Tocilizumab vs. baricitinib in hospitalized severe COVID-19 patients: results from a real-world cohort.

BACKGROUND: Tocilizumab and baricitinib are recommended treatment options for hospitalized COVID-19 patients requiring oxygen support. Literature about its efficacy and safety in a head-to-head comparison is scarce. METHODS: Hospitalized COVID-19 patients requiring oxygen were treated with tocilizumab or baricitinib additionally to dexamethasone. Tocilizumab was available from February till the 19th of September 2021 and baricitinib from 21st of September. The primary outcome was in-hospital mortality. Secondary outcome parameters were progression to mechanical ventilation (MV), length-of-stay (LOS) and potential side effects. RESULTS: 159 patients (tocilizumab 68, baricitinib 91) with a mean age of 60.5 years, 64% male were included in the study. Tocilizumab patients were admitted 1 day earlier, were in a higher WHO category at the time of inclusion and had a higher CRP level on admission and treatment initiation. Patients receiving Tocilizumab were treated with remdesivir more often and only patients in the baricitinib group were treated with monoclonal antibodies. Other characteristics did not differ significantly. In-hospital mortality (18% vs. 11%, p = 0.229), progression to MV (19% vs. 11%, p = 0.173) and LOS (13 vs. 12 days, p = 0.114) did not differ between groups. Side effects were equally distributed between groups, except ALAT elevation which was significantly more often observed in the tocilizumab group (43% vs. 25%, p = 0.021). CONCLUSIONS: In-hospital mortality, progression to MV and LOS were not significantly different in patients treated with tocilizumab or baricitinib additionally to standard of care. Both drugs seem equally effective but further head-to-head trials are needed.

Using medical comics to explore challenging everyday topics in medicine: lessons learned from teaching medical humanities.

BACKGROUND: Studying medicine requires an extensive acquisition of knowledge, skills and attitudes. At the MedUni Vienna, this wide range of skills is strengthened by discussing aspects of medical humanities (MH) with medical students in their pre-clinical fifth study year. Medical comics (MCs), as a part of MH, offer the possibility to address challenging situations within medical settings through the use of graphic illustrations. Thus, patient stories as well as different perspectives of patients, caregivers, and medical staff can be addressed. METHODS: A total of 506 medical students were randomly assigned to one of three MCs within a blended learning setting via the Moodle online learning platform. The medical students were instructed to reflect on the MC by answering three questions within one week. Depending on the MC assigned, the learning objectives were to (I) comprehend demands on a young doctor during a night shift, (II) reflect on a patient examination situation, or (III) recognize patients' physical and/or emotional needs. The word counts of the answers and the time spent online answering the questions in the learning platform were analyzed. This was followed by an analysis in which the answers and their content were rated on a three-point Likert scale (insufficient, sufficient, exceptional). Subsequently, an MH and MCs lecture was held that incorporated the medical students' reflections. After the lecture, a one-minute paper (OMP) survey comprising two questions was conducted on the learning platform. RESULTS: Of the 506 medical students assigned the online task, 505 completed it. On average, each medical student wrote 110.87 words (SD: 78.54; range, 4.00-602.00) and spent 12.75 minutes (SD: 11.60) on the task. Of all the answers, 84% were rated as sufficient or exceptional. Two OMP questions: (I) "What was the most important thing you learned today?", and (II) "What questions remain unanswered?" were answered by the medical students. "What was the most important thing you learned today?" was answered by 78% (n=393) of the medical students with a profound statement. When asked "What questions remain unanswered?", 85% (n=429) of the medical students stated that nothing was left unanswered. All the answers included 154 positive and 28 negative comments on the lecture. CONCLUSIONS: The study results indicate that medical students saw great potential in the use of MCs in medical teaching in terms of addressing challenging topics and reflecting on them deeply. This kind of blended learning (a form of learning in which the advantages of face-to-face events and e-learning are combined) successfully showed that medical students can gain a deeper understanding of MH and be inspired through the use of MCs.