposure can be drastically reduced if the patient wears a mask which is possible for most of the procedures studied, such as otoscopy, sonography, or anamnesis. Copyright © 2022 by ASME.

The Satisfaction of Covid-19 patients Self-home Care with Telepharmacy Services

Background: The impact of Covid-19 pandemic makes the hospital innovate using technology services, one of which was telepharmacy. Telepharmacy has the potential to improve Covid-19 outpatient through the use of telecommunications with self-home care patient. In July 2021, 120 patients received telepharmacy services with teleconsultation with pulmonologist, pediatrist, internist, otorhinolaryngologist, neurologist, psychiatrist and general practioners. In August 2021, telepharmacy patients were reduced to 39 patients, and in September 2021, telepharmacy patients were reduced to 11 patients. Objective(s): Evaluating outpatients with telepharmacy services by measuring satisfaction patients. Method(s): This program integrated with interprofessional doctor, pharmacy, nurse, driver and customer care unit. The satisfaction of patient depends on the multiprofessional services. This research to evaluate the satisfaction Covid-19 outpatients with received telepharmacy services. Desain study were descriptive, non-experimental and study cross-sectional. Data collected 3 months dan the samples were 170 patients with patient surveys to evaluate patient satisfaction. Result(s): 170 patients received telepharmacy ranged in age from 5-70 years, consisting of 93 women (54.7%) and 77 men (45.3%) with 76,5% satisfaction with telepharmacy services. Patients reported telepharmacy services from pulmonologist by 61.7%, internist 8.2%, otorhinolaryngologist 1.2%, pediatrist 23.5%, neurologist 0.5%, psychiatrist 0.5% and general practitioner from medical check-up by 4.1%. Conclusion(s): The satisfaction of self-home care telepharmacy patients overall reached 76.5%, and the patient felt dissatisfied were 23.5%. The decrease of patients in August and September 2021 because the telepharmacy services has not been maximized services and needs improvement. The hospital can improve the quality of telepharmacy services to increase patient satisfaction and visit telepharmacy patients. Copyright © RJPT All right reserved.

Dynamics and structure of forensic medical investigations of violent death in st. Petersburg over the past 10 years

BACKGROUND: Among other things, changes in the structure of forensic medical expert material serve as an indicator of dynamic processes in society . The levels of injuries and violent and nonviolent death somehow depend on the state of the economy and health care in the region and the state as a whole . In recent years, the spread of coronavirus disease 2019 (COVID-19), which was proclaimed as a pandemic with tangible social and economic damage to States, has been one of the determining factors . AIMS: This study aimed to investigate the dynamics of the volume and structure of violent death in the Russian Federation over the past 10 years, including the pandemic period, using the megalopolis example . MATERIAL AND METHODS: This study reviewed the annual reports of the Bureau of Forensic Medical Examination of St . Petersburg using data grouping, frequency analysis, correlation analysis, comparison, system analysis, and inductive generalization . RESULTS: Over the past 10 years, several significant changes have occurred in St . Petersburg in the scope and structure of forensic medical investigations of violent deaths . The main positive trend was a decreased absolute and relative number of cases of violent death . Statistically significantly (p <0 .05) decreased number of cases of transport injuries, injuries resulting from the action of blunt and sharp objects, gunshot, thermal injury, and mechanical asphyxia, as well as poisoning with ethanol and carbon monoxide, significantly decreased infant mortality, and fewer unidentified and unclaimed corpses were observed . Additionally, a steady increase in the number of drug poisoning was found, and the fatal injury level due to falling from a height remained consistently high . The background incidence of COVID-19 in 2020 was 2 .4–3 .2% . CONCLUSION: The proportion of cases of falling from a height, thermal burns, and strangulation with a noose increased among the dead with a confirmed COVID-19 diagnosis, and transport (primarily rail), gunshot and explosive injuries, cases of drowning, poisoning with drugs, and alcohol detection in the biological environments of the body of the victims were less common . © Eco-Vector, 2022.

