Self-study and online interactive case-based discussion to improve knowledge of medical students in the COVID-19 era.

BACKGROUND: We aimed to determine whether a new online interactive learning method for fifth-year medical students could improve their knowledge of pre- and postoperative care during the COVID-19 era. METHODS: A retrospective cohort study was conducted from June 2020 to May 2022 during the pre- and postoperative care course for fifth-year medical students in a university hospital in southern Thailand. Students in the 2020 cohort received only a 60-minute lecture on spinal anesthesia via Zoom while a 3-step online interactive learning method was used for the 2021 cohort. Step 1: students performed self-study comprised of video lectures and case-based discussion one week before the online class with a pre-test submitted via Google forms. Step 2: an online interactive case-based discussion class was performed via Zoom by two experienced anesthesia staff and a post-test was submitted by the students via Google forms. Step 3: a small group discussion of course evaluation between 13 representatives of students and anesthesia staff was performed via Zoom. A comparison of the post-test and pre-test scores containing 20 multiple choice questions as well as the final exam scores before (2020) and after (2021) the new interactive learning was performed using a t-test. RESULTS: There were 136 and 117 students in the 2020 and 2021 academic years, respectively. The final mean (SD) exam scores for the 2020 and 2021 academic years were 70.3 (8.4) and 72.5 (9.0), respectively with a mean (95% confidence interval (CI)) difference of 2.2 (4.3, -0.02). In 2021, the mean (95% CI) difference between the post-test and pre-test scores was 5.8 (5.1, 6.5). The student representatives were satisfied with the new learning method and gave insightful comments, which were subsequently implemented in the 2022 academic year course. CONCLUSION: The new interactive learning method improved the knowledge of fifth-year medical students attending pre- and postoperative care course during the COVID-19 era. The final exam scores may not be suitable to represent the overall outcomes of the new interactive learning method. Using an online two-way communication method can improve the overall satisfaction and course adaptation during the COVID-19 era.

Clinical Predictive Score for Cholecystectomy Wound Infection: WEBAC Score.

BACKGROUND: Most common surgical complications in cholecystectomy are surgical site infections (SSIs). SSIs have many factors, including patient, surgical, and disease factors. This study aims to find the factors which relate to SSIs 30 days after cholecystectomy and contribute to the scoring system to predict SSIs. METHODS AND MATERIAL: The data of patients who underwent cholecystectomy from January 2015 to December 2019 were retrospectively collected from a prospectively collected infectious control registry. The SSI was defined following the CDC criteria and assessed before discharge and at a 1-month follow-up. Variables that were independently predictive of the increased SSIs were included in the risk score. RESULTS: The patients who underwent cholecystectomy were 949, which were divided into 28 patients who had SSIs and 921 who had no SSIs. The rate of SSIs was 3%. The factors related to SSI in cholecystectomy were age ≥ 60 years (p = 0.045), history of smoking (p = 0.004), retrieval bag use (p = 0.005), preoperative ERCP (p = 0.02), and wound class III and IV (p = 0.007). Risk assessment was using five variables (WEBAC): (1) wound classifications, (2) preoperative ERCP, (3) retrieval plastic bag use, (4) aged ≥ 60 years, and (5) history of smoking (cigarette). If patients were aged ≥ 60 years and had a history of smoking, no plastic bag use, preoperative ERCP, or wound class III or IV, these parameters would all be scored 1 each. The WEBAC score revealed the probability of SSIs in cholecystectomy wounds. CONCLUSION: The WEBAC score represents a convenient and simple tool to predict the probability of SSI in the patients who underwent cholecystectomy and might increase the surgeons' awareness of postoperative SSI.

Ruptured appendicitis with undiagnosed Graves' disease: Contrast-induced impending thyroid storm.

Background: Thyrotoxicosis is a generally common endocrine condition. Widespread radiologic studies and interventional treatments can increase the prevalence of contrast-induced thyrotoxicosis. Case presentation: A younger Thai female was diagnosed acute appendicitis that underwent computed tomography of abdomen with contrast injection. After the operation, she had fever and tachycardia without source of infection, but her thyroid function test showed hyperthyroidism, so she was diagnosed graves' disease and received the treatment without thyroid storm. Discussion: Graves' disease is the most prevalent cause of hyperthyroidism in women but there are many causes of hyperthyroidism especially contrast-induced hyperthyroidism in this care, so the necessary of diagnostic tools especially contrast computed tomography should be carefully used in some patients. Conclusion: Critical radiologic studies and interventional procedures can increase the prevalence of contrast-induced thyrotoxicosis, particularly in high-risk patients. Utilizing a multidisciplinary team, clinicians must promptly address thyrotoxicosis and avert the thyroid storm.