Remote Instruction in Focused Assessment With Sonography in Trauma (FAST) Exams for Surgery Residents: A Pilot Study.

BACKGROUND: The Focused Assessment with Sonography in Trauma (FAST) exam is an important component to the evaluation of trauma patients. With advances in technology and meeting limitations due to COVID-19, remote instruction and learning have gained popularity. We sought to determine whether remote instruction of FAST exams was feasible as sustainable surgical education and a possible alternative to traditional in-person teaching. METHODS: General surgery residents completed a baseline survey and skills assessment on FAST exams and were then randomized to remote or in-person instruction. The remote group participated in an instructional session with a content expert through video conference and then practiced on a simulated mannequin while the expert remotely provided feedback. The in-person group received the experience with the content expert in the room. Both groups completed a post-course survey immediately after the session and a follow-up survey and objective assessment at six-months. Results were compared with two-way analysis of variance (ANOVA). RESULTS: 14 residents underwent the curriculum, seven in each group. There was a significant increase in self-reported confidence when comparing pre- and immediate post-course results for both the remote and in-person groups. At six months, confidence scores remained elevated and skill assessment scores improved, although the latter did not reach significance. There was no significant difference in post-course results between the groups. CONCLUSIONS: Remote instruction of FAST exams was feasible. Pilot data demonstrated an increase in confidence and suggest outcomes that are similar to in-person instruction, which has positive implications for future remote educational and potentially clinical initiatives.

Chinese expert recommendations on management of hepatocellular carcinoma during COVID-19 pandemic: a nationwide multicenter survey.

BACKGROUND: This study aimed to investigate the work status of clinicians in China and their management strategy alteration for patients with hepatocellular carcinoma (HCC) during the COVID-19 pandemic. METHODS: A nationwide online questionnaire survey was conducted in 42 class-A tertiary hospitals across China. Experienced clinicians of HCC-related specialties responded with their work status and management suggestions for HCC patients during the pandemic. RESULTS: 716 doctors responded effectively with a response rate of 60.1%, and 664 were included in the final analysis. Overall, 51.4% (341/664) of clinicians reported more than a 60% reduction of the regular workload and surgeons declared the highest proportion of workload reduction. 92.5% (614/664) of the respondents have been using online medical consultation to substitute for the "face-to-face" visits. Adaptive adjustment for the treatment strategy for HCC was made, including the recommendations of noninvasive and minimally invasive treatments such as transcatheter arterial chemoembolization for early and intermediate stage. Targeted therapy has been the mainstay for advanced stage and also as a bridge therapy for resectable HCC. DISCUSSION: During the COVID-19 pandemic, online medical consultation is recommended to avoid social contact. Targeted therapy as a bridge therapy is recommended for resectable HCC considering the possibility of delayed surgery.

The way back home: Trading behaviours of foreign institutional investors in China amid the COVID-19 pandemic

By using foreign institutional investors' daily trading data on 958 firms in China and COVID-19 infection data of six countries, this paper aims to investigate how the pandemic has influenced foreign institutional investors' trading behaviours during the first half year of 2020. In addition to domestic returns and foreign returns, ‘pull factors’ of COVID-19 pandemic in host country and ‘push factors’ of COVID-19 pandemic in home country were used to explain net foreign inflows. We find that ‘push factors’ of COVID-19 in home country are dominant in explaining the reduction of net foreign inflows in five out of 11 sectors, and ‘pull factors’ of domestic returns are dominant in explaining net foreign inflows in most sectors. The price impact of net foreign flows differs across sectors as well. A strong negative correlation between net foreign outflows and same-day return could be identified in the Financials sector. On the flip side, positive correlation between net foreign inflows and same-day return could be identified in seven other sectors. Finally, a pattern of flight-to-liquidity was discovered, as foreign institutional investors strategically sell illiquid stocks to conserve liquidity when market uncertainty is heightened.

Analyses of the clinical features of 13 corona virus disease 2019 non-survivors

Objective To investigate the clinical features of 13 fatal cases of corona virus disease 2019 (COVID-19). Methods The clinical data of 13 patients who died of COVID-19 in Central Theater General Hospital, China, between January 4, 2020, and February 24, 2020, were analyzed retrospectively. The data reviewed included clinical manifestations, laboratory test results, radiographic features and dinical treatment plan. The cellular immune function, the expression of inflammatory factors, and lactate level in deceased patients at different stages of the disease were analyzed. Results Of those who died, the patients consisted of 10 men and 3 women. The age of those who died was (74±19) years, and 10(76.9%) patients were over 70 years old. For the patients who died, 9 presented with underlying diseases, 6(46.2%) of whom had more than 2 diseases. On admission, the chest computed tomography (CT) for 8 patients (61.5%) mainly showed multiple patchy ground-glass opacities. When the disease progressed, the ground-glass opacities rapidly developed into diffuse lesions in both lungs. The lymphocyte and CD3+, CD4+, and CD8+ T lymphocyte counts in the peripheral blood of 13 patients were significantly lower than normal levels and decreased more substantially during the disease course based on the levels when admitted (P<0.01). Additionally, the interleukin (IL)-6, D-dimer, C-reactive protein (CRP), lactic acid levels gradually increased, and most peaked before death. The cause of death for most patients was acute respiratory distress syndrome (ARDS) with type I respiratory failure. Three patients eventually developed multiorgan deficiency syndrome (MODS). Conclusions The risk factors of death for COVID-19 patients included older men, more underlying diseases, poor cellular immune function and over-expression of inflammatory factors. The main cause of death in patients with COVID-19 was ARDS, which led to respiratory failure and MODS.

Fire lines as fault lines: increased trade barriers during the COVID-19 pandemic further shatter the global food system.

In this opinion piece, we highlight that trade barriers established during COVID-19 as "fire lines" to prevent cross-border transmission of the pandemic could become "fault lines" that demolish the global food system. We review restrictions on both international agricultural exports and imports, especially unilateral border controls such as import refusals and alerts, in previous epidemics and arising with two novel features amid COVID-19. Institutional causes to pervasive trade barriers in epidemics that are embedded in the WHO-WTO coordination scheme have been discussed. In the meantime, discussions on potential economic outcomes and policy recommendations have been provided.