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Introduction: Lung cancer management depends upon a timely histological diagnosis. Unprecedented pressure on various diagnostic facilities were observed during the COVID-19 pandemic. In our hospital, physician-led thoracic ultrasound guided biopsies and Rapid-On-Site-Evaluation (ROSE) ensured the prompt enrollment in the lung cancer diagnostic pathway. Aim and objectives: The COVID-19 pandemic has affected the lung cancer pathway adversely due to aerosol generating procedures, infection control, limited bronchoscopy, endobronchial ultrasound and computed tomography (CT) sessions. During this challenging time, we aimed to maintain a swift and consistent lung cancer pathway, aided by physician-led ultrasound guided interventions. Method(s): A twelve-month prospective analysis was performed on a cohort of all patients with a histological diagnosis of lung cancer, examining methods used for tissue sampling. Result(s): Between April 2020 to March 2021, our lung multi-disciplinary meeting decided the clinical management of 91 patients with confirmed histology. 41% (37/91) of those had biopsies via physician-led ultrasound-interventions. Sites sampled yielding tissue diagnosis were;59% (22/37) supraclavicular fossa nodes, 30% (11/37) lung lesions, 5% (2/37) pleural lesions, 3% (1/37) bone and 3% (1/37) axillary lymph node. Conclusion(s): Our study shows that physician led ultrasound guided biopsies and ROSE are safe and robust for prompt and speedy lung cancer management. It has future research potentials. We welcome comments and experience of other teams in this regard.
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Objective: To prospectively determine whether COVID-19 vaccination is associated with change in menstrual cycle length following vaccination. Material(s) and Method(s): We conducted a longitudinal analysis within a subgroup of 13,018 participants in the Apple Women's Health Study (AWHS) who enrolled between November 2019 and December 2021, having met the following eligibility criteria: were living in the U.S., met minimum age requirements for consent, were English speaking, actively tracked their menstrual cycles, and responded to the COVID-19 vaccination update survey. Cycles tracked when participants were not pregnant, lactating, or using hormonal contraceptives were included. We used conditional linear regression and multivariable linear mixed-effects models with random intercepts to estimate the covariate-adjusted difference in mean cycle length, measured in days, between pre-vaccination cycles and post-vaccination cycles within vaccinated participants, and between vaccinated and unvaccinated participants. We present Bonferroni-adjusted confidence intervals to account for multiple comparisons. Result(s): A total of 120,815 cycles (median = 10 cycles per participant;interquartile range: 4-21) from 9,295 women (8,129 vaccinated;1,160 unvaccinated) were included. Forty-eight percent of participants received the Pfizer-BioNTech vaccine, 32% received Moderna, and 7% received Johnson & Johnson/Janssen. We found no evidence of a difference between mean menstrual cycle length in the unvaccinated and vaccinated participants prior to vaccination (0.16 days, 95% CI: -0.44, 0.75). Among vaccinated women, COVID-19 vaccination was associated with a small increase in cycle length for cycles containing the first dose (0.47, 95% CI: 0.17, 0.76) and cycles containing the second dose (0.36, 95% CI: 0.06, 0.65) of Pfizer-BioNTech or Moderna vaccines compared with pre-vaccination cycles. Cycles containing the single dose of Johnson & Johnson/Janssen were, on average, 1.22 days longer (95% CI: 0.41, 2.03) than pre-vaccination cycles. Post-vaccination cycles returned to average pre-vaccination length, with a 0.11 (95% CI: -0.17, 0.38) day increase in mean cycle length in the first cycle following vaccination, 0.12 (95% CI: -0.15, 0.40) in the second, -0.22 (95% CI: -0.50, 0.05) in the third, and -0.25 (95% CI: -0.52, 0.02) in the fourth cycle post-vaccination. Conclusion(s): COVID-19 vaccination was associated with an immediate short-term increase in menstrual cycle length. However, the magnitude of this increase diminished in cycles following vaccination, and no association with cycle length persisted over time. Impact Statement: Menstrual cycle change following COVID-19 vaccination appears temporary and should not discourage women from becoming vaccinated. Copyright © 2022
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SETTING AND PARTICIPANTS: Internal Medicine residents at the University of Utah DESCRIPTION: The COVID-19 pandemic has presented unique challenges in delivering high-quality educational experiences in outpatient medicine. With social distancing measures in place, educational sessions are now often delivered virtually or asynchronously, generating a need for creative, engaging ways to deliver our ambulatory medicine curriculum. Our Internal Medicine residency program created a resident-led podcast called “Primary Care Anywhere.” This was integrated within ambulatory medicine rotations as an optional assignment to complete with protected academic time. Podcast episode topics consisted of high-yield topics in primary care. Residents were invited to contribute in a variety of ways: create and record a segment, host the episode, generate show notes and design an infographic. A review article and instructions for each task were provided. Residents worked on contributions independently and