Dairyland CEO Brent Ridge said the plant will help meet the demands of the utility, which provides generation for about 500,000 customers of municipal and cooperative utilities in Wisconsin, Minnesota, Iowa and Illinois.
“What is going on now is both entirely predictable, but entirely preventable,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN’s Jake Tapper Sunday, saying the outcome of the model is possible. “We know we have the wherewithal with vaccines to turn this around.” Around 80 million eligible Americans are still not vaccinated — the very group that could help turn the pandemic around, Fauci said. “We could do it efficiently and quickly if we just get those people vaccinated. That’s why it’s so important now, in this crisis that we’re in that people put aside any ideologic, political or other differences, and just get vaccinated,” he said. With a daily average of 155,000 newly reported infections, many hospitals are buckling under the weight of another surge.
Across the south last week, many hospitals were reporting oxygen shortages amid a rise in hospitalizations from the virus.
Among those hospitalizations were pediatric patients, which have also been increasing since students returned to classrooms in some areas.
Thousands of children were in quarantine over the past week due to Covid-19 exposure, creating an uncertain start to the school year as officials, teachers and parents weigh safety precautions.
On Monday, data presented by a vaccine adviser from the US Centers for Disease Control and Prevention showed a hospitalization rate 16 times greater in the unvaccinated population than in those vaccinated. “This to me seems to be a strong indication that the current epidemiologic curve that we’re seeing is really a reflection of failure to vaccinate, not vaccine failure,” Dr. Matthew F. Daley said at the CDC Advisory Committee on Immunization Practices (AICP) meeting. Vaccines a possibility for children under 12 in coming monthsWhile vaccines are currently the best defense against the spread of the virus, they have not yet been approved for those under the age of 12. For these children, masking and vaccination of the adults and teens around them are their only protection. But that could change in the coming months.
Pfizer is working to file data that would help authorize its vaccine for those ages 5 to 11, Dr. Scott Gottlieb, former commissioner of the US Food and Drug Administration, said Sunday on CBS.
Gottlieb, who is on the board of Pfizer, said the drug maker could be in a position to file the data for authorization “at some point in September.” He went on to say that Pfizer could then file the application for Emergency Use Authorization for this age group “potentially as early as October.” Gottlieb told CBS’s Ed O’Keefe Sunday that “we have to throw everything we can” at minimizing cases among school children. “I don’t think that we should be going into the school year lifting the mitigation that may have worked and probably did work last year to control outbreaks in the school setting, until we have firm evidence on what works and what doesn’t,” he explained, adding measures such as frequent testing and putting students in social pods “are probably the two most effective steps schools can be taking.” Schools that have been successful in mitigating spread include those that frequently test, contact trace, and set quarantine protocols when a positive case is detected. “Using masks and improving ventilation is also going to be very important. And finally, getting kids vaccinated. About 50% of kids who are eligible to be vaccinated, have been vaccinated. So there’s still a lot of work we can do there, getting parents more information trying to encourage parents to vaccinate their children,” Gottlieb added.
Fauci echoed those sentiments when he told CNN Sunday he would support a mandate for school children to be vaccinated should the FDA approve use of the vaccine in those under 12.
“I believe that mandating vaccines for children to appear in school is a good idea,” Fauci said. He pointed out that this wouldn’t be out of the question, saying that schools already have many vaccine mandates in place. “This is not something new. We have mandates in many places in schools, particularly public schools that if in fact you want a child to come in — we’ve done this for decades and decades requiring (vaccines for) polio, measles, mumps, rubella, hepatitis. So this would not be something new, requiring vaccinations for children to come to school,” he explained. Boosters and treatmentsThose who are already vaccinated will still likely need a booster shot to fight the spread of new variants. Starting the week of September 20, those who received their second shot eight months ago should be eligible for their third, according to Fauci, who noted there is flexibility in the plan based on the data that is available. On Wednesday, Pfizer began submitting data to the FDA for approval of a third dose of its Covid-19 vaccine. On Monday, a Pfizer official said the company plans to have data from its trial on Covid-19 vaccine booster efficacy by late September or early October. Dr. William C. Gruber, the company’s senior vice president of vaccine clinical research and development, told the AICP there’s data from Public Health England, Israel and others that speaks to the decline in vaccine efficacy over time and potential for boosters, but the company is hoping to provide a controlled study of the efficacy of boosters. “I’m figuring sort of late September, October time frame for actually being able to demonstrate the nature of efficacy,” he said.
The possibility of a third dose comes as many hospitals face an uptick in hospitalizations and a decrease in supplies, with cases in the south increasing as available oxygen — a key component in treating those with the virus — has decreased.
“We’ve had some very challenging situations over the last couple of weeks, where hospitals have had their oxygen deliveries disrupted with hours delay, putting them in a situation where they’ve had very low oxygen supplies,” Mary Mayhew, president and CEO of the Florida Hospital Association, told CNN. “Hospitals are using 3-4 times the amount of oxygen they would normally use,” she added.
Another ongoing challenge in the fight against Covid has been misinformation, the latest example of which has people taking anti-parasitic medicine in an attempt to fight the virus.
Fauci urged those considering taking the drug Invermectin — which is used to treat parasites such as worms and lice in humans and is used by veterinarians to de-worm large animals — to avoid it.
“Don’t do it,” he said on CNN’s “State of the Union” Sunday. “There’s no evidence whatsoever that that works and it could potentially have toxicity … with people who have gone to poison control centers because they’ve taken the drug at a ridiculous dose and wind up getting sick, there’s no clinical evidence that indicates that this works.” The CDC already sent out a warning about the drug, saying it has seen an increase in reports of severe illness caused by the drug to poison centers. Texas K-12 schools surpass highest Covid-19 weekly total from last yearThe Texas Health Department says 20,256 students and 7,488 employees have tested positive for Covid-19 throughout Texas districts that returned to school in August. That amounts to 0.38% of the state’s 5,340,108 students and 0.93% of its 800,078 employees. Last week alone, 14,033 students tested positive for Covid-19 statewide, surpassing the highest weekly total from the prior school year. In contrast, at its peak during the last school year, the state reported a total of 10,487 Covid-19 cases among students for the week ending January 10. CNN’s Madeline Holcombe, Kristen Holmes, Virginia Laingmaid, Mallory Simon and Maggie Fox contributed to this report. The post Covid-19: This is how to prevent another 100,000 deaths by December, Fauci says recently appeared on Medical Update News.
1 Comment
Simulation-Based Learning (SBL): A Modern Atlas of Medical TrainingFrom the birth of the first resuscitation mannequin in 1960, to the most recent development of advanced virtual reality trainers and robotic surgery simulators, medical simulation has evolved remarkably.1,2 This growth can not only be attributed to concurrent technological advancements, but also to the rise of modern medicine, including a growing medical knowledge, radical reformations in the healthcare system and the emergence of minimally invasive procedures.3 This modernisation brought key changes that transformed the profession and arguably drove simulation to take up the role of a modern Atlas of medical and surgical training. Simulation in medicine can be defined as a means of imitating a skill, attitude, or procedure to train personnel in a safe and adaptive environment. It exists in various forms, including verbal training, simulated patients, hardware-based and computing devices, and animal tissue; live (in vivo), isolated tissue flaps (ex vivo) and cadaveric. In vivo simulation is arguably at the end of the spectrum as per its level of complexity. In this article, we primarily define in vivo simulation as any SBL module that exclusively incorporates the use of live animals; likewise, by the term ex vivo SBL we refer to the use of any harvested animal tissue. Some people argue that in vivo SBL can be multifactorial and may include the use of actors or other modalities, however in this article we focused and followed the aforementioned definition. An increasing emphasis on simulation has become evident in the last three decades following fundamental shifts in the medical profession.4 These changes have affected hands-on specialties such as surgery even more. On the other hand, reduction in working hours and subsequent reduction in surgical training time have significantly led to reduction of training time.5,6 Furthermore, the introduction of techniques of a steeper learning curve and a growing emphasis on non-technical skills highlight even more the importance of a change in educational approaches.7–9 Other driving forces include increased medical litigation, operating time pressures and rising student numbers (Figure 1).10–12
AimWe aimed to summarise and critically present all the published evidence on in vivo Simulation-Based Learning (SBL) for undergraduate medical students; this includes primarily teaching concepts as well as focused assessment of students on those concepts. MethodsWe followed a three-stage approach: – Initially, we performed a structured narrative review of the literature on MEDLINE using a simple keyword strategy, including a combination of terms such as simulation-based learning, in vivo, and undergraduate or medical students. – Since authors are familiar with the topic, we integrated a core of evidence which had been previously published as part of their multifaceted surgical course.13,14 This evidence was previously synthesised using a research concept named as “FOOVEL (Feedback studies, Objective Outcomes, Validated tool studies, Expert opinions, synthesis of the Literature)”.15 This primarily involves a multi-modality evidence synthesis which includes a series of narrative16 and systematic reviews17 focused on SBL for undergraduates (eviCORE18–21), with focused original studies on in vivo SBL for undergraduates.22–28 This work has been part of a dedicated research network.29 – Regarding assessment methods, we performed a sub-group adaptation and appraisal of a systematic review published on postgraduates’ assessment tools, which summarises the current published evidence on assessment approaches.21 Finally, we performed a critical appraisal of the adaptation of in vivo SBL based on the new reality that has been brought on by COVID-19. A systematic review on the future of medical and surgical education, as well as an opinion letter from the authors, have been the basis for this section of the article.30,31 Included ArticlesOur search yielded 6 articles,13,16,17,22,25,26 all of which represent part of our previous work as part of the ESMSC Marathon Course (esmsc.gr).13,14 Manual search in the references of the included articles yielded another 2 original studies using in vivo SBL, which derive from the authors’ previous work.23,24 Following the “FOOVEL” approach, we completed the essential core of evidence needed to draw conclusions as part of this article. This includes in total 25 citations.13–37 DiscussionSBL for Undergraduates: Knowns and UnknownsSBL has long now been effectively used in medical schools both for teaching and assessment. It can be used for a wide array of skills, ranging from history taking to inserting a cannula or even suturing. Furthermore, the use of simulated patients in the Objective Structured Clinical Examination (OSCE) assessment method has proved catalytic in its establishment as the gold standard for clinical skill assessment. The benefits of using SBL in medical schools are so well-recognised that studies are shifting their focus away from evaluating its effectiveness as a discipline. In our experience, recent research is focusing on how SBL can be used to deliver more niche parts of the syllabus and assessing the effectiveness of higher fidelity simulators for medical students. As discussed above, even though low fidelity simulators are extensively used, the utilisation of in vivo simulation in medical schools is scarce. A systematic review by Theodoulou et al17 identified several studies that used animal tissue simulation for medical student training or assessment, however, only 2 used live animal tissue (in vivo).14,38 The results were promising in all studies that have used SBL for undergraduates, including the two in vivo studies. In vivo vs Low Fidelity SimulationIn Vivo SBL has an established role as an advanced postgraduate training modality. However, at the undergraduate stage, its utility is still debatable; the soft line of ethics legislation behind the use of animal tissue, but also excessive costs, and complex laboratory set up are reasons to argue against animal use for medical student training. Currently, the Helsinki declaration is the gold standard framework for animal use in European territory. The UK has yet to adopt this 2010 framework, and this seems unlikely given the recent Brexit. Technological advances and the widespread use of dry lab low-cost, lower fidelity modules as a safe alternative, have gained place in favour of animal use, especially at earlier stages of training. This justifies the lack of published evidence on the topic; hence, anyone could wonder why we would use in vivo modules for medical students. Comparison Between in vivo vs ex vivo Modules and in vivo vs Dry Lab25,26As part of our course,13 we performed 2 studies to identify the role, or equally the additional benefit, of animal use for student training. Both studies have a common ground; the 3R (Reduce, Refine, Replace) principles. These dictate that animal use is minimised and its primary role is to provide an extra adjunct. This refers mainly for the use of live animals where we achieved a ration of 1 pig/20 students achieving good quality intense training. Both studies identified no additional benefit in the use of live animals in terms of practical skill improvement as defined by the use of the standardised Direct Observation of Procedural Skills (DOPS) tools. Simply put, this means that the vast majority of skills-based training can be equally effective with the use of low fidelity