Diagnostic testing for SARS-CoV-2 infection in HHT patients: nasopharyngeal versus oropharyngeal swab

On March 11, 2020, WHO has defined the novel coronavirus disease SARS-CoV-2 (COVID-19) outbreak as a pandemic that still today continues to affect much of the world. Among the reasons for the rapid spread of SARS-CoV-2 infection, there is the role of asymptomatic or minimally symptomatic carriers. Therefore diagnostic testing is central to contain the global pandemic. Up to now real-time reverse transcriptase polymerase chain reaction-based molecular assays for detecting SARS-CoV-2 in respiratory specimens is the current reference standard for COVID-19 diagnosis. Based on current knowledge regarding the sensitivity of the molecular test, the highest positive detection rate is from lower respiratory tract specimens; alternatively it is possible to perform a nasopharyngeal or oropharyngeal swab. Nasopharyngeal swab is the preferred choice for SARS-CoV-2 testing since it seems to have a greater sensitivity; however the procedure is not always free of complications and an epistaxis can occur. Among patients with greatest risk of massive nosebleed there are HHT patients. Hereditary hemorrhagic telangiectasia is an autosomal dominant disease that leads to multiregional mucocutanous telangiectases and visceral arteriovenous malformations. Clinically, the presence of telangiectases in nasal mucosa is the cause of recurrent epistaxis. In HHT patients the execution of the nasopharyngeal swab can determine from little or no consequences to a massive epistaxis leading to the necessity of nasal packing generally followed by hospital admission. In HHT patients undergoing a diagnostic test to evaluate the SARS-CoV-2 infection status, especially in those patients with frequent epistaxis with a history of anemia and repeated hospitalizations, it is therefore advisable to perform an oropharyngeal swab. This, compared to the nasopharyngeal swab, exposes to a lower risk of severe nosebleeds related treatments, such as blood transfusions or invasive procedures. According to the risk-benefit assessment and based on our experience, we consider that, despite a lower diagnostic sensitivity, oropharyngeal swab is preferable to nasopharyngeal swab for the diagnosis of SARS CoV-2 infection in patients with HHT

Hamstring Injury Trends in Major and Minor League Baseball: Epidemiological Findings From the Major League Baseball Health and Injury Tracking System.

Background: Hamstring strains are the most common injury for professional baseball players and can result in significant time on the disabled list. To date, no study has reported the current trends in hamstring strains in professional baseball. Hypothesis: Professional baseball players would have an increased incidence of hamstring strains from 2011 through 2016. Study Design: Descriptive epidemiology study. Methods: Injury data were prospectively collected from 2011 through 2016 for every Major League Baseball (MLB) and Minor League Baseball (MiLB) team and was recorded in the MLB Health and Injury Tracking System. Data collected for this study included date of injury, activity during injury, time lost, primary injury or reinjury status, and imaging findings as well as player demographic information related to level of play, age, and position for all hamstring injury events. Injury rates were reported as hamstring injuries per number of games. Results: From 2011 to 2016, there were 2633 hamstring strains in professional baseball players. The rate of hamstring strains increased in MLB from a low of 1 injury every 39 games in 2011 to a high of 1 injury every 30 games in 2016. In MiLB, there were 2192 hamstring strains, with 1 injury every 35 games in 2011 compared with 1 injury every 30 games in 2016. The majority of injuries occurred in the infielder positions (37.5%) and resulted from base running (\u3e50%), most commonly from home to first base. The most common hamstring injury was a grade 2 injury to the distal biceps femoris. The mean time missed after a hamstring injury was 14.5 days. Grade 3 and grade 2 hamstring strains resulted in significantly more days missed compared with grade 1 injuries ( Conclusion: The rate of hamstring strains in professional baseball players has increased over the past 6 years and has resulted in a significant loss of playing time. Study results indicated that these injuries are affected by injury characteristics, position played, running to first base, seasonal timing, and history of hamstring injuries

Medical students' perceptions of the educational environment at an Iranian Medical Sciences University

