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Objectives: Pneumothorax and pneumomediastinum are associated with high mortality in invasively ventilated coronavirus disease 2019 (COVID-19) patients; however, the mortality rates among non-intubated patients remain unknown. We aimed to analyze the clinical features of COVID-19-associated pneumothorax/pneumomediastinum in non-intubated patients and identify risk factors for mortality. Methods: We searched PubMed Scopus and Embase from January 2020 to December 2021. We performed a pooled analysis of 151 patients with no invasive mechanical ventilation history from 17 case series and 87 case reports. Subsequently, we developed a novel scoring system to predict in-hospital mortality; the system was further validated in multinational cohorts from ten countries (n = 133). Results: Clinical scenarios included pneumothorax/pneumomediastinum at presentation (n = 68), pneumothorax/pneumomediastinum onset during hospitalization (n = 65), and pneumothorax/pneumomediastinum development after recent COVID-19 treatment (n = 18). Significant differences were not observed in clinical outcomes between patients with pneumomediastinum and pneumothorax (±pneumomediastinum). The overall mortality rate of pneumothorax/pneumomediastinum was 23.2%. Risk factor analysis revealed that comorbidities bilateral pneumothorax and fever at pneumothorax/pneumomediastinum presentation were predictors for mortality. In the new scoring system, i.e., the CoBiF system, the area under the curve which was used to assess the predictability of mortality was 0.887. External validation results were also promising (area under the curve: 0.709). Conclusions: The presence of comorbidity bilateral pneumothorax and fever on presentation are significantly associated with poor prognosis in COVID-19 patients with spontaneous pneumothorax/pneumomediastinum. The CoBiF score can predict mortality in clinical settings as well as simplify the identification and appropriate management of patients at high risk.
RESUMEN
Background: With the COVID-19 pandemic declared in March 2020 by the World Health Organization (WHO), many undergraduate education programs were disrupted, and some quickly transitioned to online learning. Medical students were left without crucial clinical experiences. A learner-driven telemedicine curriculum was implemented to provide learners with clinical experiences, knowledge, and skills in teleurology via the Ontario Telemedicine Network (OTN) between February and May 2021. Methods: Six volunteer Northern Ontario School of Medicine (NOSM) learners enrolled for 12 weeks. A needs assessment was completed. Learning contracts were used in the design and evaluation. Five modules were developed. Informed consent for students to participate in confidential care was received from patients. Expected activities included 2 patient encounters per month, a summary of experiences, and a "learner-faculty feedback loop." Small-group discussions were held. OTN was the platform of care for videoconferencing. Curriculum feedback and faculty and learner evaluations were completed via online surveys. Results: Of 6 enrollees, 5 completed the curriculum. Patient encounters varied from consultation, postoperative care, counselling, and education. Students gained a better understanding of how telemedicine may be utilized. All participants set learning goals, reflected on these, had successful patient encounters, and learned about office tele-urology. The participant satisfaction rate was 100%. One learner withdrew owing to excess workload. Limitations included small numbers, a solo urologist, time factor, use of only the OTN hub, and lack of formal structure. Conclusion: A learner-driven telemedicine curriculum provided medical students an opportunity to learn about telemedicine with a focus on office tele-urology. Learners gained useful telemedicine competencies. A telemedicine curriculum for undergraduate medical students is recommended.