The impact of the COVID-19 pandemic on the diagnosis of malignant neoplasms during preventive medical examinations

The restrictive social distancing strategy during the COVID-19 pandemic in the healthcare system has led to a reduction in measures for the active detection of malignant neoplasms (MNs). Objective. To evaluate the impact of a temporary stop the measures for the secondary prevention of MNs on the frequency of detected cases of the disease during preventive medical examinations (PMEs). Materials and methods. The efficiency of active MN detectability in 2020 versus the pre-COVID-19 period (2018—2019) was com-paratively analyzed in 17 regions of the Central Federal District (CFD) of Russia. Information on the coverage of the population with PMEs and on the frequency of detected cancer cases when using fluorographic, mammographic, and cytological studies was obtained from the study of the data contained in the information project «Passport of an Oncology Dispensary» of the P.A. Herzen Moscow Oncology Research Institute, as well as those available in the public domain on the Internet and on the official websites of regional health authorities. Results. The comparative analysis of the results of PMEs did not reveal significant differences in their efficiency in the studied regions of the Central Federal District of Russia in 2018 and 2019. Compared to the pre-COVID-19 period in 2020, there was a sta-tistically significant decline in the population coverage with primary care, which was 33.2±2.3% among both sexes (p<0.01), 25.8±2.3 for males (p<0.05) and 39.7±3.0% females (p<0.01). The frequency of detected cancer cases was 1.0 ‰ in the general population, 0.6‰ for males and 1.2‰ for females. There was an increase in the number of detected cases during fluorographic (+27.1%) and mammographic (+22.9%) studies and a decrease in the proportion of cytologically detected MNs (–33.2%). At the same time, due to a decline in the number of the surveyed population in 2020, there was a decrease in the number of detected cancer cases of the lung (–34.8%), breast (–37.1%), as well as tumors diagnosed cytologically (–65.9%). Conclusion. This investigation may suggest that at least 1.065 lung cancer cases and 1.875 breast ones were not diagnosed due to the temporary reduction in PMEs in the regions studied. © 2021, Media Sphera Publishing Group. All rights reserved.

Human-like tele-health robotics for older adults - A preliminary feasibility trial and vision.

Introduction: The global increase of the aging population presents major challenges to healthcare service delivery. Further, the COVID-19 pandemic exposed older adults' vulnerability to rapid deterioration of health when deprived of access to care due to the need for social distancing. Robotic technology advancements show promise to improve provision of quality care, support independence for patients and augment the capabilities of clinicians to perform tasks remotely. Aim: This study explored the feasibility and end-user acceptance of using a novel human-like tele-robotic system with touch feedback to conduct a remote medical examination and deliver safe care. Method: Testing of a remotely controlled robot was conducted with in-person clinician support to gather ECG readings of 11 healthy participants through a digital medical device. Post-study feedback about the system and the remote examinations conducted was obtained from study participants and study clinicians. Results: The findings demonstrated the system's capability to support remote examination of participants, and validated the system's perceived acceptability by clinicians and end-users who all reported feeling safe interacting with the robot and 72% preferred remote robotic exam over in-person examination. Conclusion: This paper discusses potential implications of robot-assisted telehealth for patients including older adults who are precluded from having in-person medical visits due to geographic distance or mobility, and proposes next steps for advancing robot-assisted telehealth delivery.

Effects of COVID-19 Severity on Serum Calcium Levels

Background: The hypocalcaemia may be a unique biochemical feature of COVID -19 that has the potential to influence disease severity and represents a new potential therapeutic target worth testing in this clinical setting. Because COVID -19 testing has primarily focused on individuals with respiratory symptoms rather than calcium levels, Therefore the objective of current study was to determine the effect of e COVID-19 severity on Serum calcium levels. Methods: After the ethical approval, all the RT-PCR positive patients from the record of corona isolation wards of Ganga Ram hospital Lahore. Demographic details including name, age, gender, complete history & examination serum Calcium level was noted recorded al from hospital files on a predesigned proforma. To assess clinical severity of coronavirus disease, all the enrolled patients' disease category as mild, moderate, severe & critical was note. Data was analyzed using SPSS-26. Association between age and gender between disease severity was determined by using Chi-square test. Binary logistic regression was applied to find out the effect of disease severity on serum calcium levels. P-value less than 0.05 were considered to be significant. Results: 555 patients were enrolled in the current study. The mean ages of patients were 38.34+14.86. There were 300(54.1) male and 255(45.9) female, the severity of the disease shows that the majority 490(88.3%) of the patients had mild disease and 65(11.7%) had moderate disease. The mean serum calcium level was 8.7+0.34. The majority of patients had mild disease, of which 270 were female and 220 male and 230 among 31-50 years. The results of binary logistic regression show the effect of disease severity (Mild, Moderate) on calcium, age and gender. It was reported that only serum calcium, male gender and age category 30-50 years were a significant predictor of disease severity. Conclusion: It was concluded from current study that majority of patients have mild disease severity and patients have normal serum calcium. The disease severity has no significant impact on the calcium levels as the majority of patient has mild disease.

