Background: Residency programs invest a significant amount of time and resources on the recruitment process, and maintaining efficiency and cost-effectiveness are very important. Virtual Reality (VR) has become an adaptive substitute for 'real life' experiences and its use during the interview season could help save time and resources. Objective: With the intention to maximize the interview day and provide a cost-effective alternative to facility tours, a Med-Peds residency training program introduced a VR tour of their children's hospital during recruitment. Design: The Med-Peds program replaced an in-person facility tour of the children's hospital with a VR tour. Applicants were asked to complete an anonymous, voluntary survey on their VR experience at the end of the interview season, and rank features of the interview day in order of importance. Results: There were 33 respondents out of 54 interviewees. Approximately two thirds (63-66%) agreed that VR was non-inferior and superior to in-person facility tours, and that the use of VR had a favorable impact on their perception of the program. However, almost 50% of the applicants had some difficulty using VR technology. Conclusion: Use of VR facility tours as an alternative to in-person tours of affiliate training facilities during a residency interview day is a viable and innovative option that can save time and money and favorably impact the applicant's impression of the program. More research is necessary to assess whether VR tours can replace in-person tours at the main teaching site, however, while social distancing measures are in place, VR tours may become necessary for programs moving forward.
Background The utility of convalescent COVID-19 plasma (CCP) in the current pandemic is not well defined. We sought to evaluate safety and efficacy of CCP in severely or life threateningly ill COVID-19 patients when matched with a contemporaneous cohort. Methods Patients with severe or life threatening COVID-19 were treated with CCP according to FDA criteria, prioritization by an interdisciplinary team and based on CCP availability. Individual-level matched controls (1:1) were identified from patients admitted during the prior month when no CCP was available. Safety outcome was freedom from adverse transfusion reaction and efficacy outcome a composite of death or worsening O2 support. Demographic, clinical and laboratory data were analyzed by univariate and multivariable regression analyses accounting for matched design. Results Study patients (N=94, 47 matched pairs) were 62% male with mean age of 58 and 98% (90/94) were minority (53% Hispanic, 45% Black, non-Hispanic) in our inner-city population. Seven-day composite and mortality outcomes suggested a non-significant benefit in CCP treated patients (adjusted hazard ratio (aHR), 0.70; 95% confidence interval (CI), 0.23 to 2.12; P=0.52; aHR, 0.23; 95% CI, 0.04 to 1.51; P=0.13, respectively). Stratification by pre-transfusion mechanical ventilation status showed no differences between groups. No serious transfusion reactions occurred. Conclusion In this short-term matched cohort study, transfusion with CCP was safe and showed a non-significant association with study outcomes. Randomized and larger trials to identify appropriate timing and dosing of CCP in COVID-19 is warranted. Trial Registration: ClinicalTrials.gov Identifier: NCT04420988
Widespread usage of electronic cigarettes (e-cigarettes) has driven the recent epidemic of e-cigarette, or vaping, product use associated lung injury (EVALI). Recent reports have described a heterogeneous range of pneumonitis-related sequelae from nonregulated tetrahydrocannabinol (THC) oil extract products used through various e-cigarette devices, piloting an ongoing federal investigation into the chemical constituents involved in such cases. However, to the best of our knowledge, no published reports to date have examined the impact of EVALI on post-discharge pulmonary function tests (PFTs), and the role of pulmonary rehabilitation in improving short-term functional outcomes. We describe the clinical course of an adolescent male with EVALI due to the use of an off-label THC based vaping pod. After a prolonged intubation period in the intensive care unit he exhibited exertional dyspnea at the outset of his rehabilitation. His initial PFTs were notable for a mixed obstructive and restrictive lung pattern and mildly decreased diffusion capacity. The patient had a slow and gradual improvement in his PFTs during pulmonary rehabilitation, as well as a stepwise improvement in his activities of daily living and resolution of substance abuse related stressors with continued supportive counseling.
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