these were then compiled into one cohesive episode. The Primary Care Anywhere podcast is free and available to the general public. Episodes average 500-700 downloads. EVALUATION: We observed that residents readily volunteered for this optional activity and were very enthusiastic about participating during ambulatory rotations. A total of 40 residents have participated since its initiation in August of 2020, with contributions from faculty and medical students as well. When asked about the primary motivation for participating, 29% hoped to improve primary care knowledge, 21% wanted experience with podcast production, 29% wanted protected academic time and 14% wanted to build their CV. Residents who created and recorded segments felt that it was a very worthwhile experience, specifically that this type of content creation made them more accountable to learning the topic and, by the end, they felt like experts on their sub-topic. When participants were asked to identify which aspect of the experience they found most beneficial, 64% noted improved knowledge of the topic discussed and 21% cited their gained experience with podcast production. Resident contributors appreciated the opportunity to contribute to free, open-access medical education (FOAMed), and listeners felt it was a valuable supplement to their outpatient education. DISCUSSION / REFLECTION / LESSONS LEARNED: Especially in the setting of a pandemic, podcasts seem to be a popular way to learn among medical trainees. While many of our Internal Medicine residents report learning through listening to existing Internal Medicine podcasts, the vast majority had never had an opportunity to contribute to a podcast. Creating a resident-led podcast provided a creative new learning opportunity for residents to actively engage in content creation and peer education while improving clinical knowledge, gaining a new skill in podcast production and building their CV. This is a project that could be easily adopted by other residency programs.
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Background: The use of electronic consent to recruit eligible women to the LEAP1 Study contributed greatly to the study reaching its target sample size of 900 women with, or who were likely to develop, mild to moderate iron deficiency in pregnancy. The COVID-19 pandemic in Australia between 2020-2021 greatly reduced the capacity for recruiting centres to provide in-person informed consent to potential study participants, and as such several centres adopted some form of electronic consent. Recruitment to LEAP1 was completed on the 27th of Oct 2021, when the 907th participant was enrolled. Methods: Adobe Sign was implemented at 1 recruiting centre (Epworth Freemasons), whilst 4 other centres (Monash Medical Centre, Angliss Hospital, Royal Brisbane and Women's Hospital, St George Hospital) adopted fillable PDF consent forms to obtain consent from eligible study participants. Electronic methods of consent were approved by the lead HREC and local RGOs prior to implementation. The remaining 9 participating sites in Australia continued using traditional paper informed consent. Results: A total of 5 recruiting centres implemented at least 1 form of electronic consent. These centres were able to continue study recruitment through the pandemic in 2020 and 2021. Conclusions: Electronic informed consent has shown to be a useful tool in supporting study recruitment in a perinatal context, particularly during the COVID-19 pandemic in Australia between 2020 and 2021. Future trials may benefit from adopting similar methods of informed consent for their participants.
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Background: Emerging data have shown associations between patients with diabetes (PwD) having excess mortality from COVID-19, but granularity is lacking. Methods: We performed a retrospective audit comparing outcomes of COVID-19 in inpatients with and without diabetes, admitted between 31 January and 23 May 2020. Demographic data (age, sex, BMI, ethnicity and postcode), co-morbidities and outcome (ITU admission, respiratory support required, 28-day mortality) were extracted from electronic patient records. For PwD, type and duration of diabetes, HbA1c, diabetes treatment, diabetes-related complications, admission glucose and ketones and episodes of hypoglycaemia (<4.0 mmol/L) or hyperglycaemia (≥12 mmol/L) were also recorded. Results: 405 patients (≥18 years) were analysed, including 108 PwD (2 with type 1 diabetes, 2 with secondary diabetes and 104 with type 2 diabetes). Three patients were newly diagnosed during admission. No patients had diabetic ketoacidosis or hyperglycaemic hyperosmolar syndrome. Median BMI was significantly higher and Index of Multiple Deprivation scores were lower in PwD. Diabetes was associated with higher 28-day mortality and need for non-invasive ventilation but not intubation or ITU admission. HbA1c, diabetes duration, admission glucose and inpatient glycaemic control did not influence ITU admission or mortality. Chronic kidney disease in PwD was associated with higher mortality (50% vs 25.8%, p=0.010). Interestingly, PwD taking metformin had significantly lower mortality (22.4% vs 45.8%, p=0.012) compared with those not on metformin. Conclusions: Our data add insight into associations between diabetes and COVID-19. Although sample size was limited, optimising weight and renal function as well as considering metformin in PwD could potentially be helpful in mitigating COVID-19 related mortality.