Vaccination Offer during the Occupational Health Surveillance Program for Healthcare Workers and Suitability to Work: An Italian Retrospective Cohort Study.

The active immunization of health care workers (HCWs) is a crucial measure to avoid nosocomial infection; nevertheless, vaccine coverage (VC) among health personnel in Italy is unsatisfactory. To improve VC in the healthcare set, the Hygiene and Occupational Medicine departments of Bari Policlinico General University Hospital applied a specific program. The operative procedure demands that in the context of the occupational medical examination, all workers are evaluated for susceptibility to vaccine-preventable diseases (VDPs), with immunization prophylaxis offered to those determined to be susceptible. This study analyzed data from workers who attended the biological risk assessment protocol from December 2017 to October 2021 (n = 1477), who were evaluated for the immune status for measles, mumps, rubella, and varicella. Among the enrolled subjects, non-protective antibody titers were higher for measles and mumps (13%), followed by rubella (11%) and varicella (8%). Appropriate vaccinations were offered to all susceptible HCWs, and HCWs were re-tested one month after immunization. The seroconversion rate after the administration of one or more booster dose(s) was over 80%. Overall, 2.5% of the subjects refused the offered vaccine(s); the main determinant of immunization compliance was younger age (aOR = 0.86; 95%CI = 0.80-0.92). Especially during the COVID-19 pandemic, VPDs may still present a hazard in nosocomial environment. Our experience suggests that, despite hospital procedures and dedicated human assets, satisfactory VC cannot be reached without the provision of federal regulations. Nevertheless, public health policymakers have to improve the promotion of vaccine prophylaxis and education to reach higher VC.

Anosmia and COVID-19

Introduction: Anosmia has been described as one of the characteristic symptoms of COVID-19 disease. It is even considered as a key marker for COVID-19 diagnosis. The aim of the study is to evaluate anosmia as prognostic factor in moderate and severe cases of COVID-19 patients. Method(s): Our study is a multicenter prospective study;300 patients were recruited and confirmed COVID-19 infection and admitted into 3 tertiary referral quarantine hospitals to receive medical treatment in Minia, Egypt. The study was conducted between April and October 2021. The selected random sample met the following inclusion criteria: adults older than 18 years, rhinopharyngeal swab positive for SARS-CoV-2 infection, and moderate and severe cases of COVID-19. The patients were subjected to the following protocol: full clinical history, general medical examination, otorhinolaryngological evaluation, mandatory swab for COVID-19, and recording of laboratory data. Patients underwent olfactory assessment and follow-up for 3 months. Olfactory assessment was done subjectively by odor recognition thresholds using L-butanol;after evaluation, the patients were divided into anosmic and nonanosmic groups. Collected data were compared and statistically analyzed. Result(s): Olfactory impairment was seen in 35% of moderate cases and 13% in severe cases. Our study revealed that patients with anosmia were younger and mostly female. Hospitalized patients with anosmia had a better prognosis. Our results showed no significant differences between the 2 groups regarding temperature, heart rate, and respiratory rate. Of patients with anosmia, 70% were associated with dysgeusia, and 50% recovered within 13 days while 85% recovered within 28 days. There was significant relationship (parallel relationship) between progress of anosmia and level of D-dimer, C-reactive protein, and serum ferritin. This indicateds that the prognosis of anosmia is highly related to the inflammatory process of COVID-19 pathophysiology. Conclusion(s): Anosmic patients with COVID-19 have more favorable prognosis and recovery than nonanosmic patients do, and anosmia improves with treatment of the disease.

