Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: a prospective study.

The COVID-19 pandemic has overlapped with the scheduled interview periods of over 20 surgical subspecialty fellowships, including the Complex General Surgical Oncology (CGSO) fellowships in the National Resident Matching Program and the Society of Surgical Oncology’s Breast Surgical Oncology fellowships. We outline the successful implementation of and processes behind a virtual interview day for CGSO fellowship recruitment after the start of the pandemic. The virtual CGSO fellowship interview process at the University of Chicago Medicine and NorthShore University Health System was outlined and implemented. Separate voluntary, anonymous online secure feedback surveys were email distributed to interview applicants and faculty interviewers after the interview day concluded. Sixteen of 20 interview applicants (80.0%) and 12 of 13 faculty interviewers (92.3%) completed their respective feedback surveys. Seventy-five percent (12/16) of applicants and all faculty respondents (12/12) stated the interview process was ‘very seamless’ or ‘seamless’. Applicants and faculty highlighted decreased cost, time savings, and increased efficiency as some of the benefits to virtual interviewing. Current circumstances related to the COVID-19 pandemic require fellowship programs to adapt and conduct virtual interviews. Our report describes the successful implementation of a virtual interview process. This report describes the technical steps and pitfalls of organizing such an interview and provides insights into the experience of the interviewer and interviewee.

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Virtual Surgical Fellowship Recruitment During COVID-19 and Its Implications for Resident/Fellow Recruitment in the Future.

Background In 2017, approximately 90% of U.S. orthopaedic residents chose to participate in orthopaedic fellowships. The process of applying and interviewing for an orthopaedic fellowship is expensive and time-consuming for both orthopaedic residents and orthopaedic residency programs. Considerable physician man-hours are allocated to fellowship interviews and the match ranking process, and there are unintended consequences of time away from work for the resident and his or her training program. To reduce time and cost allocated to fellowship interviews, we implemented videoconference interviews for our adult reconstruction fellowship. The purpose of this article was to communicate the lessons that we learned about this innovation. Methods Candidates and faculty who participated in videoconference interviews for our adult reconstruction fellowship during 2015 through 2017 were surveyed to learn more about the utility and acceptance of videoconference interviewing. Results Eighty-five percent of the 47 videoconference interview candidates who responded to our survey believed that the videoconference interviews gave them a satisfactory understanding of our adult reconstruction fellowship; 85% of candidates stated that the fellowship manual and the videoconference interviews gave them a satisfactory understanding of our fellowship; 89% of candidates stated that the videoconference interview met their expectations; 85% of candidates believed that the videoconference interviews allowed them to present themselves to the program to their satisfaction; and 81% of candidates were comfortable ranking our program after the videoconference interviews. Furthermore, there was universal gratitude in the subjective comments for the convenience and low cost of the videoconference interviews. However, we are concerned that 15% of the candidates did not believe that they had the opportunity to present themselves to their satisfaction with videoconference interviews; 19% of applicants were not comfortable ranking our program after a videoconference interviews; 34% of videoconference interview candidates stated that the videoconference interviews had an unfavorable impact on their ranking of our program; and 30% of candidates believed that the videoconference interview was not a good format for fellowship interviews. Conclusions This review presents what we learned about using videoconference interviews for evaluating and selecting adult reconstruction fellows. The role of videoconference interviews for selecting adult reconstruction fellows remains to be determined.

Videoconference Interviews for an Adult Reconstruction Fellowship: Lessons Learned

Machine learning analysis of social media data represents a promising way to capture longitudinal environmental influences contributing to individual risk for suicidal thoughts and behaviors. Our objective was to generate an algorithm termed “Suicide Artificial Intelligence Prediction Heuristic (SAIPH)” capable of predicting future risk to suicidal thought by analyzing publicly available Twitter data. We trained a series of neural networks on Twitter data queried against suicide associated psychological constructs including burden, stress, loneliness, hopelessness, insomnia, depression, and anxiety. Using 512,526 tweets from N = 283 suicidal ideation (SI) cases and 3,518,494 tweets from 2655 controls, we then trained a random forest model using neural network outputs to predict binary SI status. The model predicted N = 830 SI events derived from an independent set of 277 suicidal ideators relative to N = 3159 control events in all non-SI individuals with an AUC of 0.88 (95% CI 0.86–0.90). Using an alternative approach, our model generates temporal prediction of risk such that peak occurrences above an individual specific threshold denote a ~7 fold increased risk for SI within the following 10 days (OR = 6.7 ± 1.1, P = 9 × 10−71). We validated our model using regionally obtained Twitter data and observed significant associations of algorithm SI scores with county-wide suicide death rates across 16 days in August and in October, 2019, most significantly in younger individuals. Algorithmic approaches like SAIPH have the potential to identify individual future SI risk and could be easily adapted as clinical decision tools aiding suicide screening and risk monitoring using available technologies.

