Pediatric Training Crisis of Emergency Medicine Residency during the COVID-19 Pandemic

Coronavirus disease 2019 (COVID-19) is an emerging viral disease that has caused a global pandemic. Among emergency department (ED) patients, pediatric patient volume mostly and continuously decreased during the pandemic period. Decreased pediatric patient volume in a prolonged period could results in inadequate pediatric training of Emergency Medicine (EM) residents. We collected data regarding pediatric patients who were first seen by EM resident physicians between 1 February 2019, and 31 January 2021, which was divided into pre-epidemic and epidemic periods by 1 February 2020. A significant reduction in pediatric patients per hour (PPH) of EM residents was noted in the epidemic period (from 1.55 to 0.81, p < 0.001). The average patient number was reduced significantly in the classification of infection (from 9.50 to 4.00, p < 0.001), respiratory system (from 84.00 to 22.00, p < 0.001), gastrointestinal system (from 52.00 to 34.00, p = 0.007), otolaryngology (from 4.00 to 2.00, p = 0.022). Among the diagnoses of infectious disease, the most obvious drop was noted in the diagnosis of influenza and enterovirus infection. Reduced pediatric patient volume affected clinical exposure to pediatric EM training of EM residency. Changes in the proportion of pediatric diseases presented in the ED may induce inadequate experience with common and specific pediatric diseases.

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What is the impact of the COVID-19 Pandemic on Emergency Medicine Residency Training: An observational study

10.21203/rs.3.rs-42333/v2 ◽

2020 ◽

Author(s):

Hsiang-Yun Lo ◽

Shen-Che Lin ◽

Chung-Hsien Chaou ◽

Yu-Che Chang ◽

Chip-Jin Ng ◽

...

Keyword(s):

Emergency Medicine ◽

Residency Training ◽

Training Programs ◽

Primary Objective ◽

Clinical Exposure ◽

Number Of Patients ◽

Tertiary Teaching ◽

Epidemic Period ◽

Methods Of Learning ◽

The Impact

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has engendered difficulties for health systems globally; however, the effect of the pandemic on emergency medicine (EM) residency training programs is unknown. The pandemic has caused reduced volumes of emergency department (ED) patients, except for those with COVID-19 infections, and this may reduce the case exposure of EM residents. The primary objective of this study was to compare the clinical exposure of EM residents between the prepandemic and pandemic periods. Methods This was a retrospective study of EM resident physicians’ training in a tertiary teaching hospital with two branch regional hospitals in Taiwan. We retrieved data regarding patients seen by EM residents in the ED between September 1, 2019, and April 30, 2020. The first confirmed COVID-19 case in Taiwan was reported on January 11, so the pandemic period in our study was defined as spanning from February 1, 2020, to April 30, 2020. The number and characteristics of patients seen by residents were recorded. We compared the data between the prepandemic and pandemic periods.Results The mean number of patients per hour (PPH) seen by EM residents in the adult ED decreased in all three hospitals during the pandemic. The average PPH of critical area of medical ED was 1.68 in the pre-epidemic period and decreased to 1.33 in the epidemic period (p value < 0.001). The average number of patients managed by residents decreased from 1.24 to 0.82 in the trauma ED (p value= 0.01) and 1.56 to 0.51 in the pediatric ED (p value=0.003) during the pandemic, respectively. The severity of patient illness did not change significantly between the periods. Conclusions The COVID-19 pandemic engendered a reduced ED volume and decreased EM residents’ clinical exposure. All portion of EM residency training were affected by the pandemic, with pediatric EM being the most affected. The patient volume reduction may persist and in turn reduce patients’ case exposure until the pandemic subsides. Adjustment of the training programs may be necessary and ancillary methods of learning should be used to ensure adequate EM residency training.

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Pediatric Ingestions and Toxicologic Exposures

Pediatric Emergencies ◽

10.1093/med/9780190073879.003.0050 ◽

2020 ◽

pp. 611-623

Author(s):

Vincent Calleo ◽

Richard Cantor

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Pediatric Patient ◽

Pediatric Patients ◽

Sick Child ◽

Medical Intervention ◽

Severe Toxicity ◽

Recreational Drugs ◽

Gastrointestinal Decontamination

For the majority of emergency medicine providers, one of the most anxiety-provoking patients is a very sick child. This is especially true when pediatric patients present to the emergency department after a toxicologic exposure. Pediatric ingestions and toxicologic exposures are extremely common. Although only a small percentage of toxicologic exposures result in death, severe toxicity is frequently seen and requires substantial medical intervention. This chapter focuses on the approach to a poisoned pediatric patient (including gastrointestinal decontamination and common toxidromes) and common medications ingested by pediatric patients and their treatments. It also briefly discusses some recreational drugs that are commonly used in the pediatric community.