Development and Implementation of a Novel Global Health Track in Pediatric Gastroenterology, Hepatology, and Nutrition Fellowship

Background Global health interest continues to rise among pediatric trainees including those entering pediatric fellowships. While global health opportunities are being incorporated into many pediatric fellowship programs, there remains a paucity of global health training in pediatric gastroenterology, hepatology, and nutrition (GHN) fellowships. In a 2014 survey by Jirapinyo et al. only 17% of responding GHN fellowships offered global health training activities. A 2018 survey by Crouse et al. showed that 34% of responding GHN fellowships offered global health electives, and none had formal global health tracks. We believe that creating a formalized global health track for GHN fellows will not only appeal to the increasing interest among applicants, but also provide a firm knowledge base on GHN topics specific to a more global level, build international collaborations, and contribute a unique perspective in our field. We aim to describe our experience with the development and implementation of a novel global health track in a pediatric GHN fellowship. Methods Planning commenced January 2021. A multidisciplinary team was assembled bringing together experts in different areas including those in other subspecialties involved in global health fellowship training. The team involved in development included GHN program director, GHN division chief, pediatric emergency medicine global health fellowship director, director of the pediatric infectious disease fellowship tropical and global medicine track, and Baylor international pediatric AIDS initiative (BIPAI) chief medical officer. Input was also received on certain aspects of the curriculum from the pediatric viral hepatitis program director, dieticians, a radiologist, an ultrasound technologist, and the pediatric point-of-care ultrasound fellowship program director. Existing clinical niche track curriculum developed within the GHN department at Texas Children's Hospital were used as a guide for the structure and different aspects to be incorporated into the track including, but not limited to, clinical activities, procedural opportunities, research, education, and teaching. Results A comprehensive, multifaceted global health curriculum was developed, and implementation began in July 2021. Clinical activities include participation in pediatric and adult viral hepatitis clinics, nutrition focused clinics, and tropical medicine clinic. Global health electives abroad were explored but deferred given travel restrictions during the COVID-19 pandemic. For procedural opportunities an ultrasound curriculum was developed including point of care ultrasound training as well as more focused training in liver, biliary, and gastrointestinal disease. A fellowship research project was developed in conjunction with the Baylor International Pediatric AIDS Initiative (BIPAI) network in sub-Saharan Africa with mentorship both from faculty in the GHN department as well as the BIPAI network locally and abroad. The project is public health focused examining hepatitis B screening rates and prevalence among people living with HIV in sub-Saharan Africa. Education includes attendance of lectures given in different departments as well as cross departmental within the institution, and global lectures attended virtually. Other educational activities include review of a global health focused GHN topics and assembly of a library of resources including recent seminal papers for current and future fellows to use for review. Last, completion of the Diploma in Tropical Medicine and the Certificate of knowledge in Clinical Tropical Medicine and Travelers' Health Examination. Teaching opportunities include involvement in general global health education for US-based medical students and residents interested in pursuing careers in global health, and teaching residents and faculty on topics such as viral hepatitis, malnutrition, and diarrhea. Conclusion We have developed to our knowledge the first formal global health track in pediatric GHN fellowship that is feasible to integrate into the 2nd and 3rd year and omplete in the available time frame. Participation in the global health track by the first fellow is still in process and improvements are being made based on experience. A multidisciplinary team including support within the fellowship program and experts in global health training is essential to the success of a pediatric GHN global health track. International relationships either previously established by the fellow, within the department, or the institution are also necessary for the success of the track. We believe that this track will help to equip future gastroenterologists to pursue a career with a focus in global health. Future directions include recruiting future fellows to complete the curriculum within our institution, formal evaluation by fellows participating in the curriculum, and securing ongoing funding. We also hope to incorporate global health electives abroad when feasible.

