Background The coronavirus disease (COVID-19) pandemic has disrupted medical education for trainees of all levels. Although telesimulation was initially used to train in resource-limited environments, it may be a reasonable alternative for replicating authentic patient experiences for medical students during the COVID-19 pandemic. It is unclear whether a more passive approach through telesimulation training is as effective as traditional in-person simulation training. Objective Our aim was to evaluate the effectiveness of in-person versus remote simulation training on learners’ comfort with managing critical care scenarios. Methods This was a prospective observational cohort study assessing the impact of an in-person versus remote simulation course on volunteer fourth-year medical students from February to April 2021 at the University of California San Diego School of Medicine. Precourse and postcourse surveys were performed anonymously using an online secure resource. Results In the in-person learners, there was statistically significant improvement in learner comfort across all technical, behavioral, and cognitive domains. In remote learners, there was a trend toward improvement in self-reported comfort across technical and cognitive domains in the telesimulation course. However, the only statistically significant improvement in postcourse surveys of telesimulation learners, compared with baseline, was in running codes. Regardless of the training modality, the students had a positive experience with the critical care simulation course, ranking it, on average, 9.6 out of 10 (9.9 in in-person simulation vs. 9.3 in telesimulation; P = 0.06). Conclusion We demonstrated that implementation of a telesimulation-based simulation course focusing on critical care cases is feasible and well received by trainees. Although a telesimulation-based simulation course may not be as effective for remote learners as active in-person participants, our study provided evidence that there was still a trend toward improving provider readiness across technical and cognitive domains when approaching critical care cases.
Background Focused cardiac ultrasound (FOCUS) can aid in evaluation and management of patients with cardiac arrest, but image quality in this population has been questioned. Our goal was to determine how often adequate imaging can be obtained in cardiac arrest patients. Methods We conducted a prospective cohort study to examine the utility of FOCUS in cardiac arrest. All patients who presented to the Emergency Department (ED) in cardiac arrest or who had cardiac arrest while in the ED over 6 months were prospectively identified. FOCUS images were obtained as part of routine clinical care. Patients with images obtained were paired with age- and gender-matched controls who underwent FOCUS for another indication during the study period. Image quality was scored by two blinded reviewers using a 0–4 scale, with a score of ≥ 2 considered adequate. Results There were 137 consecutive cardiac arrests, 121 out-of-hospital and 16 in-hospital, during the study period. FOCUS images were recorded in 126 (92%), who were included in the analysis. The average age was 58 years, and 45% were female. Ninety-seven studies (77%) were obtained during advanced cardiac life support while 29 (23%) were obtained after return of spontaneous circulation. The controls were appropriately matched. Of the cardiac arrest studies, 106 (84%) were rated adequate, compared to 116 (92%) in controls (p = 0.08). When compared to control FOCUS studies, the scores given to studies of cardiac arrest patients were lower (p = 0.001). Conclusions FOCUS can reliably be used during cardiac arrest to obtain images adequate to answer clinical questions and guide therapies.
Purpose. To report a case of ocular involvement of Loa loa parasite. Observations. We present a rare case report of a Loiasis diagnosed in the United States from a patient presenting with subcutaneous migration of an adult worm within an eyelid who was found to have systemic disease with microfilaria in his blood. This is the second report in the United States and the eighth case in published literature worldwide. Conclusions and Importance. Due to the relatively mild disease course, Loiasis is relatively ignored in public health in low resource health districts. Understandably, the focus of public health in endemic areas must focus on basic health needs like malnutrition and diseases that entail a greater disease burden. As globalization has increased the amount of trade of physical goods, the effect of immigration also has implications for the spread of infectious disease. Medical practitioners in the United States should be aware of endemic diseases from foreign lands.
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