Educational, psychosocial, and clinical impact of SARS-CoV-2 (COVID-19) pandemic on medical students in the United States

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic altered education,exams,and residency applications for United States medical students.AIM To determine the specific impact of the pandemic on US medical students and its correlation to their anxiety levels.METHODS An 81-question survey was distributed via email,Facebook and social media groups using REDCapTM.To investigate risk factors associated with elevated anxiety level,we dichotomized the 1-10 anxiety score into low(≤5)and high(≥6).This cut point represents the 25th percentile.There were 90(29%)shown as low anxiety and 219(71%)as high anxiety.For descriptive analyses,we used contingency tables by anxiety categories for categorical measurements with chi square test,or mean±STD for continuous measurements followed by t-test or Wilcoxson rank sum test depending on data normality.Least Absolute Shrinkage and Selection Operator was used to select important predictors for the final multivariate model.Hierarchical Poisson regression model was used to fit the final multivariate model by considering the nested data structure of students clustered within State.RESULTS 397 medical students from 29 states were analyzed.Approximately half of respondents reported feeling depressed since the pandemic onset.62%of participants rated 7 or higher out of 10 when asked about anxiety levels.Stressors correlated with higher anxiety scores included“concern about being unable to complete exams or rotations if contracting COVID-19”(RR 1.34;95%CI:1.05-1.72,P=0.02)and the use of mental health services such as a“psychiatrist”(RR 1.18;95%CI:1.01-1.3,P=0.04).However,those students living in cities that limited restaurant operations to exclusively takeout or delivery as the only measure of implementing social distancing(RR 0.64;95%CI:0.49-0.82,P<0.01)and those who selected“does not apply”for financial assistance available if needed(RR 0.83;95%CI:0.66-0.98,P=0.03)were less likely to have a high anxiety.CONCLUSION COVID-19 significantly impacted medical students in numerous ways.Medical student education and clinical readiness were reduced,and anxiety levels increased.It is vital that medical students receive support as they become physicians.Further research should be conducted on training medical students in telemedicine to better prepare students in the future for pandemic planning and virtual healthcare.

The clinical impact of tricuspid regurgitation in patients with a biatrial orthotopic heart transplant

In this study,we aim to elucidate the clinical impact and long-term course of tricuspid regurgitation(TR),taking into account its dynamic nature,after biatrial orthotopic heart transplant(OHT).All consecutive adult patients undergoing biatrial OHT(1984−2017)with an available follow-up echocardiogram were included.Mixed-models were used to model the evolution of TR.The mixed-model was inserted into a Cox model in order to address the association of the dynamic TR with mortality.In total,572 patients were included(median age:50 years,males:74.9%).Approximately 32% of patients had moderate-to-severe TR immediately after surgery.However,this declined to 11%on 5 years and 9% on 10 years after surgery,adjusted for survival bias.Preimplant mechanical support was associated with less TR during follow-up,whereas concurrent LV dysfunction was significantly associated with more TR during follow-up.Survival at 1,5,10,20 years was 97%±1%,88%±1%,66%±2% and 23%±2%,respectively.The presence of moderate-to-severe TR during follow-up was associated with higher mortality(HR:1.07,95%CI(1.02–1.12),p=0.006).The course of TR was positively correlated with the course of creatinine(R=0.45).TR during follow-up is significantly associated with higher mortality and worse renal function.Nevertheless,probability of TR is the highest immediately after OHT and decreases thereafter.Therefore,it may be reasonable to refrain from surgical intervention for TR during earlier phase after OHT.

Clinical observation of bone graft impaction on posterior intervertebral body fusion for lumbar spondylolisthesis

Objective To investigate the clinical effect of bone graft impaction on posterior intervertebral fusion for lumbar spondylolisthesis.Methods From January 2001 to July 2008,36 patients with lumbar spondylolisthesis were treated by

The impact of operative timing on clinical outcomes in elderly hip fracture

Objective To study the effect of operative timing on clinical outcomes in elderly hip fracture.Methods Two hundred sixty-seven patients with hip fracture were treated from July 2006 to May 2008.The patients who had an operation within

Concomitant administration of gastric acid suppression might attenuates the clinical efficacy of gefitinib:a single cancer center retrospective study

Recent pharmacokinetic studies have demonstrated that gastric acid suppression(AS)reduces exposure of gefitinib.However,the clinical significance of this drug-drug interaction(DDI)has not been determined.We,therefore,evaluated it in this real-world study.A total of 200 NSCLC patients who received gefitinib from 2016 to 2018 at Fudan University Shanghai Cancer Center(FUSCC)were randomly selected.The patients were divided into two groups according to whether AS was used.The clinical characteristics of the patients were collected,and the efficacy and safety of gefitinib were compared between the two groups.We showed that 188 patients were considered eligible for this retrospective analysis,49 received AS(AS user group),while 139 patients did not(AS non-user group).Objective response rate(ORR)and disease control rate(DCR)in the AS user group versus AS non-user group were 69.4%versus 73.4%(P=0.591)and 89.8%versus 90.6%(P=0.486),respectively,while the progression-free survival(PFS)were 9.7 versus 12.2 months(P=0.0644).No significant difference in ORR,DCR or PFS was observed between the two groups.Further study showed that the PFS was related to the time of co-administration,and the patients receiving over 50%AS prescription overlap with gefitinib was significantly less compared with the other people(8.4 vs 12.6 months,P=0.0004).The frequencies of rash(8.2%vs 15.1%,P=0.281),diarrhea(4.1%vs 6.5%,P=0.539)and elevated ALT or AST level(6.1%vs 10.1%,P=0.407)were similar for both groups.Therefore,concomitant use of AS and gefitinib might affect the efficacy of gefitinib,which should be avoided if possible.

Pivotal Factors Concerned in Design of Acupuncture Clinical Research:From Two Articles in JAMA

Two randomized controlled trials of acupuncture concerning polycystic ovary syndrome（PCOS） and stress urinary incontinence（SUI） were published simultaneously in the 24 th issue, 2017 of The Journal of the American Medical Association（JAMA）. A trial involving PCOS indicated that active acupuncture did not increase live birth compared with sham acupuncture; meanwhile, another trial referring to SUI showed that electroacupuncture resulted in less urine leakage compared with sham electroacupuncture. With an eye to the negative and positive results of acupuncture, three pivotal factors should be contemplated：（1） proper illness for acupuncture, that is, a problem need to be solved in current medical science, and acupuncture may really work for it;（2） proper pre-studied primary outcome, which is better be objective and repeatedly measurable to reveal the therapeutic effect of acupuncture truly and objectively;（3） proper sham control, which can blind the patients to the upmost extent with minimal biological effects. Through the publication of clinical trials of acupuncture in high-impact journals in recent years, researchers should have confidence in their clinical trials by pondering over these three pivotal factors.

Hepatitis D:advances and challenges

Hepatitis D virus(HDV)infection causes the most severe form of viral hepatitis with rapid progression to cirrhosis,hepatic decompensation,and hepatocellular carcinoma.Although discovered>40 years ago,little attention has been paid to this pathogen from both scientific and public communities.However,effectively combating hepatitis D requires advanced scientific knowledge and joint efforts from multi-stakeholders.In this review,we emphasized the recent advances in HDV virology,epidemiology,clinical feature,treatment,and prevention.We not only highlighted the remaining challenges but also the opportunities that can move the field forward.