An Online Undergraduate Medical Examination conducted using the Learning Management System-Moodle 3.9 (A student centric Observational Study)

Background: With the advent of the coronavirus pandemic, Higher Education Organizations (HEOs), including medical schools, started using online education to effectively teach, and evaluate students’ performances. An increasingly popular contemporary modality offered by the digital e-learning market is a Learning Management System (LMS). Aims and Objectives: The aim isto assess Moodle v. 3.9 as a tool to conduct online medical examinations. The objectives are: 1. To collect student feedback 2. To discuss technical aspects with Moodle experts 3. To implement necessary changes based on the feedback and discussion Material and Methods: A short-term longitudinal observational study was conducted at the Symbiosis Medical College for Women, Pune, India to collect feedback from 143 students with regards to their online exam experience with Moodle and the technical difficulties they faced were noted. In collaboration with software experts, certain technical changes pertaining to bandwidth requirements were implemented. Results: We observed that the students require extra time as compared to the online exam scenario for conversion of their answer sheets into PDFs, and this technical aspect needs to be considered while designing such exams. We also established the server bandwidth that is essential for an uninterrupted online exam experience at the institute level. Lastly, student feedback suggested that the online examination environment is perceived as more stressful, compared to its live counterpart. Conclusion: We conclude that cost-effectiveness, user-friendly interface, and a multitude of assessment-related features make Moodle an efficient tool for conducting online medical examinationsattheundergraduatelevel.

Threats to operating room personnel's occupational safety and health: a qualitative study

Background & Objective: Every operating room has been associated with a variety of occupational hazards, but not many studies have been conducted to assess and address these hazards. We used a qualitative approach to explore operating room personnel's experiences of workplace hazards and how these hazards threaten their occupational safety and health (OSH). Methodology: This qualitative study was conducted in five teaching hospitals in the south-west of Iran from February 2019 to March 2021. The sample was 24 operating room personnel who were selected under convenient sampling technique. Data were collected using semi-structured, individual interviews, document review and non-participant observation. The collected data were analyzed according to the qualitative content analysis method using MAXQDA v. 2020. Results: After prolonged analysis of the data, the researchers extracted 644 codes, 13 subcategories, 4 categories, and 1 main theme. The main theme of the study was working in a context of occupational hazards. Conclusions: Operating rooms are full of potential dangers, which, when combined with the personnel's negligence and management inefficiencies, increase the risk of occupational health and safety. Therefore, making working conditions safe by providing adequate personal protective equipment (PPE), in-service training, and identifying and managing the causes of personnel negligence are recommended. Moreover, strategies should be introduced to manage stress and conflicts among the healthcare personnel, thus controlling psychological hazards.

Clinical and epidemiological characteristics of workers diagnosed with COVID-19 in the setting of an external occupational safety and health service in Lima-Peru

Objective: To describe the clinical and epidemiological characteristics of workers kept under occupational medical surveillance conducted by an occupational safety and health service. Materials and methods: An observational, descriptive, retrospective, longitudinal study of a group of workers diagnosed with COVID-19 kept under occupational medical surveillance from March 18 to July 31, 2020. The data was analyzed using the Stata Statistical Software: Release 15. Results: Males were more severely affected than females (77.16 %), among which the 20- to 39-year-old age group prevailed (63.30 %). On the other hand, study subjects with no comorbidities accounted for 81.11 %. However, the remaining 18.9 % presented one or more comorbidities, with obesity being the most frequent one (61.95 %), followed by asthma (11.09 %). Sore throat and cough were the most common symptoms with 20.67 % and 19.78 %, respectively. Conclusions: The study population mainly consisted of young male adults with no comorbidities, who neither showed predominant symptoms nor required hospitalization.

