Virtual inverted classroom to replace in-person radiology lectures at the time of the COVID-19 pandemic - a prospective evaluation and historic comparison

Background In the time of the coronavirus disease 2019 (COVID-19) pandemic, in-person lectures had to be shifted to online learning. This study aimed to evaluate students’ and lecturers’ perception and effectiveness of a virtual inverted classroom (VIC) concept on clinical radiology in comparison to a historic control. Methods In the winter semester 2020/21, 136 fourth year medical students who completed the clinical radiology VIC during the pandemic, were included in the single centre, prospective study. Results were compared with a historic control that had finished the physical inverted classroom (PIC) in the immediately preceding year. The VIC consisted of an initial phase of self-determined preparation with learning videos and a second interactive phase of clinical case studies alternating between the virtual lecture hall and virtual buzz groups. At the end of the lecture series, students rated the lecture on a scale of 1 (most positive assessment) to 6 (most negative assessment) through an online survey platform. Additionally, they reported their impressions in free-form text. Lecturers were invited to comment on the VIC in a group interview. Main outcomes were final grades and student perception of the VIC. Results Students’ general impression of VIC was lower than that of PIC (median value of 3 [IQR 4, 2] and 1 [IQR 0, 0], p < 0.001), respectively, p < 0.001). The highest rating was achieved concerning use of the audience response system (median 1 [IQR 1, 0]), and the lowest concerning the buzz groups (median 4 [IQR 5, 3]). Students stated that they would have appreciated more details on reading images, greater focus on plenary case studies, and provision of exam related scripts. Lecturers would have liked better preparation by students, more activity of students, and stronger assistance for group support. Exam grades after VIC were better than after PIC (median 1 [IQR 2, 1] and 2 [IQR 2,1], respectively, p < 0.001). Conclusions Students’ overall perception of VIC was satisfactory, although worse than PIC. Final grades improved compared to PIC. Provided an adapted buzz group size and support, VIC may serve as complement in medical education once the pandemic is over.

Patients presenting with acute coronary syndromes have unreported coronary artery calcium on historical CT imaging

Introduction Ischaemic heart disease (IHD) remains the leading cause of mortality globally1. The presence and extent of coronary artery calcification (CAC) is a strong predictor of cardiovascular events, and CAC scoring has been shown to be more predictive of cardiovascular events than other traditional risk assessment scores2. Incidental coronary calcification can be detected and quantified on non-gated CT chest scans covering the heart in the field of view3. This finding is typically not reported4 and hence an opportunity to optimise cardiovascular risk assessment and treatment is missed. Purpose We sought to investigate whether patients presenting to our centre with an acute coronary syndrome (ACS) event had historical CT imaging demonstrating coronary artery calcification. Methods We retrospectively reviewed case records for all patients referred to our centre for an invasive coronary angiogram following their first known admission with an ACS event. ACS were defined according to contemporary guidelines from the European Society of Cardiology. We reviewed a 3 month period prior to the COVID-19 pandemic (01/01/2019–31/03/2019). The national imaging database was interrogated to identify previous CT imaging that includes the heart in the field of view. The presence of coronary calcification was confirmed and quantified using an ordinal scoring method previously described3. The clinical radiology reports for the scans were reviewed to determine the frequency of CAC being reported. Demographic information was collected from our electronic patient record including the presence of risk factors for IHD. Prescribed medication prior to admission was also recorded using the on-admission medicines reconciliation documented in the electronic patient record. Results 385 patients with first presentation of ACS were identified. 75 (19%) had a prior non-gated CT chest imaging. The most common indication for CT was for investigation of possible malignancy. The mean interval from CT imaging to ACS admission was 36 months. CAC was present on 67 (89%) scans. The mean ordinal score was 4.04, corresponding to moderate CAC. The distribution of CAC by coronary artery revealed the majority of disease to involve the left anterior descending artery (Table 1). Only 12/67 (18%) of clinical radiology reports mentioned coronary calcification (Figure 1). Patients with CAC frequently had additional risk factors for IHD. Despite this only 42% were prescribed antiplatelet therapy, and only 45% prescribed a statin. Conclusions A significant proportion of ACS admissions have evidence of CAC on historical CT scans. This finding is often not reported and the majority of patients with demonstrated coronary artery disease are not prescribed appropriate preventative therapies. Systematic reporting of this finding may have a significant impact on the prevention of acute cardiovascular events. FUNDunding Acknowledgement Type of funding sources: None. Table 1

Diagnosis and Treatment of Acute Pancreatitis: Bibliographic Review

Introduction: Acute pancreatitis (AP) is a sudden, reversible inflammatory process of the pancreas, caused by self-digestion. In Ecuador in 2016, 4715 cases were presented, with a mortality of 2.99%. The etiology includes gallstones, alcoholism, hypertriglyceridemia. It presents with upper abdominal pain, nausea and vomiting, it is hospital management. Methodology: It is a descriptive review of the literature on the diagnosis and treatment of BP, based on 31 articles in English and Spanish. Discussion and Results: AP is diagnosed by the clinic and by the serum measurement of lipase and pancreatic amylase. You can also perform other studies such as C-reactive protein, alanine aminotransferase, aspartate aminotransferase, ultrasonography, computed tomography, magnetic resonance imaging, among others. The management of the intake as the main points of perfusion, analgesia, nutrition, clinical, radiology, retrograde endoscopic cholangiopancreatography, antibiotic and surgery. Conclusion: Although the diagnosis is generally clinical and laboratory, for atypical cases, imaging studies are very useful to confirm or exclude the diagnosis. The treatment of PA is summarized in the PANCREAS nemotechnics. (P perfusion, A analgesia, N nutrition, C clinical, R radiology, E endoscopic retrograde cholangiopancreatography, A antibiotic, S surgery). Keywords: pancreatitis, inflammation, diagnosis, treatment. RESUMEN Introducción: La pancreatitis aguda (PA) es un proceso inflamatorio repentino, reversible del páncreas, causado por autodigestión. En Ecuador en el 2016 se presentaron 4 715 casos, con una mortalidad del 2,99%. En la etiología constan: Cálculos biliares, alcoholismo, hipertrigliceridemia. Se presenta con dolor abdominal superior, náuseas y vómito, es de manejo hospitalario. Metodología: Es una revisión bibliográfica descriptiva, sobre el diagnóstico y tratamiento de la PA, en base a 31 artículos en inglés y español. Discusión y Resultados: La PA se diagnostica mediante la clínica y por la medición sérica de lipasa y amilasa pancreática; también se pueden realizar otros estudios como proteína C reactiva, alanina aminotranferasa, aspartato aminotransferasa, ultrasonografía, tomografía computarizada, imagen por resonancia magnética, entre otros. El tratamiento apunta a brindar una adecuada perfusión de tejidos, buena analgesia y principalmente evitar complicaciones. El manejo toma como como principales puntos perfusión, analgesia, nutrición, clínica, radiología, colangiopancreatografia retrograda endoscópica, antibiótico y cirugía. Conclusiones: A pesar de que el diagnóstico es generalmente clínico y de laboratorio, para casos atípicos son de gran utilidad los estudios de imagen para confirmar o excluir el diagnóstico. El tratamiento de PA se resume en la nemotecnia PANCREAS. (P perfusión, A analgesia, N nutrición, C clínica, R radiología, E colangiopancreatografía retrógrada endoscópica, A antibiótico, S cirugía). Palabras clave: pancreatitis, inflamación, diagnóstico, tratamiento.