modalities. More specifically, students achieved similar proficiency when using the dry lab laparoscopic simulator;25 same applies for basic dissection skills when comparing the use of live pig vs ex vivo animal tissues.26 So, what would be the rationale behind using live in vivo SBL? To authors’ opinion, it provides excitement and has a dominant inspirational character, which results in enthusiasm to take learning to the extra mile and enhances the relationship between trainer and trainee. In an era where burnout and bailout are the recipe of failure, inspiration and excitement can be a boost to push the youngest part of the medical pyramid to strive for perfection. In addition, if those modalities are carefully fitted in a multifaceted curriculum, then their role becomes multidimensional, and they aspire multifactorial benefit. On a separate note, whilst measuring the perception of the educational environment of our course,27 we concluded that limited use of live tissue results in a more positive perception, which surprisingly is predominantly expressed by younger medical students. Therefore, we could argue that eventually, providing high-quality simulation teaching at the earliest stage, this can eventually result in highly motivated who would be serving the vision of achieving excellence in patients’ care. Descriptive in vivo SBL Studies22–24,28Similar results were noted in 3 non-comparative studies which demonstrate incorporation of animal use as part of our course. Two of them23,24 primarily use ex vivo animal tissue which can arguably be used with less cost and ethical implications, and are focused on basic neurosurgical skills, as well as the measurement of dexterity in micro-suturing. A similar concept was applied when trying to measure dexterity and anxiety and their role in SBL performance using ex vivo tissues;22 although this study did not use live tissue, it can act as an example on how such modalities are perceived by students in a busy learning environment. Another study takes Interventional Radiology (IR) a step forward and shows how lower fidelity SBL can be matched and optimised by the use of live tissue for IR catheterisation using a C-arm.28 Multifaceted, Mixed Fidelity Animal Model SBL: The Esmsc Marathon Course [Unique] Model “Where Evidence Meets Novelty”The ESMSC Marathon Course13,14 is a 3-day multifaceted international surgical course geared exclusively to medical students. Its curriculum is designed to continuously evolve and currently involves 50 training modules spread across all basic surgical specialties. The ESMSC concept is based on the combination of 2 primary learning pylons (skills and knowledge) which are expanded in 4 learning cores (tetra-core concept): -Basic and Applied Surgical Science knowledge in the form of interactive workshops -Technical and Non-technical skills; technical skills are incorporating a unique combination of targeted minimal live animal tissue use (high fidelity), with ex vivo and dry lab SBL (low fidelity) ESMSC is a paradigm of how in vivo SBL can grant the extra mile in SBL at the undergraduate level. Intense preparation of students using knowledge workshops, and skills optimisation in a short period of time, in the right lab environment produces the right momentum to use live in vivo modules. In vivo SBL as part of the ESMSC course has a dominant inspirational character, and students thrive from enthusiasm during such modules, which acts as a domino and enhances learning retention in the vast majority of the remaining modules. Further to this, using a high fidelity live operating environment help consolidate other learning components, given that students can practice most of the skills taught in the remaining skills modules. ESMSC Next Generation Concept: IG4The predominant question related to the use of in vivo live animal SBL is how this can be optimised. In other words, what component of the ESMSC curriculum should this occupy, in order to optimise learning and equally respect the 3R principles. To answer this question, we focused on designing cutting edge research to develop a theoretical curriculum model to harmonise the training modules across the 4 learning cores. The first version of this effort was the Ci4R version13 (Cores Integrated for Research) which evolved into a completely novel harmonised model, the iG4 (integrated Generation 4)36 curriculum which is one of the most complex curricula concepts to ever be described in the literature. The iG4 concept was presented to a panel of experts37 and piloted in an advanced simulation centre to bring the first results.15 The primary goal of this advanced concept is to optimise learning via multilayer coordination of the several training modules of this multifaceted course. Thus, the educational value of the small live in vivo simulation modules is tailored and adapted to the wider concept of the course, optimising and enhancing its educational value. The iG4 vision is to act as a virtual engine to develop and process tailored training modules which serve the learning approach of multifaceted surgical courses. From the iG4 research, a separate version was produced (omnigon iG4), which can act as an adaptable global blueprint when designing such complex courses.18 SBL Pragmatic Performance ModelAn additional benefit from the iG4 concept is the introduction of a second-generation hexagon (6-pylon) pragmatic model which assesses the overall performance of the course.18 Aspired by Harvard Business School’s “balanced scorecard model”, the “hexagon model” assesses: how customers (stakeholders) see the course curriculum, what trainers and organisers should excel in (internal perspective), if we can continue to improve and create value (research and innovation), and how course organisers appear to shareholders (financial perspective, adaptability, and sustainability in a global setting). The ESMSC hexagon model is a fourth-generation concept (iG4) which grants an edge when optimising the course structure and subsequently the use of animals at the undergraduate level. It lends its “pragmatic” character to the scrutiny of the course from several angles creating a 360° view of how to constantly adapt and optimise learning using any local facility setting. Challenges in SBLOne can easily deem surgical simulation methods as being abstract and “fake”, as they cannot replace the actual clinical environment. Indeed, low-fidelity simulations often lack important factors, such as stress and responsibility, demoting the authenticity of the training experience.39 A rapid degradation in authenticity and a consequent lack of effort by the trainee can lead to acquirement of false traits and techniques. Furthermore, cheap surgical simulators typically belong to the low-fidelity category.4 This becomes particularly problematic in surgery, where the haptic effect is essential and, in its absence, training can lead to distortion of the manual forces one applies causing catastrophic effects.40 Moreover, the fact that less-resourceful training centres cannot acquire animal tissue produces an injustice in surgical education. In the same way that surgical education has been inspired by the aviation sector and attained various simulation techniques, it only makes sense to also look at its errors. Recent examples are two fatal air-crashes of the Boeing 738 MAX, for which the company has blamed the simulation equipment for not being able to mimic several conditions that caused the crash. Likewise, faults and inaccuracies in surgical simulators must be detected and corrected at all costs. Teaching Assessment ModelsObjective and reflective assessments are integral to all stages of medical education. Structured feedback allows learners to identify their educational needs and gauge their progress, both individually and in relation to their peers. Individual assessment is also used to certify the attainment of certain competencies. Within postgraduate educational settings, a trainee preference for regular work-based assessments has been identified,41,42 rather than single performance snapshots.43,44 SBL offers a valuable opportunity to realistically recreate these work-based scenarios, such that trainees may develop their technical and non-technical skillset. The aim for a novel SBL assessment tool is to holistically assess students’ clinical skills and provide them with meaningful objectives. The key components of applicable knowledge being basic science, applied science, non-technical and technical skills. Due to limited published evidence on undergraduate assessment methods, the authors performed a sub-group adaptation and appraisal of a published systematic review21 of postgraduate surgical assessments. In postgraduate training, there are examples of assessment modalities for the aforementioned clinical skills. Within the systematic review, the identified studies were all cross-sectional or cohort in design. A thematic analysis demonstrated the key assessment themes could be further divided into surgical skills, surgical procedures, autonomy, communication, history, clinical examination, theoretical knowledge, data, self-assessment and milestones. These themes were shared across a variety of specialities and countries. Within the available literature, surgical skills were the most commonly evaluated. There is good precedent for the use of active assessment in the improvement of surgical technique. Bohnen et al have published their system for improving procedural learning which provides real-time feedback during procedures.45 Overall, however, the systematic review demonstrated a lack of clear evidence base for current methods of assessment. There was also a lack of cohesion across specialities and across different geographical areas, despite the thematic similarity of assessments. The recommendations for SBL assessment would be to implement evidence-based methods of evaluation. These assessments would benefit from multi-disciplinary and cross-speciality collaboration. Team Assessment Models (Team OSCES)33,34Medical practice is continuously evolving and all the more incorporating non-technical skills, predominantly advanced communicational skills. There is a shift from an individual-based approach towards a multidisciplinary team-based approach in everyday practice. Hence, we developed studies to optimise assessment of such skills, which focus on individuals’ (students’) assessment as part of a team. For this purpose, we used the iTOFT tool to evaluate students’ performance as part of a trauma team, adapted for the local needs of the ESMSC course.34 We also compared several SBL fidelity modalities (hyper-realistic vs low fidelity team OSCE)33 using the TEAM tool. Both studies serve as an example of how non-technical team-based assessment can supplement in vivo simulation as part of the same multifaceted curriculum and advance learning outcomes. COVID-19: Welcome to a New World in SBLThe COVID-19 pandemic was first declared by the World Health Organisation on March 11, 2019.46 Medical education has been severely impacted by the restrictions which aim to reduce viral spread. As the world approaches the first anniversary of the pandemic, it too marks one year of disrupted learning for students who, will ultimately, become doctors. A published systematic review by the authors aimed to elucidate challenges and novel approaches to medical education during the COVID-19 pandemic.30 Seven subcategories of innovation were identified: tele-conferences, online learning, social media, telemedicine, simulation and virtual reality, assessments and remote anatomy learning. Although the COVID-19 pandemic has clearly been disruptive and detrimental to learning, there are a number of innovations which have been rapidly developed. Some of these interventions may be better than the historical didactic format of education. By augmenting the number of resources which can be used, individuals can adapt their ideal learning environment. COVID-19 has had a seismic effect on the current landscape of education, but at the same time consolidated the use of several innovations which predominantly derive from the use of novel technologies in education. Although these new circumstances arguably shift away from the use of in vivo SBL, the demand of skills-based education, especially in advanced postgraduate level is higher, due to a long cease of most operating time. This dictates a new reality where all the innovations introduced during the pandemic, merge effectively with the traditional animal model simulation creating the ultimate environment for learning. In simple terms, technological innovations can optimise the use of in vivo SBL as part of a dedicated educational curriculum. LimitationsWe acknowledge a series of limitations. This review is predominantly based on a structured review of the literature as well as the authors’ expert opinion on the topic. The evidence on in vivo SBL is limited and should be interpreted with caution and constructive criticism. Despite the complex synthesis algorithm of the literature (eviCORE) that acts as an umbrella review of the current published evidence on In-Vivo SBL, there might still be several references available which are non-peer-reviewed and outside the scope of this review. ConclusionIn vivo SBL should be used with caution at the level of undergraduate students. Strict adherence to the 3R principles in order to reduce animal tissue usage, should always be the basis of a planned course. In vivo SBL has a place in granting an extra mile towards medical students’ inspiration and aspiration to become safe surgeons; however, this should be optimised and supported by a well-designed curriculum which enhances learning via multi-level fidelity SBL. A classic example is the ESMSC Marathon Course which uses an adaptable multifaceted curriculum design to incorporate composite learning outcomes. Place of StudyWomen’s Health Research Unit, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK Ethical ApprovalEthical approval was not required for this manuscript directly; ESMSC Marathon Course (esmsc.gr) was granted by the Department of Animal Studies and Relevant Affairs (Hellenic Republic, Perifereia Attikis, PATT) and met directive 63/2010, PD 56/April 2013. The license reference number is 4857/15-09-2017, MS, AP et al. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All applicable international, national and/or institutional guidelines for the care and use of animals were followed. Author ContributionsMichail Sideris is the primary author of this work, has led and conceived the core of the evidence used for this article, including the ESMSC course, the iG4 model as well as the hexagon assessment performance model. Marios Nicolaides has primarily drafted this article with MS, and they are equal contributors for this review work. George Tsoulfas is the senior author of study. MS and GT have conceived this article and are responsible for the views expressed and the critical revision of this work. Jade Jagiello and Kathrine Rallis, John Hanrahan, Elif Iliria Emin, Efthymia Theodorou, have contributed to drafting sections of the articles which were reviewed by MS. Rebecca Mallick, Funlayo Odejimi, Nikolaos Lymperopoulos and Apostolos Papalois have offered input in critically reviewing this manuscript. AP has been the lead of the ESMSC Marathon course with MS. All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work. DisclosureMS/AP are the leads of the ESMSC course; GT has extensive contribution in the eMERG project. The views expressed on this manuscript reflect the interpretation of the authors towards the topic and are based on previous work of the eMERG collaboration. The authors report no other conflicts of interest in this work. References1. Rosen KR. The history of medical simulation. J Crit Care. 2008;23(2):157–166. 