Evolution of Therapeutic Drug Monitoring requests in a tertiary University Hospital in the last 16 years

Introduction: TDM has been widely used in clinical practice for many years and has application in various groups of drugs,mainly in drugs with pharmacokinetic variability, concentration related therapeutic and adverse effects, narrow therapeutic index, defined therapeutic concentration range and desired therapeutic effect difficult to monitor. Objectives: The aim of this study is to assess the evolution of TDM application throughout the years and its usefulness and necessity nowadays in a tertiary University Hospital. Methods: Data of Therapeutic Drug Monitoring requests were collected for the years 2005, 2010, 2015, 2019, 2020 and 2021 from the records of the Laboratory of Pharmacology General University Hospital of Alexandroupolis. Drugs monitored included digoxin, valproic acid, carbamazepine, phenytoin, phenobarbital, cyclosporine, tacrolimus, amikacin, gentamycin, vancomycin, serum benzodiazepines, methotrexate, cortisol, acetaminophen, salicylate, theophylline, tobramycin and primidone. More specifically, the data collected were the drug's level measurement and the clinic that requested the specific drug order. Results: A total of 1357 drug level measurement records were found for 2005, 1442 for 2010, 766 for 2015, 520 for 2019, 442 for 2020 and 622 for 2021. During these years the most frequent drug requested for TDM was digoxin (2005), cyclosporine (2010, 2019), valproic acid (2015, 2020), and tacrolimus (2021). In regards to the drugs requested, digoxin was predominantly requested by Cardiology and Pathology, cyclosporine and tacrolimus by Nephrology and valproic acid by Psychiatry. Furthermore, the percentage of non optimal therapeutic levels that required dose adjustments were calculated and will be presented. Conclusion: TDM retains a degree of its value as shown by the number of incidents requiring dose modifications. In addition, the presented results obtained from 2005 to 2021 show that there is a notable decrease in the number of requests for TDM per year. This can be imputed to several reasons such as the replacement of specific drugs with new therapeutic regimens and the evolution of therapeutic drug protocols in several diseases. Another major factor was the measures taken against the Covid-19 pandemic in the last two years which resulted to a substantial decrease of routine health examinations and scheduled appointments in the Hospital.

THE OPPORTUNITIES OF TELEMEDICINE IN BULGARIA IN THE CONDITIONS OF COVID-19 – A SURVEY

In times of global pandemic, telemedicine is emerging as an effective and sustainable solution to stop the spread of COVID-19. The aim of this article is to study the public attitudes towards the application of telemedicine in Bulgaria in the conditions of the COVID-19 pandemic. Material and methods: To study the public attitudes for the application of telemedicine in a pandemic, 253 people were interviewed voluntarily and anonymously. We used our own tools – a questionnaire distributed online. Statistical data processing was performed using IBM SPSS v. 23. Results: Respondents with higher education and healthcare workers were more distrustful of health information on the Internet. Over 75% of the respondents stated that they would use remote medical services for consultation with a medical professional in case of a health problem, and nearly 59% of them would pay for remote medical services for consultation and/or monitoring of treatment. The issuance of an electronic referral, an electronic sick leave form and an electronic prescription could limit the spread of COVID-19 according to 77.4% of them. Almost ¾ of our respondents would install a mobile application to contact a doctor in case of emergency. The preferred means of consulting a medical professional in the current pandemic is a telephone conversation. Conclusion: Telemedicine is essential to ensure that patients have access to medical care. In times of global public health emergency, health systems must rely on remote medical examinations and electronic prescriptions to deal with the further spread of the disease.