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A machine learning approach predicts future risk to suicidal ideation from social media data.

Every year in the United States, medical students and residency programs dedicate millions of dollars to the residency matching process. On-site interviews for training positions involve tremendous financial investment, and time spent detracts from educational pursuits and clinical responsibilities. Students are usually required to fund their own travel and accommodations, adding additional financial burdens to an already costly medical education. Similarly, residency programs allocate considerable funds to interview-day meals, tours, staffing, and social events. With the rapid onslaught of innovations and advancements in the field of telecommunication, technology has become ubiquitous in the practice of medicine. Internet applications have aided our ability to deliver appropriate, evidence-based care at speeds previously unimagined. Wearable medical tech allows physicians to monitor patients from afar, and telemedicine has emerged as an economical means by which to provide care to all corners of the world. It is against this backdrop that we consider the integration of technology into the residency application process. This article aims to assess the implementation of technology in the form of web-based interviewing as a viable means by which to reduce the costs and productivity losses associated with traditional in-person interview days.

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Feasibility and Usability of Tele-interview for Medical Residency Interview.

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) is a highly infectious viral syndrome currently threatening millions of people worldwide. It is widely recognized as a disease of the pulmonary system, presenting with fever, cough, and shortness of breath. However, a number of extrapulmonary manifestations have been described in the literature. Objective In this review, we seek to provide a comprehensive summary of the hematologic, gastroenterological, renal, dermatologic, neurologic, and psychiatric manifestations of COVID-19. Discussion Hematological presentations of COVID-19 include laboratory abnormalities such as decreased total lymphocyte count, prolonged prothrombin time (PT), elevated d-dimer, and increased lactate dehydrogenase (LDH). Several of these findings are associated with increased mortality among infected patients. The most common gastrointestinal symptoms include nausea, vomiting, diarrhea, and abdominal pain. Furthermore, presence of viral RNA in patient stool suggests the possibility of additional testing modalities for COVID-19. Nephrological findings such as proteinuria, hematuria, and elevated BUN and creatinine levels have been observed. Additionally, several studies demonstrated that patients with COVID-19 who developed acute kidney injury (AKI) had a greater risk of mortality. The virus can also present with cutaneous symptoms such as erythematous rashes, urticaria, and chicken pox-like lesions. Neuropsychiatric symptoms have been described in the literature, and patients can exhibit findings consistent with viral encephalitis, cerebral vascular disease, peripheral nerve disorders, and psychosis. Conclusion Although COVID-19 does usually present primarily with respiratory symptoms, the extra-pulmonary manifestations of the virus are unpredictable and varied. Better understanding and awareness of these symptoms can lead to more efficient diagnosis, rapid treatment, isolation, and decreased spread of the disease.

/pdf/non-respiratory-presentations-of-covid-19-a-clinical-review-3cce08nomp.pdf

Non-respiratory presentations of COVID-19, a clinical review.

Introduction: Suicide is a significant public health problem among teenagers and young adults in the United States, placing significant stress on emergency departments (EDs) to effectively...

Social Media and Suicide: A Review of Technology-Based Epidemiology and Risk Assessment.

Targeted Glycemic Control for Adult Patients With Type 2 Diabetes Mellitus in the Acute Care Setting.

Human sex trafficking is a global public health crisis. Emergency departments (EDs) are important access points for trafficked persons who seek medical care. However, because of victims’ hesitancy to disclose their situation and health care practitioners' lack of training and institutional protocols, many trafficked persons go unrecognized.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/emp2.12638

Amy Caggiula

Papers

Feasibility and Usability of Tele-interview for Medical Residency Interview.

Non-respiratory presentations of COVID-19, a clinical review.

Social Media and Suicide: A Review of Technology-Based Epidemiology and Risk Assessment.

Targeted Glycemic Control for Adult Patients With Type 2 Diabetes Mellitus in the Acute Care Setting.

Sex trafficking screening and intervention in the emergency department: A scoping review