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What is the impact of the COVID-19 pandemic on emergency medicine residency training: an observational study

BMC Medical Education ◽

10.1186/s12909-020-02267-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Hsiang-Yun Lo ◽

Shen-Che Lin ◽

Chung-Hsien Chaou ◽

Yu-Che Chang ◽

Chip-Jin Ng ◽

...

Keyword(s):

Emergency Medicine ◽

Residency Training ◽

Training Programs ◽

Primary Objective ◽

Clinical Exposure ◽

Number Of Patients ◽

Tertiary Teaching ◽

Epidemic Period ◽

Methods Of Learning ◽

The Impact

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has engendered difficulties for health systems globally; however, the effect of the pandemic on emergency medicine (EM) residency training programs is unknown. The pandemic has caused reduced volumes of emergency department (ED) patients, except for those with COVID-19 infections, and this may reduce the case exposure of EM residents. The primary objective of this study was to compare the clinical exposure of EM residents between the prepandemic and pandemic periods. Methods This was a retrospective study of EM resident physicians’ training in a tertiary teaching hospital with two branch regional hospitals in Taiwan. We retrieved data regarding patients seen by EM residents in the ED between September 1, 2019, and April 30, 2020. The first confirmed COVID-19 case in Taiwan was reported on January 11, so the pandemic period in our study was defined as spanning from February 1, 2020, to April 30, 2020. The number and characteristics of patients seen by residents were recorded. We compared the data between the prepandemic and pandemic periods. Results The mean number of patients per hour (PPH) seen by EM residents in the adult ED decreased in all three hospitals during the pandemic. The average PPH of critical area of medical ED was 1.68 in the pre-epidemic period and decreased to 1.33 in the epidemic period (p value < 0.001). The average number of patients managed by residents decreased from 1.24 to 0.82 in the trauma ED (p value = 0.01) and 1.56 to 0.51 in the pediatric ED (p value = 0.003) during the pandemic, respectively. The severity of patient illness did not change significantly between the periods. Conclusions The COVID-19 pandemic engendered a reduced ED volume and decreased EM residents’ clinical exposure. All portion of EM residency training were affected by the pandemic, with pediatric EM being the most affected. The patient volume reduction may persist and in turn reduce patients’ case exposure until the pandemic subsides. Adjustment of the training programs may be necessary and ancillary methods of learning should be used to ensure adequate EM residency training.

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Alternative medicine as a treatment options for COVID-19

Current Traditional Medicine ◽

10.2174/2215083807666210104142934 ◽

2021 ◽

Vol 07 ◽

Author(s):

Mahfuza Marzan ◽

Md. Shahedur Rahman ◽

Md. Abu Hena Mostofa Jamal ◽

Mohammad Hossain Shariare ◽

Md. Anowar Khasru Parvez

Keyword(s):

Health Care ◽

Vitamin D ◽

Distress Syndrome ◽

Scientific Evidence ◽

Treatment Options ◽

Viral Disease ◽

Global Pandemic ◽

Medicinal Properties ◽

Mode Of Transmission ◽

High Infectivity

: COVID-19, a viral disease caused by SARS-CoV-2 is the reason of a global pandemic since the starting of the year 2020. The characteristic of the disease varies from mild common cold like symptoms to acute respiratory distress syndrome and multi-organ failure leading to death. World has already observed 213,453 deaths from this disease while 3,095,839 have been infected in 210 countries in total till 28 April, 2020. This disease has a devastating impact over the health care system because of its high infectivity, easy mode of transmission, lack of proper medicine and vaccine and deficiency of enough supportive healthcare arrangement. On verge of this situation scientists are searching the treatment options. However, nature has provided us with enormous herbs which have disease preventive as well as have medicinal properties. In this article we have reviewed several of these plants (ginger, clove, tea, black seed, tulsi, neem) and some vitamins (vitamin C and vitamin D) and zinc which have antiviral, anti-inflammatory, antioxidant, anti-asthmatic properties with scientific evidence. The intake of these products regularly to keep the immune system active, to experience its positive aspects might be supportive to prevent infection with the new coronavirus or to treat COVID-19.