2. Badash I, Burtt K, Solorzano CA, Carey JN. Innovations in surgery simulation: a review of past, current and future techniques. Ann Transl Med. 2016;4(23):453. 3. 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Introducing in vivo dissection modules for undergraduate level trainees: what is the actual benefit and how could we make it more efficient? Indian J Surg. 2018;80(1):68–76. 27. Sideris MC, Papalois AE, Athanasiou T, et al. Evaluating the educational environment of an international animal model-based wet lab course for undergraduate students. Ann Med Surg. 2016;12:8–17. 28. Theodoulou I, Louca C, Sideris M, et al. A prospective study integrating a curriculum of interventional radiology in undergraduate education: a tetra-core simulation model. CVIR Endovasc. 2020;3(1):12. 29. Sideris M, Hanrahan J, Staikoglou N, et al. Optimizing engagement of undergraduate students in medical education research: the eMERG training network. Ann Med Surg. 2018;31:6–10. 30. Dedeilia A, Sotiropoulos MG, Hanrahan JG, Janga D, Dedeilias P, Sideris M. Medical and surgical education challenges and innovations in the COVID-19 era: a systematic review. In vivo. 2020;34(3 Suppl):1603–1611. 31. Sideris M, Hanrahan JG, Papalois V. COVID-19 and surgical education: every cloud has a silver lining. Ann Med Surg. 2020;58:20–21. 32. Nicolaides M, Cardillo L, Theodoulou I, et al. Developing a novel framework for non-technical skills learning strategies for undergraduates: a systematic review. Ann Med Surg. 2018;36:29–40. 33. Nicolaides M, Theodorou E, Emin EI, et al. Team performance training for medical students: low vs high fidelity simulation. Ann Med Surg. 2020;55:308–315. 34. Nicolaides M, Theodorou E, Hanrahan JG, et al. Advancing medical students’ non-technical skills in a group-based setting. J Invest Surg. 2021;34(1):39–43. 35. Pantelidis P, Staikoglou N, Paparoidamis G, et al. Medical students’ satisfaction with the applied basic clinical seminar with scenarios for students, a novel simulation-based learning method in Greece. J Educ Eval Health Prof. 2016;13:13. 36. Sideris M, Papalois V, Athanasiou T, et al. A novel multi-faceted course blueprint to support outcome-based holistic surgical education: the integrated generation 4 model (iG4). In vivo. 2020;34(2):503–509. 37. Theodoulou I, Sideris M, Lawal K, et al. Retrospective qualitative study evaluating the application of IG4 curriculum: an adaptable concept for holistic surgical education. BMJ Open. 2020;10(2):e033181. 38. Ferreira Galvão FH, Bacchella T, Cerqueira Machado M. Teaching intestinal transplantation in the rat for medical student. Microsurgery. 2007;27(4):277–281. 39. Aggarwal R, Mytton OT, Derbrew M, et al. Training and simulation for patient safety. BMJ Qual Saf. 2010;19(Suppl 2):i34–i43. 40. Chmarra MK, Dankelman J, van den Dobbelsteen JJ, Jansen FW. Force feedback and basic laparoscopic skills. Surg Endosc. 2008;22(10):2140–2148. 41. Miller A, Archer J. Impact of workplace based assessment on doctors’ education and performance: a systematic review. BMJ. 2010;341:c5064. 42. Shalhoub J, Marshall DC, Ippolito K. Perspectives on procedure-based assessments: a thematic analysis of semistructured interviews with 10 UK surgical trainees. BMJ Open. 2017;7(3):e013417. 43. Khan KZ, Gaunt K, Ramachandran S, Pushkar P. The objective structured clinical examination (OSCE): AMEE guide no. 81. Part II: organisation & administration. Med Teach. 2013;35(9):e1447–1463. 44. Bode C, Ugwu B, Donkor P. Viva voce in postgraduate surgical examinations in Anglophone West Africa. J West Afr Coll Surg. 2011;1(1):40–52. 45. Bohnen JD, George BC, Williams RG, et al. The feasibility of real-time intraoperative performance assessment with SIMPL (System for Improving and Measuring Procedural Learning): early experience from a multi-institutional trial. J Surg Educ. 2016;73(6):e118–e130. 46. World Health Organisation. Timeline: WHO’s COVID-19 response; 2021. The post In vivo simulation-based learning for undergraduate students recently appeared on Medical Update News. 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Deliberations in Lansing over a new state budget will decide whether a state-backed initiative to increase the number of new doctors serving in rural and underserved markets across Michigan can expand next year. House lawmakers have approved Gov. Gretchen Whitmer’s proposal to direct $5.1 million for the MIDOCS program in the 2021-22 fiscal year that starts Oct. 1. A Senate-passed budget plan allocated $6.4 million, an amount MIDOCS requested and hopes to still receive to support 24 medical residents next year. “We’re still hopeful on negotiations that we can get there and, quite frankly, there’s funding in the state budget that can get us there,” said Jerry Kooiman, assistant dean and chief external relations officer for Michigan State University’s College of Human Medicine. MSU, Wayne State University School of Medicine, Central Michigan University College of Medicine, and Western Michigan University Homer Stryker M.D. School of Medicine (WMed) formed MIDOCS in 2019 as a way to ease physician shortages in the state. Each medical school supports MIDOCS by matching state-budget funding. MIDOCS also receives funding from the federal Centers for Medicare and Medicaid Services. Since 2019, MIDOCS has placed 52 medical residents at health care providers in underserved markets across the state. Participating medical residents represent a “strong mix” across disciplines such as psychiatry, internal and family medicine, pediatrics, general surgery and OB/GYN, Kooiman said. MIDOCS is a new model to begin addressing a growing physician shortage in rural and underserved markets in Michigan by funding additional residency slots. Nationwide, the American Association of Medical Colleges estimates that the U.S. will have a shortage of at least 37,800 primary care and specialty physicians by 2034. That shortage could grow to as high as 124,000 as the nation’s population continues to age and requires more care, according to the association’s June 2021 report. The estimated shortage of primary care physicians alone runs from between 17,800 and 48,000, according to the association. Staying in the communityA $75,000 scholarship is key to drawing medical students into the program to serve their residencies in an underserved or rural market where care providers historically have difficulty recruiting. MIDOCS participants can use the money to pay their medical school debt if they spend two years working in a rural or underserved urban market after completing their medical residency. The partner medical schools hope medical residents will opt to later live and work in the communities where they are placed for their graduate medical education. Surveys show that about 60 percent of medical residents end up in practice within 50 miles of where they serve their residency, a percentage that MIDOCS expects to exceed, Kooiman said. “The goal is to have these students practicing in these areas five or 10 years out, and we want them to be looking at this program as this is where they’re going to live and practice medicine in the future,” Kooiman said. ‘Natural pathway’MIDOCS started in 2019 with a cohort of eight medical residents, which grew to 24 in 2020 and then fell back to 20 positions for the new year academic that began July 1. As more medical residents enter MIDOCS each year, the medical schools have a hard time sustaining their funding, Kooiman said. A Centers for Medicare and Medicaid Services interpretation of graduate medical education funding rules has also resulted in MIDOCS receiving a lower amount from the federal government than initially expected, he said. Psychiatry and family medicine are the biggest specialties represented in MIDOCS, with 18 positions each. Psychiatry especially has what Kooiman calls a “huge” shortage in the northern reaches of the state. MIDOCS has been able to place four psychiatry residents in the Upper Peninsula — where just seven psychiatrists previously worked — and will place two more next year, Kooiman said. “Three years worth of cohorts in the U.P. pretty much doubles the psychiatrists in the Upper Peninsula, and we want every one of those residents to end up practicing psychiatry in the Upper Peninsula,” Kooiman said. “If that happens … this will be an incredibly successful program.” Dr. Stephen Murata, a native of suburban Los Angeles who attended Loyola University Chicago Stritch School of Medicine, is among the MIDOCS medical residents in psychiatry. Murata was attracted to MIDOCS as he was applying for a medical residency because he wanted to work in an underserved market, an interest he developed while teaching in Chicago prior to medical school. He’s presently serving his medical residency at Pine Rest Christian Mental Health Services in Grand Rapids. Next summer, Murata will move up to Munson Healthcare in Traverse City to serve the final two years of his residency. MIDOCS “is like a natural pathway for me to integrate my love for mental health care, psychiatry and the underserved,” particularly adolescents and their families, he said. “It helps connect me to those particular communities,” said Murata, who wants to stay in Michigan to practice once his residency ends. The post State-backed program seeks to train, keep med students in underserved areas recently appeared on Medical Update News. Helipad project moving forward as part of the changing face of Floyd Medical Center | Business8/29/2021 The addition of a helipad to Floyd Medical Center may be the first noticeable change to the hospital as it transitions to what will eventually be Atrium Health Floyd. The elevated helipad will be constructed at the updated Emergency Care Center entrance off Second Avenue. The landing pad will have direct elevator access to the emergency department’s trauma bays as well as allow ambulances to pass and park beneath. Some of the prep work for the $4 million helipad project began this week, David Early, vice president of support services and operations, said. The addition will eliminate the 1.5- mile drive to the current location on Riverside Parkway and cut minutes off the time between a patient’s arrival and treatment. “In a trauma situation, every second counts,” Early said. “If you think of the life of this helipad — 30 to 40 to 50 years — think of all the lives that will be saved.” HealthFloyd began as the first designated trauma center in Georgia in 1981, Floyd Medical Center CEO Kurt Stuenkel said, and since then they’ve constantly been working to improve their standards. Within the last decade, the American College of Surgeons issued guidelines for Level I and II trauma centers in the United States. Floyd, as a Level II trauma center for the region, has made it a priority to adhere to those guidelines and as part of the process developed a plan for a readily accessible helipad. The hospital is the only Level II Trauma Center in Georgia EMS Region 1, which covers 16 counties as well as providing service to four Alabama counties. In addition, Stuenkel said they’ve made new arrangements with Harbin Clinic to have available surgeons and specialized trauma surgeons dedicated 100% of the time to Floyd. “For any trauma patient that shows up, we will have a trauma surgeon ready to go,” he said. They’ve also brought in Dr. Chad Beck, an orthopaedic traumatologist. Beck cares for patients with complex bone fractures that often occur in car wrecks or other traumatic injuries. “He’s helped us lift the level of care,” Stuenkel said. HopeLater this year, Floyd will discontinue using its traditional bright green and move to the Atrium Health teal as it also takes on the new Atrium Health Floyd name. Floyd’s other properties, Polk Medical Center as well as Cherokee Medical Center in Alabama, will do the same. “We’ll do an unveiling of the brand later this year,” Floyd Public Relations Manager Dan Bevels said. But for now, with the incredible volume of COVID-19 patients coming in to the hospital’s emergency room as part of a surge in cases of the highly infectious Delta variant, Stuenkel looks back at what he feels have been good decisions. One of those decisions was to create a dedicated entrance for the Family Birth Center. Expectant mothers used to enter the maternity ward through the Emergency Room, and with the current number of COVID-19 patients being treated in the ER, the situation would have been untenable, Stuenkel said. Now they enter and leave, with their newborn, through that dedicated area. “We’ve gotten a lot of great comments from delivery staff and moms,” Stuenkel said. Other renovations have been noticeable on the hospital’s campus, from pressure washing the facade of the building to installing tinted windows along a walkway to the parking deck. HealingAs part of determining best practices there has been a continuing investment in the hospital system’s abilities to provide care to the region. “The Atrium integration has been very exciting,” Stuenkel said. “We’re working with all of our colleagues within 40 hospitals and comparing notes for best practices.” Floyd is investing in two new robotic-assisted surgical systems as part of a $3.9 million project. The hospital will add a DePuy Synthes VELYS Robotic-Assisted Solution, used for total knee replacement surgery, and a second da Vinci Xi Surgical System. Floyd is also adding another catheterization laboratory, commonly referred to as a cath lab, to the three already at the hospital. The addition will make four fully functioning examination areas with diagnostic imaging equipment used to visualize the chambers and arteries of the heart. For allThe newly formed Floyd-Polk Foundation resumes the work done by the Floyd Healthcare Foundation. With the integration into Atrium Health, the foundation was infused with approximately $140 million. “What we especially want to do is create and identify projects that address disparities of care,” Stuenkel said. Much of the money in the foundation will be reinvested. The earnings from that fund will go toward addressing healthcare disparities in the region, Stuenkel said, and the foundation alongside the More Heart Advisory Board has already made some headway. The board was formed by Floyd in 2020 and is made up of leaders from minority communities in Floyd, Polk and Chattooga counties. In this case, they specifically targeted high blood pressure in minority and low-income populations. Through the program, the board installed four blood pressure kiosks, so those who may not see a physician regularly can check their blood pressure. Lovejoy Baptist Church is home to one of the machines in South Rome and the other three machines are at Wraps Styling Salon on Second Avenue, Frost and Barron Apartments on Fifth Avenue and One Door Polk on North Main Street in Cedartown. Another is planned for placement in Chattooga County. “That’s been a really successful program,” Stuenkel said with a touch of pride. “We’re going to be doing lots of things like this going forward.” The post Helipad project moving forward as part of the changing face of Floyd Medical Center | Business recently appeared on Medical Update News.