TIERED EVALUATION MODEL TO OPTIMIZE FASD DIAGNOSTIC CAPACITY IN A DEVELOPMENTAL & BEHAVIORAL PEDIATRICS CLINIC

Purpose: FASD is a highly prevalent disorder where the majority of affected individuals remain undiagnosed. Reliance on multidisciplinary diagnostic models hold little hope of meeting needed diagnostic capacity, creating barriers to care. Therefore, a new clinical model aiming to optimize access to diagnostic evaluation was tested. In this model, referred children with symptoms of FASD needing evaluation were triaged into a single discipline model (Nurse Practitioner (NP) or physician (MD)) or a multidisciplinary model (NP + neuropsychologist), depending on factors including age, results of past psychoeducational testing, alcohol confirmation, and growth data. The purpose of this study was to evaluate the impact of this new model utilizing clinical data. Methods: Retrospective review and analysis of clinical data extracted from the billing and electronic medical records for the time period between April, 2014 and November, 2021. Data: During the 6.5 year time period studied, 402 patients received a FASD diagnosis. Of these, 196 (48.8%) were diagnosed using the multidisciplinary model, and 206 (51.2%) were diagnosed using the single discipline model. There was steady growth in diagnostic capacity from initiation through 2019, with an almost 6-fold increase in diagnosed patients. Patients came from a wide geographic region, including 34 NYS counties, and 2 bordering states. Diagnosed children ranged from <1 - 20 years of age (m = 7.19), with 140 (36.5%) female and 244 (63.5%) male. Of single discipline evaluations, 205 (89.1%) were conducted in person and 25 (10.9%) by telemedicine, primarily during peak periods of the Covid-19 pandemic. MDs and NPs had roles in both models, with team medical examinations completed by NPs for 192 (98%), MDs, 4 (2%) and single discipline evaluations by NPs in 105 (51%), and MDs 101 (49%). Results: Use of a tiered model of FASD diagnostic evaluation more than doubled diagnostic capacity in the studied clinical setting, and allowed continued evaluation during pandemic conditions. Conclusions: Use of a tiered model of evaluation, in which evaluation of more straight forward cases are provided by a physician or nurse practitioner utilizing psychoeducational testing completed in the school setting, and evaluation of children with more a more complex diagnostic presentation utilizing an interdisciplinary team, has the potential to expand diagnostic capacity.

Functional vitamin K status and lung function in the Danish general population: The DanFunD study

Background and Aims: Vitamin K activates vitamin K-dependent proteins or Gla proteins by a process called γ-carboxylation. The most well-described Gla proteins are coagulation factors. However, other Gla proteins, such as the Matrix Gla Protein (MGP) may also exert important functions. MGP is present in various tissues, including lung tissue. The inactive form of MGP dephosphorylated-uncarboxylated MGP (dpucMGP) has been associated with elastin degradation in lungs of patients with chronic obstructive pulmonary disease (COPD), and it has been associated with COVID-19 mortality. Dp-ucMGP has been proposed as a biomarker of functional vitamin K status. We aim to assess the association between functional vitamin K levels and lung function to elaborate on vitamin K's role in lung diseases. Methods: In a cohort, representative of the Danish general population, the DanFunD study, we will assess the association between functional vitamin K status (reflected by dp-ucMGP plasma levels) and lung function. The 4,096 participants were examined between 2017 and 2020 with a general health examination, questionnaires, spirometry, step test, and blood and urine samples. Using linear regression models, we estimate the association between dp-ucMGP and continuous measurements of lung function. Furthermore, in multiple logistic regression models, we estimate the association between dp-ucMGP and dichotomous outcomes of respiratory symptoms. Results: Preliminary crude analyses suggest that higher levels of dp-ucMGP are associated with having an FEV1 below 80% of the expected value. Conclusions: Results will be presented at the Nordic Lung Congress.

Long term sequelae after hospitalization for severe COVID-19: a comparison between the first two pandemic waves

Background: A significant proportion of survivor COVID-19 patients presented sequelae that impact on the quality of life and social-health systems. We described long term sequelae in hospitalized for severe disease patients. Materials and Methods: 143 patients was evaluated at 6 and 12 months after discharge in a prospective study by medical examination, laboratory tests, spirometry, Hamilton test for anxiety and depression, ECG. The results was compared between survivors of the first two pandemic waves. Results: mean age was 66±8 years;90 (63%) was male, median BMI was 26,7±2 Kg/m2. After 6 months 32,1% of patients reported dyspnoea, 35% fatigue, 14% transiet hair loss, 18,8% arthralgia, 10,4% concentration and memory deficit, about 53% anxiety and/or depression. At 12 months symptom prevalence decreased. Prevalent spirometric feature was restrictive. DLCO was altered in about 70% of patients at 6 months. At 12 months the percentage was the same in first wave patients and decreased to 45% in second wave patients. Healthy state was worse in survived of first wave. Conclusions: approximately 1/3 of patients recovered from COVID-19 have sequelae of disease that improved over time. Data analysis are invalidated by patients heterogeneity (background, severity disease and clinical feature, received therapy);its possible that better knowledges in disease management in second pandemic wave had a favorable impact on long-term outcomes.