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Literature Review of the Implications of Exercise Rehabilitation Strategies for SARS Patients on the Recovery of COVID-19 Patients

Healthcare ◽

10.3390/healthcare9050590 ◽

2021 ◽

Vol 9 (5) ◽

pp. 590

Author(s):

Wei Cui ◽

Ting Ouyang ◽

Ye Qiu ◽

Di Cui

Keyword(s):

Exercise Intervention ◽

Treatment Strategies ◽

Severe Pneumonia ◽

Clinical Indicators ◽

Exercise Rehabilitation ◽

Global Pandemic ◽

Epidemic Period ◽

Local Risk ◽

And Control ◽

Rehabilitation Strategies

As a global pandemic, COVID-19 shows no sign of letting up. With the control of the epidemic in China, the proportion of patients with severe and critical diseases being cured and discharged from hospital has increased, and the recovery of COVID-19 patients has become an important issue that urgently needs attention and solutions. By summarizing the exercise rehabilitation strategies and progress of SARS in 2003, this paper analyzed the differences in clinical indicators and recovery characteristics of severe pneumonia caused by the two viruses, and provided comprehensive exercise guidance and intervention strategies for COVID-19 patients for rehabilitation and nursing by referring to the problems and treatment strategies in the rehabilitation and nursing work of SARS. In the post-epidemic period, China will build a multi-dimensional epidemic prevention system by improving the effectiveness of mass training and strengthening local risk prevention and control. This paper discusses the exercise rehabilitation strategy of SARS patients after recovery, which has guiding significance for exercise intervention and scientific fitness of COVID-19 patients after recovery during epidemic prevention period.

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Case Study Comparison: Limitations in Telehealth Relating to Poverty and Family Support

Seminars in Hearing ◽

10.1055/s-0041-1731696 ◽

2021 ◽

Vol 42 (02) ◽

pp. 158-164

Author(s):

Lindsey E. Jorgensen ◽

Rachel E. Barrett

Keyword(s):

Family Support ◽

Pediatric Patients ◽

Internet Access ◽

Smart Devices ◽

Internet Connection ◽

The Third ◽

Global Pandemic ◽

Internet Connections ◽

Made In

AbstractTelehealth appointments have grown in popularity due to the COVID-19 global pandemic. Three cases presented in this article show several different perspectives where telehealth was utilized. For the first patient, appointments were successfully completed via telehealth; however, the patient's family opted to continue with an unsecure internet connection at a local laundromat. For the second patient, a stable internet connection could not be obtained in his home, thus making telehealth appointments unavailable. The caregiver of this patient ended up driving to the clinic to have adjustments made in person. For the third patient, telehealth appointments were unavailable due to unstable internet connections as well as difficulty setting up video interpreting services. These cases highlight the idea that telehealth can be incredibly beneficial, when used correctly. For some, the option to attend appointments virtually gives them access to specialists that otherwise may not be available. For other patients, aspects such as access to smart devices and steady internet access must be considered to ensure a successful connection. The hope is that this article sheds light on some of the potential setbacks that can come from the use of telehealth appointments in a practice and provides discussion regarding for whom telehealth may be appropriate, even in pediatric patients. After reading this article, readers should be able to discuss ways in which there could be solutions for these barriers that may prevent some patients from utilizing these types of virtual appointments.

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UPDATE ON CARDIOVASCULAR IMPLICATIONS OF COVID 19

10.36106/gjra/8013840 ◽

2021 ◽

pp. 238-242

Author(s):

Pradeep Kumar Radhakrishnan ◽

Gayathri Ananyajyothi Ambat ◽

Roshini Ambat ◽

Syed Ilas Basha ◽

Hema Prakash ◽

...

