RESUMO
Vascular compression syndromes (VCS) are rare diseases, but they may cause significant symptoms interfering with the quality of life (QoL) of patients who are often in their younger age. Given their infrequent occurrence, multiform clinical and anatomical presentation, and absence of dedicated guidelines from scientific societies, further knowledge of these conditions is required to investigate and treat them using modern imaging and surgical (open or endovascular) techniques. This consensus document will focus on known VCS, affecting the arterial and venous system. The position paper, written by members of International Union of Angiology (IUA) Youth Committee and senior experts, will show an overview of pathophysiology, diagnostic, and therapeutical approaches for patients with VCS. Furthermore, this document will provide also unresolved issues that require more research that need to be addressed in the future.
RESUMO
BACKGROUND: The COVID-19 pandemic has created a hiatus in in-person clinical assessments due to safety and logistical concerns. We aimed to evaluate student perception and utility of an online Integrated Structured Clinical Examinations (ISCEs) during the pandemic. METHODS: Final-year medical students from a single institution were offered an online mock ISCE through a student-to-student ("near-peer") teaching-programme. A questionnaire-based cross-sectional study was conducted pre- and post-online mock ISCE. RESULTS: Sixty-four students completed the study. Pre- and post-data showed an increase in confidence (p<0.0001), less worry regarding the online format (p<0.0001) and less anxiety about excelling in ISCEs (p<0.001). Students felt that having done the mock, an online format would more positively affect their overall performance (p=0.007). CONCLUSION: This study demonstrates a positive change in student perception and confidence in online ISCEs. Online ISCEs are thus feasible, though sole reliance on this format may provide an incomplete assessment of student's overall clinical competency.
RESUMO
BackgroundChest CT (CT) is the reference for assessing pulmonary injury in suspected or diagnosed COVID-19 with signs of clinical severity. We explored the role of lung ultrasonography (LU) in quickly assessing lung status in these patients. MethodseChoVid is a multicentric study based on routinely collected data, conducted in 3 emergency units of Assistance Publique des Hopitaux de Paris (APHP); 107 patients were included between March 19, 2020 and April 01, 2020 and underwent LU, a short clinical assessment by 2 emergency physicians blinded to each others and a CT. LU consisted of scoring lesions in 8 chest zones from 0 to 3, defining a severity global score (GS) ranging from 0 to 24. CT severity score ranged from 0 to 3 according to the extent of interstitial pneumonia signs. 48 patients underwent LU by both an expert and a newly trained physician. FindingsThe GS showed good performance to predict CT severity assessment of COVID-19 as normal versus pathologic: AUC=0.93, maximal Youden index 1 with 95% sensitivity, and 83% specificity. Similar performance was found for CT assessment as normal or minimal versus moderate or severe (n=90): AUC 0.89, maximal Youden index 7 with 86% sensitivity, and 78% specificity. Good agreement was found for zone scoring assessed by new trainee (30mn theory + 30mn practice) and expert (n=14,14*8 checkpoints), weighted kappa 0.85-1; moderate agreement was found for new trainee (n=48, 30mn theory) and expert, kappa 0.62-0.81. InterpretationGS score is a simple tool to assess lung damage severity in patients with suspected or diagnosed COVID-19. Comparing the performance of new trainees and expert physicians opens a path for adoption beyond the scope of experts. LU is a good candidate for patients triage, especially in case of CT availability issues.