If you ever have trouble seeing your way clear to getting your eyes checked, here’s a case to consider: Genida White could tell her vision was gradually getting worse, but she rationalized away the need to see an ophthalmologist – a medical doctor who specializes in eye care. She could still do all the things she enjoyed, such as bowling every Monday. But mostly, she was nervous to hear what the doctor would say about her eyes. Her daughter provided the encouragement she needed, telling her about a radio advertisement she heard about free eye exams with EyeCare America. No more excuses; it was time for an appointment. While, unfortunately, White did receive the diagnosis she feared – she would need surgery to remove cataracts in both eyes – the results were brilliant. The improvement in her vision was swift and dramatic. “I’d never had eye surgery before,” White said. “Before I knew it, it was over.” Cataract Facts A cataract is when your eye’s natural lens becomes cloudy. People with cataracts describe it as looking through a foggy window; vision is blurred and colors are dulled. About half of all Americans over age 75 have cataracts. As you age, you’re increasingly likely to develop cataracts. Fortunately, cataracts are treatable. An ophthalmologist surgically removes the cloudy lens and replaces it with an artificial one. Cataract surgery is the most effective and most common procedure performed in all of medicine with some 3 million Americans choosing to have cataract surgery each year. Thankful for sight-saving surgery Within two weeks of calling EyeCare America, White had cataract surgery in both eyes – just in time to enjoy the Thanksgiving holiday. She was amazed at how simple it was to set up the initial eye exam with EyeCare America and at how quickly her vision was restored. “Reading the eye chart was so bad at first,” White recalled. She could just barely read the last two lines of the eye chart during her initial eye exam with her ophthalmologist, Dr. Douglas Wilson. The day after surgery, White was able to read the whole way through the chart, top to bottom. “Dr. Wilson asked me, ‘Are you sure you couldn’t see before?’ and I said, ‘Yes, I’m positive.’ It was amazing.” Proof of her quick recovery was evident at the bowling alley, where White didn’t miss one Monday on the lanes. EyeCare America right for you? If the cost of an eye exam is a concern, the American Academy of Ophthalmology’s EyeCare America program may be able to help. This national, public service program provides eye care through thousands of volunteer ophthalmologists for eligible seniors, 65 and older, and those at increased risk for eye disease, mostly at no out-of-pocket cost to the patient. – Courtesy of NAPSI The post Cataract surgery saves avid bowler’s vision in record time | Senior Living recently appeared on Medical Update News. IPOH: Volunteers, who were part of a Covid-19 Phase Three clinical trial and received placebos, should be vaccinated, says the Perak MCA public service and complaints bureau. Its chief Low Guo Nan said of the 3,000 volunteers who took part in the trial, only half received the vaccine. He said the volunteers were concerned for the safety and health, as well as that of their families. “Given that the transmission rate and daily cases of Covid-19 are still high nationwide, the affected volunteers are at a risk of infection. “The 13-month study will be completed in March next year, meaning they have to wait for another six months while being part of the high-risk group,” he said in a statement on Sunday (Aug 29). It was reported on Jan 22 that thousands of Malaysian volunteers were screened for the clinical trials, which also involved nine Health Ministry hospitals. It was reported that Malaysia was the first country outside China to trial the vaccine, which was developed by the Institute of Medical Biology, Chinese Academy of Medical Sciences in China. Low said under the National Recovery Plan (NRP), clinical study volunteers were not categorised as vaccinate recipients. He said only Appreciation certificates, and alert cards were given to all volunteers for their involvement in the study. “This does not mean that they are vaccinated, because 50% of the volunteers are still not vaccinated. “I am hoping that the volunteers who are yet to be vaccinated can be inoculated soon,” he added. Low also suggested for the study to be modified to become a crossover study, whereby volunteers who received the placebo are vaccinated, and vice versa. “This will ensure all participants are vaccinated. I hope the parties concerned will review the matter, and find a solution for the 3,000 volunteers nationwide,” he added. The post Perak MCA: Volunteers of Covid-19 Phase Three clinical trial who received placebos should be vaccinated recently appeared on Medical Update News. SNOHOMISH — Fire departments across Snohomish County worry they could lose responders who haven’t been vaccinated against COVID-19, in the wake of a state mandate requiring it. Vaccination rates vary across the county. Snohomish Regional Fire & Rescue, with 260 emergency responders covering 110,000 residents in east and central county, was 58% vaccinated Wednesday. Mukilteo Fire Department’s 27 staffers were at 76%. Unionized firefighters in Marysville were at about 70%, union president Dean Shelton said Friday. Gov. Jay Inslee mandated earlier this month that state workers, educational employees and health care providers be fully vaccinated against the virus by Oct. 18, as the more infectious delta variant has strained the local hospital system and caused a resurgence in COVID-19 cases. “Health care providers” includes EMTs, firefighters and paramedics. Across the state, departments fear an exodus of firefighters over the requirement. “You’d think it would be a huge sacrifice to give up what you think is going to be your life’s work” over one vaccine, said Fire District 5 Chief Merlin Halverson, who serves the Sultan area. Some local groups claim it could affect emergency responses. South County union firefighters from IAFF Local 1828 wrote a letter to the governor Tuesday urging alternatives to mandatory vaccinations, like weekly testing, masking and social distancing. They write that while 80% of members are fully vaccinated, they still stand to lose 60 firefighters in an already strained workforce. The union writes it is not against vaccines, “however we are against mandatory vaccinations that strip away our members’ right to choose and would also lead to them being terminated from a career they have worked hard for and served selflessly to our communities, even during this pandemic.” Firefighters have been on the frontlines of the pandemic, responding to urgent calls and staffing mass vaccination sites. Paul Gagnon, president of IAFF Local 46 for Everett firefighters, said his union disagrees with the governor’s requirement. Members should be able to choose to not get vaccinated without worrying about losing their career, he added. And IAFF Local 2781, which represents firefighters in south and east county cities like Monroe, Sultan and Mill Creek, wrote its own letter to the governor Wednesday saying the mandate “could result in a loss of essential workers.” The union said it is seeing an increase in cases of both its vaccinated and unvaccinated members. A spokesperson for the governor’s office, Mike Faulk, said in an email the mandate won’t be changing. Officials considered an option letting workers get frequently tested for the virus, instead of getting vaccinated. Faulk said, however, that alternative was determined to be “infeasible and ineffective.” One estimate put the price tag for regular testing at $66 million annually across all state agencies. Faulk also wrote the emergency response sector faces a different staffing conundrum if workers aren’t vaccinated: Responders are missing shifts in “incredibly high numbers” due to exposures to the virus and infections. In a statement, the Snohomish County Fire Chiefs Association said they were working to implement the governor’s order. Don Waller, who has been in the firefighting field since he was 16, holds a master’s degree in health policy and administration. As the chief at Fire District 4 in Snohomish, Waller has used his medical background to lay out the facts about the COVID-19 vaccine to his crews. He said that helped get his 40 full-time operational staffers to 92% vaccinated. “I don’t think this is any different, with the fire service, than all of our society in America right now trying to determine that risk-benefit analysis between individual rights and public health,” Waller said Thursday. Just over 66% of the county’s residents 16 and older were fully vaccinated as of this week, according to the state Department of Health. More than 72% had gotten at least one dose. Kevin O’Brien, chief of Snohomish Regional Fire and Rescue, said in an email his department is prepared to comply with the governor’s mandate. Despite a vaccination rate below 60%, the chief doesn’t expect any disruptions to service. While concerned about the impact, O’Brien said, “I can assure you that when a citizen calls 911, our excellent firefighters will be there to help 24/7 365.” The department has been working to up its vaccination levels. For example, on Tuesday, it offered vaccines at its station in Clearview, O’Brien said. He added they will continue to offer those opportunities. If employees get the vaccine while off-duty, they get two hours worth of overtime pay. Chris Alexander, the Mukilteo Fire Department’s chief and president of the county fire chiefs association, said Wednesday his 27-member staff could lose two to four responders because of the requirement. In that case, they’d have to pay additional overtime to the remaining firefighters to fill the gaps. Alexander, like many of the other fire leaders interviewed for this article, is vaccinated. “I’m sad that it had to come down to a mandate,” he said. “I look at this as this is the biggest disaster that everyone in the health care profession has been asked to respond to.” Part of that response, Alexander said, is wearing PPE; part is going and treating patients infected with the virus; and part is protecting the community by getting vaccinations. “Some people have chosen not to respond with all three of those,” he said, “and I feel that’s a sad reflection on our profession.” Jake Goldstein-Street: 425-339-3439; [email protected]. Twitter: @GoldsteinStreet. The post Snohomish County fire unions rail against vaccine mandate recently appeared on Medical Update News. NEW YORK â Find the latest information on the COVID-19 pandemic in New York state and New York City, including data on positive cases and other indicators, and information from local officials. COVID-19 variants significantly reduce protection of vaccines, prior infection: studyA new study confirms that vaccinations and even prior COVID-19 infection provide significantly less protection against newer variants. Researchers from Oregon Health & Science University say in order to protect against the Alpha, Beta, and now Delta variants, these findings stress the importance of doubling down on both vaccinations and public health measures during the pandemic. Mask debate moves from school boards to courtroomsThe rancorous debate over whether returning students should wear masks in the classroom has moved from school boards to courtrooms. In at least 14 states, lawsuits have been filed either for or against masks in schools. In some cases, normally rule-enforcing school administrators are finding themselves fighting state leaders in the name of keeping kids safe. Supreme Court allows evictions to resume during pandemicThe Supreme Courtâs conservative majority is allowing evictions to resume across the United States, blocking the Biden administration from enforcing a temporary ban that was put in place because of the coronavirus pandemic. New Yorkâs statewide rent moratorium remains in effect only through the end of August. NYC mayor outlines safety guidelines for public schoolsThe mayor and the schools chancellor outlined several protocols that will be implemented by the start of school, including mask requirements for everyone no matter their vaccination status, three-feet social distancing where possible and health screenings. These foods are extra hard to find right now because of shortages, supply chain issuesNotice your grocery store shelves looking a little bare lately? Youâre definitely not the only one. Supply chain issues have created shortages of highly specific ingredients. âItâs up to usâ: Fauci says pandemic could possibly end by spring 2022The nationâs top infectious disease expert believes the pandemicâs end is near as long as the U.S. follows the right protocols to contain COVID-19. Dr. Anthony Fauci said he sees the light at the end of the tunnel, but itâs only open if the countryâs 80 million to 90 million unvaccinated people are convinced to get the shot. Comirnaty: Whatâs the story behind the new Pfizer vaccine name?Comirnaty, who? Itâs the same exact mRNA vaccine Pfizer has been producing through the emergency use authorization, but now itâs being marketed under a new name. How in-home COVID vaccinations in NYC help lower infection rateThe five boroughs are seeing COVID case rates decline after weeks of increases. Itâs in sharp contrast to the nationâs COVID indicators, and city medical leaders have mainly attributed the decreases to increased vaccinations as well as precautions, including masking and social distancing. Cardinal Dolan: No vaccine mandate for Catholic school teachersTimothy Cardinal Dolan spoke with PIX11 News about clergy getting involved in the push for COVID-19 vaccinations. Remote instruction plans for NYC still in the worksThe start of the new academic year for New York City students is less than three weeks away, but plans for in-home instruction were still in the works, officials said on Thursday, Aug. 26. Is an earache a new COVID-19 symptom?Doctors say theyâre seeing a new COVID-19 symptom in some patients. According to experts, an earache has been reported more frequently by those testing positive for COVID. Earaches can cause pain, a feeling of blockage and sometimes muffled hearing. With help from Avengers, health officials push COVID vaccinations in Times SquareSOMOS Community Care, the largest minority-led health network in New York, partnered with the city, state, and Marvel Avengers for a pop-up vaccination site at 47th Street and Seventh Avenue to encourage vaccinations among the 12+ age group. Group in NYC protests COVID vaccine mandates outside City HallA large group of employees of the City of New York gathered outside City Hall in Manhattan on Wednesday, Aug. 25, to protest COVID-19 vaccine mandates. Only 0.33% of fully vaccinated New Yorkers diagnosed with COVIDLess than 1% of fully vaccinated New Yorkers have contracted COVID, Mayor Bill de Blasio said Wednesday, Aug. 25, as the cityâs vaccination efforts continue. Hochul adds 12,000 deaths to publicized NY COVID tallyNew Yorkâs new governor acknowledged that the state has had nearly 12,000 more deaths from COVID-19 than former Gov. Andrew Cuomo told the public. Gov. Kathy Hochulâs office said on Wednesday, Aug. 25 that almost 55,400 people had of the coronavirus in New York based on death certificate data submitted to the Centers for Disease Control and Prevention. Thatâs up from about 43,400 that Cuomo reported to the public as of his last day in office. Johnson & Johnson: Vaccine booster provides ârapid, robustâ responseJohnson & Johnson on Wednesday, Aug. 25, announced new data the company said supports the use of its COVID vaccine as a booster shot for people previously vaccinated with their single-shot vaccine. J&J said the new data showed that a booster shot of their vaccine generated a ârapid and robust increase in spike-binding antibodies, nine-fold higher than 28 days after the primary single-dose vaccination.