Keyword(s):

Virus Disease ◽

Systemic Vasculitis ◽

Myocardial Damage ◽

Viral Disease ◽

Cardiac Damage ◽

Corona Virus ◽

Global Pandemic ◽

Acute Myocardial Injury ◽

Exercise Induced

On March 11 2020 WHO declares corona viral disease as a global pandemic .COVID 19 pandemic has taken the world by storm and many countries like India is now experiencing a second surge due to mutant strains. Global health emergency has been precipitated by this corona virus disease caused by SARS CoV2.Acute and intermediate effects on cardiovascular system are becoming obvious with progression of time. SARS-CoV-2-related endothelial dysfunction results in an augmented risk for venous thromboembolism, systemic vasculitis, endothelial cell apoptosis, and inammation in various organs. Acute infections have troponin elevation more due to indirect cardiac damage though denite patterns of direct damage do exist. Intermediate evaluation in patients with resolved infections shows increased incidence of exercise induced arrhythmias and residual cardiovascular symptoms. The virus with its zoonotic origin based upon its genomic identity to bat derived SARS corona virus has a human to human transmission mode.ACE 2 receptors facilitate cellular entry and has been implicated in direct and indirect myocardial damage. Myocarditis, acute myocardial injury, arrhythmias and thromboembolism dominates the clinical picture. Role of imaging must be dened in relation to relevant clinical ndings. With arrival of vaccine and widespread vaccination global programs, we can look forward to understanding and managing long term complications of this disease. Prognostic implications of a resolved disease need to be evaluated by future studies.

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Bilateral Destructive Hip Disease from Untreated Juvenile Idiopathic Arthritis

Case Reports in Orthopedics ◽

10.1155/2019/4593129 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Arash Calafi ◽

Alton W. Skaggs ◽

Trevor J. Shelton ◽

Brian M. Haus

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Case Report ◽

Femoral Head ◽

Pediatric Patient ◽

Acetabular Dysplasia ◽

Pediatric Patients ◽

Similar Case ◽

Hip Pain ◽

Complete Destruction ◽

Hip Disease

We report a novel case of a pediatric patient with bilateral hip destruction from untreated Juvenile idiopathic arthritis (JIA). She was presented at the age of 9 with hip pain associated with bilateral acetabular dysplasia and a dislocated left femoral head. Only 1.5 years later, the patient developed complete destruction of the left femoral head and dislocated right femoral head. The authors have not identified literature describing a similar case report of bilateral femoral head destruction resulting from Persistent Oligoarticular JIA. Pediatric patients presenting with rapidly evolving destructive process should be evaluated for rheumatologic, infectious, and spinal etiologies.

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Warfarin-Rifampin Drug Interaction in a Pediatric Patient

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-22.5.375 ◽

2017 ◽

Vol 22 (5) ◽

pp. 375-377 ◽

Cited By ~ 2

Author(s):

Michael Poon ◽

Brady S. Moffett ◽

Donald L. Yee

Keyword(s):

Drug Interaction ◽

Pediatric Patient ◽

Warfarin Therapy ◽

Pediatric Patients ◽

Extreme Case ◽

Inhibitory Effect ◽

Adult Patients

Rifampin has been documented to significantly attenuate the effect of warfarin in adult patients. No data have been presented on the use of rifampin and warfarin in a pediatric patient. We report an extreme case of increased warfarin metabolism in a pediatric patient who was concomitantly receiving rifampin, despite receiving other medications that significantly decrease warfarin metabolism. The inhibitory effect of rifampin on warfarin therapy may be amplified in pediatric patients.

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MR Imaging of Meningioangiomatosis in a Pediatric Population

Neurographics ◽

10.3174/ng.1900005 ◽

2019 ◽

Vol 9 (5) ◽

pp. 325-329

Author(s):

A. Bhatia ◽

S. Saade-Lemus ◽

J.M. Ndolo ◽

W. Chow ◽

E.S. Schwartz

Keyword(s):

Mr Imaging ◽

Pediatric Patient ◽

Pediatric Patients ◽

Pediatric Population ◽

Brain Lesion ◽

Solitary Lesion ◽

Leptomeningeal Enhancement ◽

Histopathologic Diagnosis

Meningioangiomatosis (MA) is a rare intracranial hamartomatous lesion. We retrospectively reviewed the MRIs in 6 pediatric patients with a histopathologic diagnosis of MA. Patients with MA demonstrated a solitary lesion in the frontotemporal regions, with FLAIR hyperintensity and leptomeningeal enhancement. A solitary brain lesion in the frontotemporal lobes associated with leptomeningeal enhancement and T2/FLAIR hyperintensity should include the possibility of MA in a pediatric patient who presents with seizures or headaches.

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