<p>Abstract</p> <p>Background</p> <p>Students' perceptions of their educational environment have a significant impact on their behavior and academic progress. The aim of this study was to assess the perceptions of medical students concerning their educational environment at Hormozgan University of Medical Sciences in Iran.</p> <p>Methods</p> <p>In this cross-sectional study, questionnaires were distributed to 210 medical students and 182 were analyzed (response rate = 86.6%); twenty-eight questionnaires were excluded because they were incomplete or unreturned for analysis. Data were collected using a DREEM questionnaire which comprised 50 items based on the Likert scale (scores could range from 0 to 200). There were five domains to the questionnaire including students' perceptions of learning, students' perceptions of teachers, students' academic self-perceptions, students' perceptions of atmosphere and students' social self-perceptions. Data were analyzed using SPSS16 software.</p> <p>Results</p> <p>The mean age of the subjects was 21.7 years (SD = 2.7); 38.5% were male and 61.5% were female. Students' perceptions of learning, students' perceptions of teachers, students' academic self-perceptions, students' perceptions of atmosphere, students' social self-perceptions and total DREEM score were 21.2/48, 24.2/44, 15.8/32, 23.8/48, 14.5/28 and 99.6/200, respectively. There was no significant difference between male and female students in educational environment subscales, but there were significant differences between students enrolled on a basic sciences and pathophysiology course and those enrolled on a clinical course in terms of perceptions of learning, academic self-perceptions, perceptions of atmosphere and overall perceptions of educational environment (p < 0.05). The latter group rated each of the aforementioned aspects more highly than the students studying basic science and pathophysiology.</p> <p>Conclusion</p> <p>Overall, respondents assessed the educational environment as average. Therefore, improvements are required across all five domains of the educational environment.</p

Characterization of epidemiological distribution and outcome of COVID-19 in patients with hereditary hemorrhagic telangiectasia: a nationwide retrospective multi-centre study during first wave in Italy

Background: Coronavirus Disease 2019 (COVID-19) continues to have a devastating impact across the world. A number of pre-existing common clinical conditions were reported to represent risk factors for more severe COVID-19 outcomes. Hereditary Hemorrhagic Telangiectasia (HHT) is a rare vascular heritable disorders, characterized by complications secondary to visceral Arterio-Venous Malformations. The impact of HHT, as well as for many Rare Diseases (RDs) on infection susceptibility profile and clinical adverse outcome risk is an unresolved issue. Objectives: The main objectives were: to assess the clinical features and outcomes of HHT patients infected with COVID-19; to compare the relative infection risk in these patients with the Italian general population throughout the first pandemic wave; to investigate the factors potentially associated with severe COVID-19 outcome in HHT patients, and the possible impact of COVID-19 infection on HHT-related symptoms/complications. Finally, we aimed to estimate how the lockdown-associated wearing of personal protective equipment/individual protection devices could affect HHT-related telangiectasia bleeding frequency. Methods: The study is a nation-wide questionnaire-based survey, with a multi-Center retrospective cross-sectional design, addressed to the whole Italian HHT population. COVID-19 cases, occurring throughout the first pandemic wave, were collected by a questionnaire-based semi-structured interview. Only the cases ascertained by laboratory confirmation (molecular/serological) were included for epidemiological estimates. Information concerning eventual SarS-Cov-2 infection, as well as regarding HHT-related manifestations and HHT-unrelated co-morbidities were collected by the questionnaire. Prevalence data were compared to Italian general population in the same period. Results: The survey disclosed 9/296 (3.04%) COVID-19 cases, 8/9 of them being resident in Lombardy, the main epidemic epicenter. Pneumonia was reported by 4/9 patients, which prompted hospital admission and intensive care management in 2 cases. No fatal outcome was recorded. After careful refinement of epidemiological analysis, the survey evidenced overlapping infection risk in HHT compared to general population. Conclusions: COVID-19 infection profile parallels geographical distribution of epidemic foci. COVID-19 in HHT patients can lead to highly variable clinical profile, likely overlapping with that of general population. The HHT disease does not seem to involve a different approach in terms of hospital admission and access to intensive care with respect to general population

Willing suspension of disbelief: a study in online learning through simulation, and its potential for deeper learning in Higher Education

This article describes the replacement of a 'traditionally taught' law of probate course (lectures and workshops/tutorials) with an on-line collaborative learning exercise using simulation and role-play which is referred to hereafter as the Transactional Learning Project ('TLP'). The article considers the theory that the emotional engagement that comes about through role play in simulation leads to deeper learning, a process Maharg (2010) has dubbed as the 'integration of the cognitive and the affective'. The article includes statistical analysis of student feedback on the TLP in an attempt to measure how easy it is to carry students predisposed to expect information to be 'given' rather than 'acquired' along the journey leading away from traditional didactic teaching. The project was motivated partly by the dearth of such learning practices on the Legal Practice Course. It is suggested that the findings of the project add to the body of research which tends to illustrate the success in terms of student learning from working in leaderless (i.e. where the tutor is absent from the collaborative group) groups engaged in practical tasks involving simulation

