Reduced survival after upper gastrointestinal bleed endoscopy in the COVID-19 era is a secondary effect of the response to the global pandemic: a retrospective cohort study.

OBJECTIVE: The COVID-19 pandemic has placed increased strain on healthcare systems worldwide with enormous reorganisation undertaken to support 'COVID-centric' services. Non-COVID-19 admissions reduced secondary to public health measures to halt viral transmission. We aimed to understand the impact of the response to COVID-19 on the outcomes of upper gastrointestinal (UGI) bleeds. DESIGN/METHODS: A retrospective observational multicentre study comparing outcomes following endoscopy for UGI bleeds from 24 March 2020 to 20 April 2020 to the corresponding dates in 2019. The primary outcome was in-hospital survival at 30 days with secondary outcomes of major rebleeding within 30 days postprocedure and intervention at the time of endoscopy. RESULTS: 224 endoscopies for 203 patients with UGI bleeds were included within this study. 19 patients were diagnosed with COVID-19. There was a 44.4% reduction in the number of procedures performed between 2019 and 2020. Endoscopies performed for UGI bleeds in the COVID-19 era were associated with an adjusted reduced 30-day survival (OR 0.25, 95% CI 0.08-0.67). There was no increased risk of major rebleeding or interventions during this era. Patients with COVID-19 did not have reduced survival or increased complication rates. CONCLUSION: Endoscopy for UGI bleeds in the COVID-19 era is associated with reduced survival. No clear cause has been identified but we suspect that this is a secondary effect of the response to the COVID-19 pandemic. Urgent work is required to encourage the public to seek medical help if required and to optimise patient pathways to ensure that the best possible care is provided.

FEEDBK: a novel approach for providing feedback.

BACKGROUND: High-quality feedback is fundamental to students' learning. We describe and evaluate FEEDBK, a novel feedback tool that encompasses the focus of learning, student self-evaluation (reflection), the encounter with the patient (professionalism), one task that the student should continue to do (reinforcement), one task that they could do better (improvement) and a key take-home message for self-directed learning. METHODS: Medical students received regular bedside teaching and feedback during a 9-week clinical placement at a teaching hospital. Teaching fellows gave feedback in their usual style during weeks 1-3 and then used the FEEDBK tool during weeks 4-9. Questionnaires and focus groups were used to evaluate the students' experience of feedback before and after the introduction of FEEDBK. RESULTS: FEEDBK significantly enhanced the feedback experience across six domains: identifying learning objectives, chance to reflect, feedback on communication skills/professionalism, specific suggestions for improvement, clear take-home message and personalised feedback. The analysis of the feedback from focus groups yielded four categories: (i) FEEDBK influenced the feedback process (delivering timely feedback); (ii) the nature of the feedback (enhancing both the quantity and the quality of the feedback received); (iii) the structure of the feedback; and (iv) the evolution of teaching and learning. DISCUSSION: FEEDBK may enhance both the quantity and the quality of feedback and has the potential to improve the quality of teaching. It provides teachers with a quick and easy-to-follow framework to signpost curriculum-aligned feedback.