â NY health officials optimistic FDA approval will sway more COVID vaccinationsHealth officials around New York said theyâre optimistic the FDA approval of the Pfizer vaccine will sway more hesitant people to get protected against COVID-19. Immunocompromised NYC students will get in-home instruction; no remote learningRemote learning remains off the table for immunocompromised students in New York City, but they will be given the option of having a licensed instructor teach them at home, the Department of Education told PIX11 on Tuesday, Aug. 24. NY Gov. Hochul: Expect school mask mandates, vaccine requirementsSafely reopening schools amid the COVID-19 pandemic is a top priority for New Yorkâs newly sworn-in Gov. Kathy Hochul. The governor on Tuesday, Aug. 24, outlined several ways she plans to ensure children safely return to the classroom in September, including plans for a mask mandate and vaccine requirement. Hochul ânot satisfiedâ with speed of financial relief for NYers: âI want the money out nowâIn her first address as the stateâs chief executive, New York Gov. Kathy Hochul skewered the COVID relief process from Washington down, saying sheâs ânot at all satisfiedâ with the pace in which funds have been distributed. Cuomo: NY businesses should require COVID vaccinations for eligible employeesGov. Andrew Cuomo, with just hours left in office, called for all employers in New York to require vaccinations for eligible employees. His announcement on Aug. 23 came as the Food and Drug Administration gave full approval to the COVID-19 vaccine made by Pfizer. NYC public school teachers, staff will be required to get vaccinatedAll NYC public school teachers and staff (about 148,000 school employees â and contractors who work in schools) will be required to get vaccinated and have to get at least a first dose by Sept. 27. There will be no testing option. Will COVID booster shot have the same side effects as the first two shots?The Biden administration said Wednesday, Aug. 18, that COVID booster shots will soon be available, but how will the Sept. 20 rollout work, and what side effects should Americans expect? Mayoral candidates, union leaders urge NYPD officers to get vaccinated, improve numbersLess than half of uniformed and civilian personnel in the NYPD are vaccinated, according to new data, a sign of vaccine hesitancy within the department. Lambda and B.1.621: New COVID variants could be the worst yet, doctor warnsAt least two new COVID-19 variants have hit the United States and they could be worse than the delta variant in their infectiousness and ability to stand up to vaccines, according to a top medical authority. COVID variants a worry even with 75% of adults in NYC receiving at least 1 dose of vaccineNew York State and New York City officials say about 75% of adults have received at least one vaccine shot. But, according to immunologist Dr. Purvi Parikh of NYU Langone Heath, the arrival of the delta variant means the 70% vaccination rare wonât bring about the end of COVID any time soon. U.S. health officials call for booster shots for all to battle COVID-19U.S. health officials recommended all Americans get COVID-19 booster shots to shore up their protection amid the surging delta variant and evidence that the vaccinesâ effectiveness is falling. The announcement was made on Aug. 18. What is the lambda variant and how contagious is the strain of COVID-19?Although delta remains the most prevalent variant, the lambda strain of COVID-19 is starting to emerge and thereâs little known about it. According to the World Health Organization, lambda was first discovered in Peru last year. Since April, itâs been responsible for more than 80% of cases reported there. BK business defies Key to NYC vaccine mandateNew York Cityâs vaccine mandate for restaurants, gyms and entertainment venues began on Aug. 17, but a business owner in Brooklyn says she wonât turn away unvaccinated customers. NYC indoor vaccine mandate beginsNew York Cityâs vaccine mandate, called the Key to NYC Pass, went into effect on Aug. 17. However, it will not be fully enforced until Sept. 13. While not actually a vaccine passport as the name might imply, the plan is the first of its kind in the United States, Mayor Bill de Blasio said. The plan requires vaccinations for all workers and customers at indoor dining, indoor fitness and indoor entertainment venues. NYC COVID vaccine mandate: Who is responsible for enforcement?Details about the implementation and enforcement of the cityâs new vaccination requirement at restaurants, gyms, and theaters are still being worked out. However, one thing is certain: it will not be enforced by the NYPD. August child tax credit payments issued: Hereâs why yours might be delayedThe second installment of expanded child tax credits was issued Friday, Aug. 13, to millions of eligible families, but some payments will likely be delayed due to a technical glitch, the U.S. Department of Treasury said. Schumer calls for federal crackdown on fake vaccine cardsThe Senateâs top Democrat says federal law enforcement officials need to crack down on fake COVID-19 vaccination cards being sold online. COVID claims more young victims as deaths climb yet againThe COVID-19 death toll has started soaring again as the delta variant tears through the nationâs unvaccinated population and fills up hospitals with patients, many of whom are younger than during earlier phases of the pandemic. Concerts, outdoor events still risky as delta variant surges, experts sayConcerts and outdoor events are returning, and many are requiring proof of vaccination as part of new safety protocols designed to help prevent the transmission of COVID-19. But while experts say being outdoors is less risky in general, they continue to recommend additional precautions for those visiting crowded outdoor venues. Biden weighs stiffer vaccine rules as delta variant spreads rapidly across USWhen the pace of vaccinations in the U.S. first began to slow, President Joe Biden backed incentives like million-dollar cash lotteries if thatâs what it took to get shots in arms. But as new COVID infections soar, heâs testing a tougher approach. Who doesnât need the COVID-19 vaccine?It has been eight months since the first doses of the COVID-19 vaccine were administered to health care workers nationwide. Since then, the vaccine has become available to anyone over the age of 12. Experts explain the few instances in which a person would not qualify for, or should delay getting vaccinated. Extra COVID shot OKâd for those with weak immune systemsThe FDA has approved an extra, third dose of the Pfizer or Moderna COVID-19 vaccine for transplant recipients and others with severely weakened immune systems. Diocese of Brooklyn announces mask mandate for schoolsAll students, staff and faculty at Brooklyn and Queens Catholic academies and Parish Schools will be required to wear masks beginning on the first day of class. COVID vaccines would be required for military under new planMembers of the U.S. military would be required to have the COVID-19 vaccine beginning Sept. 15, under a plan announced by the Pentagon and endorsed by President Joe Biden. What to do if you lose your COVID-19 vaccine cardDonât worry if youâve lost your COVID-19 vaccine card, there are several ways you can get it replaced. No matter where you got your shots, getting a replacement card is possible. NYC vaccine push for studentsAug. 9 was the last day NYC public school students can get their first COVID-19 vaccine dose in order to be fully vaccinated by first day of school on Sept. 13. U.S. teachers union president supports COVID vaccine mandateThe head of the American Federation of Teachers union said on Aug. 8 that she supports a vaccine mandate for educators. âAs a matter of personal conscience, I think that we need to be working with our employers â not opposing them on vaccine mandates,â AFT President Randi Weingarten said during an appearance on âMeet the Pressâ on Aug. 8. âThe circumstances have changed. ⦠It weighs really heavily on me that kids under 12 canât get vaccinated.â How do you know if you have the delta variant of COVID-19?So youâve tested positive for COVID â but which COVID exactly? Is there a way to tell if you have the highly transmissible delta variant? There is a way to tell, but thereâs not really a way for you to tell. COVID breakthrough cases: Is one vaccine better than others?COVID-19 breakthrough cases are rising, and now people want to know which vaccine offers the best protection from the coronavirus. COVID survivors, victimsâ families march across Brooklyn Bridge in call for more resourcesSurvivors of COVID-19, family members of victims, health care workers and others marched across the Brooklyn Bridge on Aug. 7. The event was held in honor of the more than 616,000 lives lost to the virus in the United States and to bring more awareness to the issues a growing number of COVID survivors are dealing with. Are kids more vulnerable to the delta variant of COVID-19?Hospitals around the United States, especially in the South, are starting to fill back up again as the delta variant tears though the country. With previous waves of infection, weâve been most worried about the elderly being vulnerable. Now, itâs younger people â even children â starting to show up in hospital beds. U.S. averaging 100,000 new COVID-19 infections a day as delta surgesThe United States is now averaging 100,000 new COVID-19 infections a day, returning to a milestone last seen during the winter surge in yet another bleak reminder of how quickly the delta variant has spread through the country. The U.S. was averaging about 11,000 cases a day in late June. Now the number is 107,143. 50% of U.S. population is fully vaccinated, White House saysThe United States reached a vaccination milestone on Aug. 6: 50% of the population, all ages, were fully vaccinated, the White House COVID-19 data director confirmed. CDC says people whoâve had COVID should get shot or risk reinfectionEven people who have recovered from COVID-19 are urged to get vaccinated, especially as the extra-contagious delta variant surges â and a new study shows survivors who ignored that advice were more than twice as likely to get reinfected. Vaccination will be required for air travel if new legislation passes; lawsuit against vax passes is filedFederal and local officials are pushing congressional legislation that would require air travelers to show proof of vaccination to board a plane. Meanwhile, those opposed to New York Cityâs proof of vaccine requirement for indoor restaurants and venues filed their first lawsuit. New Yorkers warned of dangers of fake COVID vaccination cardsNew York Attorney General Letitia James released a consumer alert on Aug. 6 regarding fake COVID-19 vaccination cards. There have been many reports of these cards in the state, which can lead to a list of dangers, according to they attorney general. Warning of more delta mutations, Fauci urges vaccinationsThe White House COVID-19 response team said the delta variant continues to surge across the country. During a briefing on Aug. 5, Dr. Anthony Fauci called on Americans to take precautions to stop the virus from mutating. âThe ultimate end game of all this is vaccination,â he said. Moderna says vaccine 93% effective after 6 monthsModerna said its COVID vaccine has 93% efficacy six months after the second shot, according to a report released on Aug. 5. Can I get âlong COVIDâ if Iâm infected after getting vaccinated?Itâs unclear, but researchers are studying the chances of long-term symptoms developing in anyone who might get infected after vaccination. Brooklyn nurse honored for COVID fight gets her own Barbie dollA New York City nurse who fought COVID, contracted the virus herself and then went right back to battling the pandemic now has a Barbie doll designed to look like her. What is the delta plus variant of COVID?The latest surge in COVID-19 infections is fueled by the highly contagious delta variant first identified in India late last year. Now, a variation of that variant is beginning to generate headlines. Hereâs what we know about the COVID sub-strain being called delta plus. 2021 NY International Auto Show canceled due to rise in delta variantThe New York International Auto Show (NYIAS) became a casualty of the fast-spreading coronavirus delta variant. Show organizers said on Aug. 4 that theyâve decided to cancel it this year, a little over two weeks before the scheduled start. Who are the unvaccinated and how are they being reached?PIX11 Newsâ Henry Rosoff spent an eye-opening few hours with vaccination outreach workers to learn more about the unvaccinated population. More âpain and sufferingâ ahead as COVID cases rise, Fauci saysDr. Anthony Fauci warned on Aug. 1 that more âpain and sufferingâ is on the horizon as COVID-19 cases climb again and officials plead with unvaccinated Americans to get their shots. Walmart requiring COVID vaccination, masks for many employeesIn a memo, Walmart announced that associates who work in multiple facilities, and associates of its campus office, will need to be vaccinated against COVID-19 by Oct. 4. Walmart also required associates, including those fully vaccinated, to wear masks in its stores. COVID cases rising across NY faster than fall 2020 despite vaccinationsThe number of people testing positive for COVID-19 in New York is rising at a faster and steadier pace now than it did last fall, before anyone was vaccinated. New delta variant research makes strong case for vaccinationA report released by the Centers for Disease Control and Prevention emphasized the delta variant is more dangerous and fast-spreading than first thought. The findings also made clear why efforts to get more people vaccinated are vital. Bronx teacher goes door-to-door to encourage vaccinationA Bronx teacher is trying to convince people to get vaccinated and send their kids back to school. High school social worker Justin Spiro says heâs on a mission, alongside the teachersâ union, to speak to parents with concerns. Broadway will require audiences be vaccinated, wear masksWhen curtains rise again on Broadway in September, theatergoers will need to mask up and show proof of vaccination. CDC data shows delta variant spreads as easily as chickenpoxThe Centers for Disease Control and Prevention released new information on July 30, saying the coronavirus delta variant can spread as easily as chickenpox. NYC will pay $100 to newly vaccinatedNew York City officials announced the city will give $100 debit cards to New Yorkers who get their first COVID shot at a city-run vaccination site. Bronx 16-year-old gets vaccine to help convince hesitant familyA 16-year-old high schooler in the Bronx said she was vaccinated at school in part to convince her doubtful parents and family that the vaccine is safe. Cuomo warns of schools becoming superspreaders amid COVID spikeGov. Andrew Cuomo on July 28 advised school districts to take action and ensure schools wonât become COVID-19 superspreaders. Pfizer: COVID vaccine protective for at least 6 monthsThe effectiveness of the Pfizer COVID-19 vaccine wanes slightly over time but it remains strongly protective for at least six months after the second dose, according to company data released on July 28. Disney World requires masks indoors regardless of vaccination statusBeginning July 30, Disney World required all visitors ages 2 and older to wear a face covering while indoors as well as in Disney buses, the monorail and the Disney Skyliner, regardless of vaccination status. NY plans COVID vaccine mandate for state employees, health care workersNew York will require all state employees to get vaccinated against the coronavirus by Labor Day or undergo weekly COVID-19 testing. Additionally, all patient-facing health care workers at state hospitals will be required to get the vaccine. There will be no alternative testing option for these employees. NY workers should be back in offices by Labor DayEmployers should bring workers back to offices by Labor Day, the governor said on July 29 amid an increase in COVID cases. CDC mask guidance: Vaccinated people should wear face coverings in public indoor settingsThe Centers for Disease Control and Prevention reversed course on some masking guidelines on July 27, recommending that even vaccinated people return to wearing masks indoors in parts of the U.S. where the coronavirus is surging. Streamlined NY rent relief application unveiled amid delayed paymentsFacing backlash over delayed pandemic rental assistance payments, Gov. Andrew Cuomo announced a more streamlined online application process for tenants and landlords. The new online application, which will be implemented on July 27, loosens the standards for documentation, including for multi-tenant landlords who need to submit arrears documents. Vaccines offered at Summer Rising schoolsStarting July 26, select schools in New York Cityâs Summer Rising summer school program began offering vaccine shots to eligible students, parents and community members. The free Pfizer shots will be available at 25 Summer Rising sites through Aug. 13 across all five boroughs. Find out when and where here. U.S. headed in âwrong directionâ on COVID-19, Fauci saysThe United States is in an âunnecessary predicamentâ of soaring COVID-19 cases fueled by unvaccinated Americans and the virulent delta variant, the nationâs top infectious diseases expert said on July 25. Sen. Schumer demands New York release billions in rental assistanceRoughly $2 billion in federal rental assistance remained in the hands of New York State on July 25, as thousands of tenants continued to struggle to make ends meet amid the COVID-19 pandemic. Sen. Chuck Schumer released a letter he sent to the State Office of Temporary and Disability Assistance, demanding the agency âmove heaven and earthâ to quickly release the Emergency Rental Assistance Program funding. NYC mask mandate debate heats up as delta variant spurs new