BackgroundA study evaluating subjective trainee responses to simulation training organized by the Malta Foundation Program in particular whether this changed their clinical practice.MethodFeedback using a standardized questionnaire was obtained from 120 (M=55%) participants. A 0–10 Likert scale was used to evaluate responses.ResultsParticipants scored the simulation sessions as “useful” at 7.7 (95% confidence interval [CI] 7.4–8.0), rated “the overall experience” at 7.5 (95% CI 7.2–7.8), and thought it made a change in “daily practice” at 5.83 (95% CI 5.4–6.3). The score for the tutor “creating a satisfactory learning environment” and “quality of simulator equipment” was 7.8 (95% CI 7.6–8.1) and 7.7 (95% CI 7.4–8), respectively. Trainees rated “how close was the simulation to a real-life scenario” as 6.24 (95% CI 5.9–6.6). When asked whether the presence of colleagues hindered or helped, the majority were neutral 50 (41.7%), 36 (30%) said it hindered, while only 21 (28.3%) felt it helped. In contrast, 94 (78.33%) stated it was useful to observe colleagues while only 5 (4.2%) stated it was not. Likelihood for future participation was 7.4 (95% CI 7–7.8). Trainees recommended a median of 3 (interquartile range 2–5) simulations per year.ConclusionTrainees rated the sessions as useful and asked for more sessions possibly at an undergraduate level. Rating for equipment and tutors was positive; however, some felt that the effect on daily practice was limited. Most were comfortable observing others and uncomfortable being observed. The value of increasing sessions to 3–4 per year, timing them before clinical attachments and audiovisual prebriefing for candidates naïve to simulation needs to be evaluated in future studies.
The advent of the COVID-19 pandemic in Malta led to a number of innovations in terms of work practices, including the introduction of blanket swabbing of all hospital admissions for Covid-19 using PCR nasopharyngeal swab as well as the temporary indiscriminate use of Low dose CT Thorax (CT Pneumonia) as a screening tool in all patients with respiratory symptoms or fever, a recent positive contact, history of travel abroad and all health care workers presenting to hospital.Our aim was to assess the performance of CT pneumonia as a screening tool for Covid-19 in a cohort of patients presenting to large teaching hospital. 661 screening CTs performed between 29/3/20 and 14/4/20 were included. 4 CTs (0.6%) were reported as positive for Covid-19, 45 (6.8%) were reported as 'indeterminate' with the remaining 612 (92.6%) reported as 'alternative diagnosis' or negative.Covid-19-PCR-swab was positive in 21 patients (3.2%). Of these, 14 (66.7%) had a Negative CT Pneumonia, 6 (28.6%) had a CT reported as 'Alternative Diagnosis' and 1 (4.8%) had a positive CT for Covid-19. Among the remaining cases testing negative on PCR swab, 3 were reported as having a positive CT and in 2 of these cases, 5/4/22, 2:14 PM An Assessment of the Performance of Low Dose CT Thorax (CT Pneumonia) as a screeing tool in the diagnosis of Covid-19 | Euro… https://erj.ersjournals.com/content/58/suppl_65/PA3251 2/5Covid-19 was confirmed using serology testing. Within the entire population of patients who underwent CT Pneumonia, the overall sensitivity for Covid-19 was 13.0%, specificity was 99.8%, positive predictive value was 75.0% and negative predictive value was 96.7%.CT Pneumonia had a low sensitivity for Covid-19 in our cohort of patients making it a poor screening tool, however it may have a role in those who test negative on PCR swab where a high index of suspicion persists.
Chronic kidney disease patients on maintenance dialysis (CKD 5D) experience major morbidity and mortality. No data on survival in Maltese dialysis patients exist; therefore, the aim of this study was to rigorously examine survival statistics in a complete cohort of Maltese CKD 5D patients. The study population was comprised of all incident chronic patients (N=328) starting dialysis at the renal unit, Mater Dei hospital, Msida, Malta, for 4 consecutive years (2009–2012). Each yearly cohort was analysed in detail up to 31st December 2017, providing up to 8 years follow-up. Demographics (male 65%; female 35%), aetiology of renal failure (diabetic kidney disease: n=191; 58.2%), comorbidities, transplant status, and death were documented. Data collection and follow up were completed and statistical analysis was performed on the aggregated cohorts with SPSS version 23 with censoring up to 31st December 2017. The cumulative adjusted 5-year overall survival in Maltese CKD 5D patients was 0.36 and 0.25 at 8 years. No statistical difference was observed according to the year of starting dialysis. Cox regression analysis showed that age and transplant status influenced survival. The unadjusted hazard of death increased by 3% for every 1-year increase in age and was increased by 7% if the patient did not receive a transplant, and overall 22% (n=72) of the entire cohort eventually received transplants. This study reports an approximate 65% mortality at 5 years in Maltese haemodialysis patients, a poor prognosis that, despite optimal medical management, is consistent with worldwide reports.
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