The DREEM, part 1: measurement of the educational environment in an osteopathy teaching program

Background Measurement of the educational environment has become more common in health professional education programs. Information gained from these investigations can be used to implement and measure changes to the curricula, educational delivery and the physical environment. A number of questionnaires exist to measure the educational environment, and the most commonly utilised of these is the Dundee Ready Educational Environment Measure (DREEM). Methods The DREEM was administered to students in all year levels of the osteopathy program at Victoria University (VU), Melbourne, Australia. Students also completed a demographic survey. Inferential and correlational statistics were employed to investigate the educational environment based on the scores obtained from the DREEM. Results A response rate of 90% was achieved. The mean total DREEM score was 135.37 (+/- 19.33) with the scores ranging from 72 to 179. Some subscales and items demonstrated differences for gender, clinical phase, age and whether the student was in receipt of a government allowance. Conclusions There are a number of areas in the program that are performing well, and some aspects that could be improved. Overall students rated the VU osteopathy program as more positive than negative. The information obtained in the present study has identified areas for improvement and will enable the program leaders to facilitate changes. It will also provide other educational institutions with data on which they can make comparisons with their own programs

Using Latent Profile Analysis to Understand Health Practitioners’ Attitudes Toward Voluntary Assisted Dying

Prior work has documented considerable diversity among health practitioners regarding their support for voluntary assisted dying (VAD). We examined whether their attitudes are characterised by different combinations of personal support, normative support by other health practitioners, and whether they are predisposed to vicariously experience others’ emotions (i.e., empathy). We also examined whether these profiles experienced different mental health outcomes (i.e., burnout and posttraumatic stress) in relation to VAD. To test this, 104 Australian health practitioners were surveyed after VAD was legalised in Victoria, Australia in 2019. Results indicated that practitioners’ attitudes were characterised by three profiles: 1) strong personal and normative support (strong VAD supporters), 2) moderate personal and normative support (moderate VAD supporters), and 3) lower personal and normative support (apprehensive practitioners). However, each profile reported similar mental health outcomes. Findings suggest that the normative environments in which health practitioners operate may explain their diverse attitudes on VAD

Using Latent Profile Analysis to Understand Health Practitioners’ Attitudes Toward Voluntary Assisted Dying

Prior work has documented considerable diversity among health practitioners regarding their support for voluntary assisted dying (VAD). We examined whether their attitudes are characterised by different combinations of personal support, normative support by other health practitioners, and whether they are predisposed to vicariously experience others’ emotions (i.e., empathy). We also examined whether these profiles experienced different mental health outcomes (i.e., burnout and posttraumatic stress) in relation to VAD. To test this, 104 Australian health practitioners were surveyed after VAD was legalised in Victoria, Australia in 2019. Results indicated that practitioners’ attitudes were characterised by three profiles: 1) strong personal and normative support (strong VAD supporters), 2) moderate personal and normative support (moderate VAD supporters), and 3) lower personal and normative support (apprehensive practitioners). However, each profile reported similar mental health outcomes. Findings suggest that the normative environments in which health practitioners operate may explain their diverse attitudes on VAD

Peer mentoring to develop psychological literacy in first-year and graduating students

First- and final-year undergraduate students have unique transition issues. To support both the transition of first-year students into the program, and the transition of third-year students out of the program and into the workforce or further study, a face-to-face peer mentoring program was embedded into the first-year psychology curricula at RMIT University, Melbourne, Australia. The 34 peer mentors, third-year students taking a course on mentoring and career preparation, worked in pairs with small groups of first-year students (N = 231) in class time to help them develop study skills that underpin the first-year assessment tasks. This article reports on a peer mentoring program designed to develop and consolidate psychological literacies of both first- and third-year students. Comparing pre- and post-tests for first-year students, there was a significant increase in self-ratings across 8 of the 9 ability areas used to measure psychological literacy. In contrast, third-year mentors only showed significant change in the ability to understand basic psychological concepts. Correlational data reveal, for mentees, final course grades were significantly correlated with domain-specific psychological literacy, comprising knowledge and understanding of basic psychological concepts, scientific research practices, application of psychology, and ethics; for mentors, final course grades were significantly correlated with general psychological literacy, comprising cultural competence, critical thinking, problem solving, communication, and self-awareness skills. While first-year students indicated an overall positive experience with the mentoring program, the third-year mentors showed strong support for the program. The key implications are discussed