COVID casesSome New York City officials called on Mayor Bill de Blasio to retighten COVID-19 restrictions as the delta variant spurs an uptick in cases in the five boroughs. De Blasio, however, said he would hold off on reinstating an indoor mask mandate as COVID-19 hospitalizations in the city remain relatively low. Doctors warn about slightly different symptoms with delta variant of COVIDAs concern grows regarding the COVID-19 delta variant, health leaders are warning about somewhat different symptoms that come with it. Most unvaccinated Americans unlikely to get COVID-19 shots, new AP poll findsA new poll shows that most Americans who havenât been vaccinated against COVID-19 say they are unlikely to get the shots. About 16% say they probably will get the vaccine. Is asking about someoneâs COVID vaccine status a HIPAA violation?HIPAA was signed into law by President Bill Clinton in 1996 during a time when medical records were being computerized. It was created to simplify the administration of health insurance and to prevent unauthorized access to peoplesâ medical histories. In fact, HIPAA doesnât block anyone from asking another person about their health status, according to Alan Meisel, law professor and bioethics expert at the University of Pittsburgh. DOJ says no probe into state-run nursing homes in NYThe Justice Department says it has decided not to open a civil rights investigation into government-run nursing homes in New York over their COVID-19 response. NYC public hospitals still awaiting FEMA reimbursement for COVID-19 expensesThe New York City public hospital system said itâs still waiting on a big reimbursement from FEMA for expenses incurred during the COVID-19 pandemic. Vaccine or weekly testing mandated for NYC health care workersNew York City will require workers in city-run hospitals and health clinics to either get vaccinated or get tested weekly, Mayor Bill de Blasio said. The COVID-19 safety requirement for health workers goes into effect beginning Aug. 2. NYC COVID-19 uptick: Nearly 70% of new cases are delta variantAs COVID-19 cases slowly rise in the area, the City Councilâs health committee chairman said the delta variant has become the dominant strain of the virus. City Councilmember Mark Levine said the delta variant makes up 69% of new cases in the city â up from 44% the week before. Child tax credit checks: Will they become permanent?The parents of an estimated 60 million American children began receiving child tax credit payments from the IRS in mid-July in a move expected to lift millions of families above the poverty baseline for the remainder of 2021. Should they become permanent? Biden grapples with âpandemic of the unvaccinatedâPresident Joe Biden is confronting the worrying reality of rising cases and deaths â and the limitations of his ability to combat the persistent vaccine hesitance responsible for the summer backslide. Common cholesterol drugs may significantly reduce risk of death from COVID-19: studyStatins, a common medication for lowering cholesterol, may be saving lives among patients with COVID-19. A new study reveals hospitalized coronavirus patients who take statins are much less likely to die from the illness. De Blasio: No plan to bring back indoor mask mandate if hospitalizations remain lowOn the heels of the announcement that Los Angeles County will reinstitute its indoor mask mandate, New York City Mayor Bill de Blasio was asked on the âBrian Lehrer Showâ on WNYC radio if he has plans to make a similar move and bring back mask rules for the city. NYC not dropping mask mandate for studentsNew York City students will still have to wear masks in schools next fall, Mayor Bill de Blasio said in July. Child tax credit: When to expect payments, how it may impact tax returnsPayments for the highly anticipated expanded child tax credits were being sent to families in the tri-state area, and the rest of the nation, for the first time in mid-July. While the additional money may be very helpful for some families across the economic spectrum, the overall tax credit situation is complicated. WHO chief says it was âprematureâ to rule out COVID lab leakThe head of the World Health Organization acknowledged it was premature to rule out a potential link between the COVID-19 pandemic and a laboratory leak, and he said he is asking China to be more transparent as scientists search for the origins of the coronavirus. Wildfire smoke linked to increased COVID-19 risk, study saysA new study suggests that exposure to wildfire smoke is linked to an increased risk of contracting COVID-19. What can I do if I didnât get my child tax credit payment?The official disbursement date for the first child tax credit payments from the Internal Revenue Service was July 15, but parents may not see the cash right away. New York takes conservative approach to counting COVID deathsThe federal governmentâs count of those who died of COVID-19 in New York has 11,000 more victims than the tally publicized by the administration of Gov. Andrew Cuomo, which has stuck with a far more conservative approach to counting virus-related deaths. NYC COVID hospitalizations likely to grow as delta variant rapidly spreadsThe delta variant is fueling new COVID-19 cases in New York City, and health officials are urging New Yorkers to get vaccinated if they havenât already. NYC Health Commissioner Dr. Dave Chokshi told PIX11 Morning Newsâ Betty Nguyen that heâs very concerned about the delta variant. Global COVID-19 deaths hit 4 million amid rush to vaccinateThe global death toll from COVID-19 eclipsed 4 million as the crisis increasingly becomes a race between the vaccine and the highly contagious delta variant. 99 percent of U.S. COVID deaths are unvaccinated people: FauciAmericaâs top infectious disease expert says about 99.2% of recent COVID-19 deaths in the United States involved unvaccinated people. And Dr. Anthony Fauci says âitâs really sad and tragic that most all of these are avoidable and preventable.â NY chief judge, family got preferential COVID-19 testing at home, official saysNew York Chief Judge Janet DiFiore and some relatives received COVID-19 testing from the state at her private Long Island residence last summer after a member of the family tested positive, a state court official said. Why unvaccinated people still have to wear a mask in New YorkThe State of Emergency in New York may have ended but the state Department of Health remains cautious about the spread of COVID-19. The same day the State of Emergency expired, DOH readopted some emergency regulations that would allow the agency and local health departments to react quickly should another spike in COVID cases happen, such as its âSurge and Flexâ strategy and requiring masks in public for unvaccinated people. Thereâs more to the worker shortage than pandemic unemployment, experts sayThe workforce shortage is a combination of several factors, including the COVID-19 pandemic, a shift in the economy, and changes in the workforce demographics, experts say. Free health insurance included in stimulus benefits for unemployment recipientsAlong with $1,400 stimulus checks and monthly child tax credit payments, the American Rescue Plan has another important benefit available to people who qualified for unemployment assistance this year: free health care. Essential workers monument to change location, remain in Battery Park CityA monument honoring essential workersâ efforts during the COVID-19 pandemic will change locations after residents in Battery Park City were unhappy with where it was originally going to be built. Workers enjoy the upper hand as companies scramble to hireWith the economy growing rapidly as it reopens from the pandemic, many employers are increasingly desperate to hire. Yet evidence suggests that as a group, the unemployed arenât feeling the same urgency to take jobs. Vaccine freebiesNew York, New Jersey and several companies nationwide are offering incentives for those who get vaccinated, including free food, drinks and discounts. Latest official numbersAs of Saturday, there have been 2,248,506 confirmed cases of COVID-19 since March 2020 and 43,504 fatalities, according to data from the state. CDC data shows 55,453 deaths. COVID-19 timeline: How novel coronavirus spread Tips to protect yourself and others amid coronavirus outbreaks The New York state coronavirus hotline is 1-888-364-3065; information is also being posted here The post NY COVID latest: Sunday, August 29, 2021 recently appeared on Medical Update News.
NEW ORLEANS (AP) — A Florida couple who met in a gross anatomy class as Tulane University undergraduates has given Tulane Medical School $5 million for an endowed professorship. Drs. Philip and Cheryl Leone, of Naples, Florida, are now retired pathologists and current members of the School of Medicine Board of Governors, a university news release said Wednesday. Their endowment will support a medical school professor who will also hold a joint appointment in another school or unit, and will focus on areas such as public health, immunology, parasitology or anthropology, the university said. The Leones have worked in both academic and private practice. “Tulane University has played a major role in our lives and the lives of our family members,” Phil Leone said. “Our son graduated from Tulane, and Cheryl’s siblings earned undergraduate and graduate degrees from the university.” “Endowing a Presidential Chair with an emphasis on interdisciplinary academic study allows us to contribute to the university in these challenging times,” Cheryl Leone said. “We hope our gift will strengthen the medical school and help train future physicians who can significantly advance the field of medicine.” The post Florida couple gives Tulane med school $5M for professorship recently appeared on Medical Update News.
Refusing to get vaccinated against COVID-19 was already a reckless health decision. Lately, it’s been turning into an expensive one, too. Take the price of insurance. On Wednesday, Delta Airlines announced that it would charge unvaccinated employees an extra $200 per month for their health coverage and require that they be tested for the coronavirus weekly. At least part of the airline’s motivation was financial. Like many major corporations, the airline is self-insured, meaning that it pays the medical claims of its own workers, and in an open memo to staff, CEO Ed Bastian noted that the average hospital stay for COVID had cost it $50,000. While 75 percent of its workforce is vaccinated, Delta wants to push the number higher. It wouldn’t be surprising if other big companies followed suit. A number of employers, from hospital networks to Disney, have decided to simply require that their workers get vaccinated or submit to testing. But for various reasons, others worry that mandates will seem too overbearing—Delta, for instance, might be concerned about blowback from Republican politicians in its home state of Georgia—and may prefer to prod their employees with insurance surcharges. One corporate consultant told the New York Times that about 50 companies had spoken with him about imposing these sorts of penalties. There are probably limits on how much companies can increase premiums for the unvaccinated. Under the Health Insurance Portability and Accountability Act—better known as HIPAA—employers generally are not allowed to charge workers extra for insurance based on their health status (the rule is somewhat similar to the Affordable Care Act’s regulations for the individual market). But federal law makes an exception for employer wellness programs, which can offer workers financial rewards or penalties to take steps such as quitting smoking. Vaccine surcharges would probably have to be structured under the same rules, which means the punishments for going without a shot can’t be so stiff that they can be considered “coercive”—a slightly fuzzy standard—and are limited to no more than 30 percent of the cost of individual coverage under the company’s plan. Delta seems to be keeping all of this in mind, though all their spokesman would tell me when I asked about it was that the company “is well within the plan and legal parameters to make this change.” Simply mandating vaccines for employees might be the more straightforward and superior strategy as far as public health is concerned, compared to using the wellness program model. After all, there’s no question that businesses can outright require workers to get vaccinated before they return to the workplace (which, ironically, is a vastly more “coercive” option than any premium increase). And some hardline anti-vaxxers might choose to simply go without the shot or coverage, which could further isolate them from mainstream medical advice. “I’m not sure that pricing someone out of their insurance by charging them more is a good strategy for getting them vaccinated,” Sabrina Corlette, the director of Georgetown University’s Center on Health Insurance Reforms, told me. “Why would we cut people off from their family doctors or pediatricians to convince them to get vaccinated? That seems like biting off your nose to spite your face.” But companies aren’t necessarily looking for the optimal choice from a public-health standpoint—they’re looking for an option that makes sense to them financially, politically, and from a workforce-management perspective, which might mean using higher premiums as a strong nudge. Policies at large corporations, meanwhile, aren’t the only way it’s getting pricier to go unjabbed. Let’s say you get sick. At start of the pandemic, private insurers largely chose to waive out-of-pocket expenses for coronavirus patients who needed hospital care. But most have stopped offering those breaks; a recent Kaiser Family Foundation analysis found that almost three quarters of insurance carriers have brought back cost-sharing, and another 10 percent plan to do so by October. As a result, Americans who land in the ER with COVID might well face a hefty bill. (Unlike with coronavirus testing, federal law doesn’t require free care for people who actually get sick.) Why are insurers no longer waiving out-of-pocket costs? There’s a confluence of factors. Covering COVID care at no charge was essentially an inexpensive way for carriers to generate good will early in the pandemic, not to mention avoid a federal mandate requiring them to do so, Cynthia Cox, a health care expert at the Kaiser Family Foundation, told me. The Affordable Care Act requires insurance companies to spend 80 percent of the premiums they collect on medical claims; otherwise, they have to refund some of the money to enrollees. When Americans cut back on hospital visits early in the pandemic for anything other than COVID, insurers essentially found themselves earning too much money, and needed to spend it on something in order to meet Obamacare’s rules. Using the money waiving out-of-pocket costs was essentially “a free way to build good PR,” Cox said. “They weren’t losing anything,” Cox further explained. “But this year, health care use has mostly rebounded, and there’s a vaccine, so hospital costs can mostly be avoided. So there isn’t as much sympathy, I think, for people who are hospitalized with COVID.” How much can COVID patients expect to pay for a trip to the hospital? Cox told me that her think tank hadn’t found good real-time data yet, but that they had looked at the charges faced by pneumonia patients in past years, which averaged out to around $1,300 to $1,464 depending on complications, similar to the deductibles on many health plans. People with a higher deductible or out-of-pocket maximum could pay more—especially if they wind up in the intensive care unit or need a ventilator. One way you could look at all this is that some of the worst aspects of the U.S. health care system are currently being used to reasonably good ends. After all, wellness programs are a major loophole in insurance law that allow companies to discriminate against some of their employees, which is why patient advocates fought hard against writing them into the Affordable Care Act. Likewise, it is generally a bad thing that Americans can face thousands of dollars in charges when they end up in the hospital with an illness. But right now we’re in an exceptional situation, where a major chunk of the country has made the personally and socially irresponsible decision to not get vaccinated in the midst of a plague. If the threat of a potentially deadly illness won’t convince them, well, hopefully the threat to their bank account will. The post Delta, health insurers are making the unvaccinated pay for their choice. recently appeared on Medical Update News. The Fayetteville Observer honored the best in restaurants, businesses, organizations and other professionals across more than 150 categories during the 27th annual Readers’ Choice Awards on Friday evening. After the 2020 awards were held virtually due to the COVID-19 pandemic, guests returned to the Crown Expo for