COVID-19 Drive-Through Point of Screening and Testing (POST) System: A Safe, Efficient, and Adaptable Model for Nasopharyngeal Swab Collection.

OBJECTIVE: The authors aim to demonstrate that the current drive-through testing model at a health district was improved in certain parameters compared with a previous testing protocol, and to provide the methodology of the current model for other coronavirus disease (COVID-19) testing sites to potentially emulate. METHODS: Initially, a small drive-through site was constructed at a converted tuberculosis clinic, but due to an increase in testing needs, an expanded point of screening and testing (POST) system was developed in an event center parking lot to administer tests to a higher volume of patients. RESULTS: An average of 51.1 patients was tested each day (2.0 tests per personnel in personal protective equipment [PPE] per hour) at the initial tuberculosis clinic drive-through site, which increased to 217.8 patients tested each day (5.9 tests per personnel in PPE per hour) with the new drive-through POST system (P < 0.001). Mean testing time was 3.4 minutes and the total time on-site averaged 14.4 minutes. CONCLUSIONS: This POST drive-through system serves as an efficient, safe, and adaptable model for high volume COVID-19 nasopharyngeal swabbing that the authors recommend other COVID-19 testing sites nationwide consider adopting for their own use.

Motivational Interviewing Training: A Case-Based Curriculum for Preclinical Medical Students.

Introduction: With the rise of chronic medical problems involving lifestyle behaviors and the benefits of patient involvement in preventative care, medical students need to learn how to help patients change health risk behaviors and improve patient involvement in order to improve health outcomes. Motivational interviewing (MI) is a patient-centered therapeutic approach that is effective in the treatment of lifestyle behaviors and diseases. Methods: This 2-hour didactic training session, along with a 3-hour case-based practice session involving role-plays and a 3-hour evaluated session utilizing standardized patients, was delivered to 68 preclinical medical students. Knowledge, attitudes, and self-efficacy were evaluated via pre- and posttraining surveys, and satisfaction with the training was assessed upon completion. Results: Students who completed both pre- and postsurveys (n = 48) showed a statistically significant improvement in knowledge of MI (t = -29.73, df = 47, p < .001), attitudes regarding implementing MI in health care settings (t = -3.04, df = 47, p < .005), and self-efficacy (t = -10.699, df = 47, p < .001) in talking with patients about behavior change. Students were also highly satisfied with the MI training package (M of 4.4, SD = 0.6, out of 5.0). Discussion: A training package to teach preclinical medical students about MI was effective in helping students learn the knowledge and skills necessary to deliver MI in a broad range of clinical cases.

Successful Treatment of a Case of Ectopic Jejunal Varices with Portal Venous Stenting.

BACKGROUND Management of patients with ectopic variceal bleeding can be challenging and requires a multidisciplinary approach. Ectopic bleeding from jejunal varices at the anastomotic site of choledochojejunostomy is rare and difficult to treat. CASE REPORT We report a case of ectopic jejunal variceal bleeding secondary to portal vein stenosis at the anastomotic site of a prior choledochojejunostomy for pancreatic cancer. The patient was successfully treated with portal vein metallic stent placement that remained patent for 7 months. CONCLUSIONS The management of ectopic of variceal bleeding remains difficult and controversial. Portal vein stenting has been reported as a successful method of treatment that is minimally invasive especially in patients who had prior major surgeries.

A Case of Cerebral Venous Sinus Thrombosis Presenting During Relapse of Ulcerative Colitis.

BACKGROUND Extra-intestinal manifestations of inflammatory bowel disease (IBD) include thromboembolic events that can present as deep vein thrombosis, pulmonary embolism, and cerebral venous sinus thrombosis. Cerebral venous sinus thrombosis is a rare complication of IBD that can be associated with high morbidity and mortality. This report is of a case of cerebral venous sinus thrombosis presenting in a young man during a relapse of ulcerative colitis (UC). CASE REPORT A 27-year-old man presented with seizures and focal neurological deficit during a relapse of chronic UC. He was found to have left cerebral venous sinus thrombosis complicated by left frontotemporal infarction that was treated with anticoagulation therapy. CONCLUSIONS Thromboembolic events are well documented extra-intestinal manifestation of IBD. Cerebral venous sinus thrombosis is a rare but serious complication that can be fatal. The correct diagnosis and timely management require a high degree of suspicion in patients with IBD who present with a new-onset headache, focal neurological symptoms, seizure, or altered mental status.

Systematic evaluation of factors controlling Perkinsus marinus transmission dynamics in lower Chesapeake Bay.

The transmission of Perkinsus marinus in eastern oysters Crassostrea virginica in relation to water temperature, host oyster mortality, and water-column abundance of anti-P. marinus antibody-labeled cells was systematically examined for 20 mo at a site in the lower York River, Virginia, USA. Uninfected sentinel oysters were naturally exposed to the parasite at 2 wk intervals throughout the course of the study to determine the periodicity and rates of parasite transmission. The timing and magnitude of disease-associated oyster mortalities in a local P. marinus-infected oyster population were estimated by monitoring a captive subset of the local oyster population. Flow cytometric immunodetection methods were employed to estimate the abundance of P. marinus cells in water samples collected 3 times each week. The acquisition of P. marinus infections by naïve sentinel oysters occurred sporadically at all times of the year; however, the highest incidence of infection occurred during the months of August and September. This window of maximum parasite transmission coincided with the death of infected hosts within the captive local oyster population. Counts of antibody-labeled cells ranged from 10 to 11900 cells l(-1), with the highest abundances in July and August coincident with maximum summer temperatures. A statistically significant relationship between water-column parasite abundance and infection-acquisition rate was not observed; however, highest parasite-transmission rates in both years occurred during periods of elevated water-column abundance of parasite cells. These results support the prevailing model of P. marinus transmission dynamics by which maximum transmission rates are observed during periods of maximum P. marinus-associated host mortality. However, our results also indicate that transmission can occur when host mortality is low or absent, so alternative mortality-independent dissemination mechanisms are likely. The results also suggest that atypically early-summer oyster mortality from Haplosporidium nelsoni infection, at a time when infections of P. marinus are light, has a significant indirect influence on P. marinus transmission dynamics. Elimination of these hosts prior to late-summer P. marinus infection-intensification effectively reduces the overall number of P. marinus cells disseminated.