the awards gala. Miss North Carolina 2021 Carli Batson emceed the event. National Black Business Month: Here are 40 Black-owned businesses in the Fayetteville area Below is a list of the 2021 winners, decided from more than 113,000 votes. The complete list of winners will also be featured in a special publication in Sunday’s Fayetteville Observer. Beauty & HealthBarber shop: Pinky’s Chop Shop Chiropractor: Nelson & Nelson Chiropractor Cosmetic/Plastic Surgeon: Cape Fear Aesthetics-Edward Dickerson Dentist: Lewis Family Dentistry Doula Services: Doris Ann McMurray Eye Doctor: Risk Optometric Associates Eyecare/Eyewear Center: Risk Optometric Associates Fitness Center/Gym: (TIE) Fit 4 life and Planet Fitness Hair Salon: Blown Away Hair Studio Hearing Aid Center: Advanced Hearing Care Hospital: Cape Fear Valley Medical Center Nail Salon: Nails by Sonja Nurse/Nurse Practitioner: Rainbow Pediatrics: Follrod Cinthia, NP OB/GYN: Meeks, Earl, MD-Womens Wellness Orthodontist: Olsen Orthodontics Pediatrician: Rainbow Pediatrics Pharmacy/Drug Store: Cape Fear Discount Drug Primary Care Physician: Rainbow Pediatrics Spa/Wellness Center: Renaissance European Day Spa Tanning Salon: Sunshine Beauty & Bliss Urgent Care: NextCare Urgent Care Weight Loss Center: Fit 4 life Yoga Studio: Shanti Wellness- Fayetteville Wellness Center DiningLocal Asian: Samurai Japanese Steak House & Sushi Bar Local Bakery: Superior Bakery Local Barbeque: Mission BBQ Local Breakfast: Zorba’s Gyro Local Buffet: Grandsons Buffet Local Burger: R Burger Local Caterer: Kinlaw’s Welcome Grill Local Chicken Wings: 301 Wingz Local Coffee Shop: The Coffee Scene Local Country Cooking: Grandsons Buffet Local Craft Brewery: Dirtbag Ales Brewery & Taproom Local Dessert: Superior Bakery Local Doughnuts: Superior Bakery Local Fine Dining: Luigi’s Italian Chophouse and Bar Local Food Truck: R Burger Local Fried Chicken: Kinlaw’s Welcome Grill Local Gyro: Zorba’s Gyro Local Healthiest Menu: Bowls On A Roll 2 Go Meal Prep Store Local Hot Dog: Hot Diggidy Dog Local Ice Cream/Frozen Yogurt: Gillis Hill Farm Local International Cuisine: Pharaohs Legacy Local Italian Food: Antonella’s Italian Ristorante Local Kid Friendly: (TIE) Mellow Mushroom Fayetteville and Segra Stadium Local Lunch: The Fried Turkey Sandwich Shop Local Mexican Food: Mi Casita Local New Restaurant – Open Less than 12 Months: Maple Street Biscuit Company – Fayetteville Local Outdoor Dining: Antonella’s Italian Ristorante Local Pizza: Elizabeth’s Local Ribs: Mission BBQ Local Sandwich Shop: The Fried Turkey Sandwich Shop Local Seafood: 316 Oyster Bar Local Spaghetti: Sammio’s Italian Restaurant Local Sports Bar: Mac’s Speed Shop Local Steak: Chris’s Steak & Seafood House Local Sushi: Nona Sushi Local Tea: Winterbloom Tea Local Vegetarian or Vegan: Blue Moon Cafe Entertainment & LeisureDance Studio or School: Alpha and Omega Dance Academy Date Night Activity: Fayetteville Woodpeckers DJ (Special Events): Five Star Entertainment Event or Festival: Dirtbag Ales Farmers Market Event Venue: Cape Fear Botanical Garden Family Amusement: Fayetteville Woodpeckers Girls Night Out Activity: Wine, Paint & Create Golf Course: Gates Four Golf & Country Club Nightlife: Dirtbag Ales Place to Feel Like a Kid Again: DEFY Fayetteville Place to Take Out of Town guests: Dirtbag Ales Home, Home Services & FinanceAccountant: Heather Harris McManus-Harris Accounting and Tax Apartment Complex: The Preserve at Grande Oaks Carpet Cleaning Company: 911 Restoration Electrician: Blanton’s Air, Plumbing & Electric Flooring Company: Webb Carpet Company Heating & A/C Service Company: Ryan Air Home Builder: Jonah Blankenship, Blankenship Construction Home Repair & Remodeling Company: Paul Blankenship Vinyl Siding and Windows Home Security Company: Holmes Security Systems Insurance Agent/Agency: State Farm-Kurt Riehl Lawn Care/Landscaping Company: NC Design Concepts Mortgage Lender: Jennifer Rivers- Carolina Home Mortgage Moving Company: Two Men and a Truck Painter: Ark’s Painting Pest Control Company: J & J Pest Control Plumber: Blanton’s Air, Plumbing & Electric Pressure Washing/Gutter Company: NC window cleaning Real Estate Company: The TK Real Estate Group Roofing Company: Gremillion Roofing Senior Living Facility: Heritage Place Senior Living Siding Company: Paul Blankenship Vinyl Siding and Windows Swimming Pools/Pool Supplies Company: Crystal Clear Pools and Spas Windows Company: Paul Blankenship Vinyl Siding and Windows Kids & EducationClub Youth Sports Organization: Fayetteville Guard Youth Sports College or University: Campbell University Gymnastics Studio: The Little Gym of Fayetteville Learning Center/Tutor: Fayetteville Christian School Martial Arts: Tiger Team Karate Place to Have a Birthday Party: Round-A-Bout Skating Center Pre-school/Child Care Center: Trinity Christian School Private School: Fayetteville Christian School Public School: E E Miller Elementary School People & PlacesAttorney: Drew Dempster- Smith, Dickey, Dempster Barber: Elyssa Sax-Foundations Church Youth Director: Josh Long, Northwood Temple Emergency Responder (Police, Fire, EMT): Aaron Hagen-Fayetteville fire dept Hairstylist: Lauren Bunce-Salon 31 Place of Worship: Manna Church: Place to Work: Riverside Christian Academy Real Estate Agent: Chasity Poole School Principal: Gerald Hernandez-EE Miller Elementary School Teacher: Dr. Polly Lusk-Howard Hall Elementary Small Business: The Hemp Farmacy Sports Team: Fayetteville Woodpeckers Veteran or Military-Spouse Owned Business: Dirtbag Ales Brewery & Taproom ServicesBailbondsman Company: A1 Bail Bonds Business with the Best Customer Service: Bullard Furniture Cell Phone/Computer Repair Company: iFixandRepair – Fayetteville Skibo Road Document Shredding: Patterson Record Storage and Shredding Center Doggy Daycare: Bed & Biscuits Dry Cleaner: Smitty’s Cleaners Employment Agency: Maxim Staffing Solutions – Kelly Maxwell Financial Planner: Debbie Best-Edward Jones Foster Care Services: Boys & Girls Home Funeral Home: Rogers and Breece Non Profit: Partnership for Children Pet Boarding: Bed and Biscuits Pet Grooming Company: Woof Gang Bakery & Grooming Fayetteville Pet Sitting: Bed & Biscuits Tattoo/Piercing Studio: New Addiction Tattoos Veterinarian: Southern Oaks Animal Hospital-Kently Dean ShoppingLocal Antique Store: The Pickin Coop Antique Mall Local Boutique: Off the Racks Boutique Local Consignment Store: High Cotton Consigment Local Florist: The Downtown Market Local Formal Wear/Bridal: An Affair to Remember: Prom, Pageant, and Formal Wear Local Fresh Meat: Kinlaw’s Supermarket Local Fresh Produce: Gillis Hill Road Produce Local Furniture Company: Bullard Furniture & Mattress Local Garden Center/Nursery: Bell’s Seed Store Local Gift Store: A Bit of Carolina Local Grocery Store: The Downtown Market Local Jewelry Store: Rhudy’s Jewelry Showroom Local Lawn Equipment Company: Hope Mills Saw & Mower Local Mattress Store: Bullard Furniture Local Men’s Clothing: Stevies on Hay Local Pawn Shop: Rhudy’s Pawn Shop Local Pet Supplies Company: Woof Gang Bakery & Grooming Local Shoe Store: Off The Racks Boutique Local Thrift Store: The Salvation Army Family Store Local Women’s Clothing: Off the Racks Boutique Vehicles, Dealers & ServicesAuto Body/Collision: Cape Fear Collision Auto Glass Repair: Hope Mills Glass Company Auto Service: Ernie and sons automotive Car Audio: Rhudy’s Car Dealer: I-95 Muscle Car Wash: 5 Star Motorcycle/ATV Dealer: Fort Bragg Harley-Davidson Oil Change: Black’s Tire & Auto Service Tire Center: Black’s Tire The post Fayetteville Observer’s Readers’ Choice Awards 2021: See the winners recently appeared on Medical Update News. I first learned about the Oklahoma Medical Research Foundation a few years after I arrived in Oklahoma. I’d received a freelance writing assignment from Oklahoma Today magazine, and my editor tasked me with writing a profile of Dr. Jordan Tang. Tang had recently discovered the enzyme believed responsible for Alzheimer’s disease, cloned the enzyme, and then developed an experimental inhibitor that stopped the enzyme. When I sat with Dr. Tang in his office overlooking Northeast 13th Street, he explained the mind-bogglingly complicated work using metaphors that even I, an attorney and English major, could understand. The enzyme, he said, was like a Pac-Man that cut proteins, and he and his OMRF research team had invented a chemical chewing gum that would stop the waka-waka-waka. “These are monumental discoveries,” Dr. J. Donald Capra, then OMRF’s president, told me when I interviewed him for the article. “I will be stunned if a decade from now, corner drugstores are not selling a drug to inhibit Alzheimer’s disease that came out of this foundation.” That was 20 years ago. And, as anyone reading this column knows, despite Dr. Tang’s best efforts, Alzheimer’s remains a disease without an effective treatment. More:Inhofe’s funding request for OMRF data center could help clear ‘huge bottleneck in science’ But this is not a story about failure. In fact, it’s quite the opposite. This weekend marks the 75th anniversary of the day in 1946 when Oklahoma’s Secretary of State signed OMRF’s charter. The articles of incorporation set forth, in lawyerly language, a charge that was both simple and daunting: “conducting scientific investigations in medicine.” Over the ensuing three-quarters of a century, OMRF researchers have done just that. And, for a relatively small place – OMRF employs a bit under 500 employees in total, whereas a major academic medical center like Harvard Medical School counts 12,000 faculty members alone – the foundation has punched well above its weight. More:Oklahoma Medical Research Foundation scientist connects gut health to ability to heal Today, health care providers around the world use three different lifesaving drugs born at OMRF to help patients. Soliris and Ceprotin treat life-threatening blood disorders and a debilitating neurological disease. And Adakveo, now approved in the U.S. and 43 other countries, is the first targeted therapy approved by the U.S. Food and Drug Administration for sickle cell disease, a debilitating and potentially fatal condition that affects an estimated 100,000 Americans, most of African descent. OMRF has also become a national and international leader in the quest to understand, manage and prevent autoimmune diseases. Foundation scientists have helped identify and confirm more than 60 genes tied to lupus. They’ve assembled a world-renowned collection of biological samples from patients and their families that researchers from across the globe have tapped for hundreds of studies. Their work also gave birth to Vectra DA, a disease management test used by rheumatologists everywhere to help guide the care of patients with rheumatoid arthritis. COVID-19 resurges:OKC hospitals report their own capacity data, showing how scarce beds are amid COVID-19 surge Medical research is, by nature, experimental. And not every experiment that OMRF scientists performed has succeeded. Far from it. But that’s okay. As we’ve been reminded time and again during the pandemic, science is an iterative process. We think we know things, but until researchers have had time to kick the tires – from every angle and over a prolonged period – we can’t tell for sure. And even what we thought we knew a month, a year or a decade ago may turn out to be wrong. Or at least different. Like nature itself, science requires constant adaptation. Observation and creativity are crucial to the process, but so is a willingness to change course when a hypothesis proves faulty. When an experiment fails. More:As OMRF hits 75-year milestone, here are 5 of its scientists’ key discoveries More:Integris Health joins other Oklahoma health systems in requiring COVID-19 vaccine for staff Dr. Tang passed away last year at the age of 89. He spent more than 50 of those years at OMRF. And while he never reached that holy grail of an Alzheimer’s drug, his work pushed the field forward significantly. Many of the experimental treatments currently in development rely upon insights that Dr. Tang and his research team made. Dr. Tang’s spirit also lives on in protease inhibition drugs that transformed the therapeutic landscape for patients with HIV and AIDS. His expertise provided pharmaceutical companies with a key element in overcoming drug resistance in treatments for the deadly disease. Now, when taken in combination with other antiretroviral drugs, protease inhibitors add decades to the lives of people with HIV and AIDS, decreasing viral loads to undetectable levels and allowing patients to effectively manage and live with the disease. That’s quite a legacy. As we blow out the candles on OMRF’s first 75 years, it’s worth remembering the words of Sir Alexander Fleming, the British physician-researcher who discovered penicillin. When he spoke at OMRF’s dedication, he wondered what the future would hold for the young foundation. “You might call it a frightful gamble, just as it is a gamble when a baby is born into this world, or when a bore is sunk for oil,” he said. “But the results of the work done here may prove a thousand times more valuable to humanity than all the oil in Oklahoma.” Has OMRF has yet met that lofty charge? At the very least, our scientists have already made a good dent. And unlike a human being who’s been around for the better part of a century, a 75-year-old research institute can look to the future and confidently say the best is yet to come. ‘Barely hanging on’:An Oklahoma City ICU nurse on the exhaustion of another COVID surge Adam Cohen is senior vice president & general counsel and interim president of the Oklahoma Medical Research Foundation. He can be reached at [email protected]. The post Oklahoma Medical Research Foundation celebrates 75 years of discovery recently appeared on Medical Update News. (HealthDay)—Medical students who experience mistreatment and perceive a less favorable learning environment are more likely to develop higher levels of exhaustion and disengagement, lower levels of empathy, and career regret, according to a study published online Aug. 9 in JAMA Network Open. Liselotte N. Dyrbye, M.D., M.H.P.E., from the Mayo Clinic in Rochester, Minnesota, and colleagues examined the association between mistreatment and perceptions of the learning environment with subsequent burnout, empathy, and career regret among U.S. medical students. Data were used from 14,126 respondents to the 2014 to 2016 Association of American Medical Colleges (AAMC) Medical School Year 2 Questionnaire (Y2Q) and 2016 to 2018 AAMC Graduation Questionnaire (GQ). The researchers found that 22.9 percent of respondents on the Y2Q reported mistreatment, which was significantly associated with a higher exhaustion score, a higher disengagement score, and a higher likelihood of career regret on the GQ. In contrast, a more positive emotional climate reported on the Y2Q was significantly associated with a lower exhaustion score and lower disengagement score on the GQ. There was an association noted between more positive faculty interactions on the Y2Q and a higher empathy score on the GQ. There were lower odds of career regret during year 4 of medical school among those reporting better student-student interactions (odds ratio, 0.97). “Strategies to improve student well-being, empathy, and experience should include approaches to eliminate mistreatment and improve the learning environment,” the authors write. One author disclosed receiving royalties from CWS Inc. Copyright © 2021 HealthDay. All rights reserved. Citation: This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no The post Learning environment issues tied to medical school burnout recently appeared on Medical Update News. The federal Department of Energy has awarded $37 million to help a Wisconsin company manufacture radioactive isotopes used in millions of medical procedures. Two grants announced Friday will help NorthStar Medical Technologies of Beloit increase commercial production of molybdenum-99 (Mo-99), which decays into an isotope used to detect cancer, heart disease and other conditions. NorthStar is one of five companies working with the DOE to produce Mo-99 without the use of highly enriched uranium, which is typically imported and produces long-lasting toxic waste and can be used in nuclear weapons if stolen. “Establishing a domestic supply for a whole host of products, including this critical medical isotope, is good for our national security and good for job creation here at home,” Secretary of Energy Jennifer M. Granholm said in a statement. A NorthStar spokesperson did not immediately respond to a request for comment Friday. This spring NorthStar installed two particle accelerators at its $80 million Beloit facility that will be used to remove a neutron from the concentrated mineral. The post Department of Energy awards Beloit company $37 million to support medical isotope production | Technology recently appeared on Medical Update News.
In celebration of Roger and Kathy (Honcik) Kahny’s 50th wedding anniversary on Sept. 9, their children would like to honor them with a card shower. The couple married in Norfolk and then later moved to Germany as Roger was in the Army. This is where they had their first child, Chris. The next move was Columbus, Ga., where they had their daughter, Mandy. They moved back to Norfolk where they had their son, Nick. Roger retired from Nucor Steel and Kathy retired from Authier Pape Miller Eyecare. Chris and wife Heidi Kahny (three children) reside in Sioux Falls, S.D., Mandy and husband Mickey Pederson (two children) reside in Amarillo, Texas, and Nick and wife Beth Kahny (two children) live in Norfolk. They are enjoying retirement doing a lot of traveling and doting on their seven grandchildren. Cards of congratulations can be sent to 1108 Westbrook Drive, Norfolk, NE 68701. The post Roger and Kathy Kahny | Anniversaries recently appeared on Medical Update News. SummaryBackgroundThe full range of long-term health consequences of COVID-19 in patients who are discharged from hospital is largely unclear. The aim of our study was to comprehensively compare consequences between 6 months and 12 months after symptom onset among hospital survivors with COVID-19. MethodsWe undertook an ambidirectional cohort study of COVID-19 survivors who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7 and May 29, 2020. At 6-month and 12-month follow-up visit, survivors were interviewed with questionnaires on symptoms and health-related quality of life (HRQoL), and received a physical examination, a 6-min walking test, and laboratory tests. They were required to report their health-care use after discharge and work status at the 12-month visit. Survivors who had completed pulmonary function tests or had lung radiographic abnormality at 6 months were given the corresponding tests at 12 months. Non-COVID-19 participants (controls) matched for age, sex, and comorbidities were interviewed and completed questionnaires to assess prevalent symptoms and HRQoL. The primary outcomes were symptoms, modified British Medical Research Council (mMRC) score, HRQoL, and distance walked in 6 min (6MWD). Multivariable adjusted logistic regression models were used to evaluate the risk factors of 12-month outcomes. Findings1276 COVID-19 survivors completed both visits. The median age of patients was 59·0 years (IQR 49·0–67·0) and 681 (53%) were men. The median follow-up time was 185·0 days (IQR 175·0–198·0) for the 6-month visit and 349·0 days (337·0–361·0) for the 12-month visit after symptom onset. The proportion of patients with at least one sequelae symptom decreased from 68% (831/1227) at 6 months to 49% (620/1272) at 12 months (p<0·0001). The proportion of patients with dyspnoea, characterised by mMRC score of 1 or more, slightly increased from 26% (313/1185) at 6-month visit to 30% (380/1271) at 12-month visit (p=0·014). Additionally, more patients had anxiety or depression at 12-month visit (26% [331/1271] at 12-month visit vs 23% [274/1187] at 6-month visit; p=0·015). No significant difference on 6MWD was observed between 6 months and 12 months. 88% (422/479) of patients who were employed before COVID-19 had returned to their original work at 12 months. Compared with men, women had an odds ratio of 1·43 (95% CI 1·04–1·96) for fatigue or muscle weakness, 2·00 (1·48–2·69) for anxiety or depression, and 2·97 (1·50–5·88) for diffusion impairment. Matched COVID-19 survivors at 12 months had more problems with mobility, pain or discomfort, and anxiety or depression, and had more prevalent symptoms than did controls. InterpretationMost COVID-19 survivors had a good physical and functional recovery during 1-year follow-up, and had returned to their original work and life. The health status in our cohort of COVID-19 survivors at 12 months was still lower than that in the control population. FundingChinese Academy of Medical Sciences Innovation Fund for Medical Sciences, the National Natural Science Foundation of China, the National Key Research and Development Program of China, Major Projects of National Science and Technology on New Drug Creation and Development of Pulmonary Tuberculosis, the China Evergrande Group, Jack Ma Foundation, Sino Biopharmaceutical, Ping An Insurance (Group), and New Sunshine Charity Foundation. MethodsStudy design and participants
This is an ambidirectional cohort study of COVID-19 survivors discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7 and May 29, 2020. Inclusion and exclusion criteria of survivors have been described previously.
Briefly, all patients with laboratory confirmed COVID-19 discharged from Jin Yin-tan Hospital between Jan 7 and May 29, 2020, were eligible for participation. Patients were excluded if they died after discharge; were living in a nursing or welfare home; had psychotic disorder, dementia, or osteoarthropathy; or were immobile. To determine whether COVID-19 patients completely recovered at 12 months, we recruited community-dwelling adults without SARS-CoV-2 infection (controls) from two districts of Wuhan city between Dec 24, 2020, and Jan 16, 2021. The inclusion and exclusion criteria are shown in the appendix (p 4). COVID-19 survivors and controls were further matched 1:1 by age, sex, and comorbidities including cardiovascular disease, chronic respiratory disease, chronic kidney disease, hypertension, and diabetes. The maximum allowed age difference between COVID-19 patients and their controls was 10 years. The study was approved by the Research Ethics Commission of Jin Yin-tan Hospital (KY-2020-78.01, KY-2020-78.03). Written informed consent was obtained from controls and COVID-19 survivors who attended the follow-up visit. Data collection of COVID-19 patients at acute phase
The definitions for the acute phase, collected data, and category of disease severity according to the highest seven-category scale during the hospital stay (termed the severity scale)
are described in our previous study and appendix (p 4). We confirmed the data for demographic and self-reported comorbidity with participants, face to face, at the 12-month follow-up visit. Follow-up assessment of COVID-19 survivors
Eligible COVID-19 survivors were invited to attend two follow-up visits at Jin Yin-tan Hospital at 6 and 12 months after symptom onset. The detailed 6-month follow-up procedures have been described previously.
At each visit, patients underwent a detailed interview, physical examination, and a 6-min walking test; completed a series of questionnaires, including a self-reported symptom questionnaire, the modified British Medical Research Council (mMRC) dyspnoea scale, the EuroQol five-dimension five-level (EQ-5D-5L) questionnaire to assess health-related quality of life, the EuroQol Visual Analogue Scale (EQ-VAS) (scores range from 0–100; a higher score indicates a better health status), and an ischaemic stroke and cardiovascular event registration form; and received laboratory tests. Notably, at the 12-month visit, they were also asked to complete a questionnaire to record their health-care use after discharge and work status.
A stratified disproportional random sampling procedure according to severity scale was used to select patients to receive pulmonary function tests and chest high-resolution CT (HRCT) at 6-month follow-up visit.
Of participants selected, 349 had completed the pulmonary function tests and 353 chest HRCT at the 6-month visit. The 349 participants who had completed the pulmonary function tests at 6-month visit were all invited to perform this test again at the 12-month visit. Of 353 participants who had completed chest HRCT at 6-month visit, the 186 who presented with abnormal CT were further invited to receive another HRCT scan at the 12-month visit.
COVID-19 patients whose plasma samples were all collected at the acute phase, discharge, 6-month visit, and 12-month visit received a cytokine test. They had previously been enrolled in the Lopinavir Trial for suppression of SARS-CoV-2 in China (LOTUS).
Their plasma samples were screened with the Bio-Plex Pro Human Cytokine Screening Panel 27-plex (Bio-rad, Hercules, CA, USA) in Bio-Plex 200 System (Bio-rad). The concentrations of 27 cytokines were measured: interleukin (IL)-1ra, IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-12, IL-13, IL-15, IL-17, eotaxin, interferon (IFN)-γ-induced protein (IP)-10, monocyte chemoattractant protein (MCP)-1, macrophage inflammatory protein (MIP)-1α, MIP-1β, RANTES, fibroblast growth factors, platelet derived growth factor-BB, vascular endothelial growth factor, granulocyte colony stimulating factor (G-CSF), granulocyte-macrophage colony stimulating factor (GM-CSF), IFN-γ, and tumor necrosis factor (TNF)-α. Data collection of community-dwelling non-COVID-19 adults
Community-dwelling non-COVID-19 adults were interviewed face to face at their community centre by trained medical staff from Jin Yin-tan Hospital. Standard questionnaires were administered to collect information about demographic characteristics, personal medical history, and lifestyle information. They were also asked to undergo physical examination and completed a questionnaire to record prevalent symptoms, the mMRC dyspnoea scale,
the EQ-5D-5L questionnaire, and EQ-VAS. Venous blood samples were collected for laboratory tests. Outcome measures
All outcome measures and assessment tools are listed in the appendix pp 9–12. The primary outcomes were symptoms, mMRC score, health-related quality of life (pain or discomfort, anxiety or depression, mobility, personal care, and usual activity), and distance walked in 6 min (6MWD). The secondary outcomes were lung function, chest CT pattern, outpatient visit and hospital admission after discharge, and work status at follow-up.
Statistical analysisDemographic characteristics and long-term health consequences of COVID-19 in patients are presented as median (IQR) for continuous variables and expressed as absolute values along with percentages for categorical variables. Participants were categorised into three groups according to their severity scale during their hospital stay (scale 3, not requiring supplemental oxygen; scale 4, requiring supplemental oxygen; or scale 5–6, requiring high-flow nasal cannula, non-invasive mechanical ventilation, or invasive mechanical ventilation). Demographic and clinical characteristics and long-term consequences across participants with different categories of severity scale are shown. For the comparison of demographic and clinical characteristics among participants with different disease severity, Kruskal-Wallis test, χ2 test, Fisher’s exact, or Mann-Whitney U test were used when appropriate. For the comparison of symptoms, exercise capacity, and health-related quality of life between 6-month and 12-month follow-up, we used Wilcoxon signed-rank test, or McNemar test when appropriate. The comparison of demographic and clinical characteristics, symptoms, health-related quality of life, and laboratory test results between COVID-19 patients and controls was done with Mann-Whitney U test, χ2 test, or Fisher’s exact test when appropriate. We used multivariable adjusted logistic regression analysis to explore risk factors associated with diffusion impairment, anxiety or depression, and fatigue or muscle weakness. For the association of disease severity with outcome, age, sex, cigarette smoking, education, comorbidity, corticosteroids, antivirals, and intravenous immunoglobulin were adjusted. For the association of factors including sex, corticosteroid, antiviral, and intravenous immunoglobulin with outcome, the aforementioned variables were all included in the model. When exploring the associations of education and smoking with outcome, the aforementioned variables except for comorbidity, and both comorbidity and disease severity (due to the potential mediation) were included, respectively. Only sex, smoking, and education were adjusted for the association between age and outcome due to the potential mediation of other factors. For the association of comorbidity with outcome, the aforementioned variables except for disease severity were all included. Additionally, a sensitivity analysis with inverse probability-weighted generalised estimating equations was done to reduce the effect of bias due to differences between patients who were included in these analyses and those who were not because of loss to follow-up. For the comparison of cytokine concentrations at the acute phase, discharge, 6-month follow-up, and 12-month follow-up, Wilcoxon signed-rank test was used. Log10-transformation was done for each cytokine. Partial correlation coefficients between different cytokine pair in COVID-19 patients at discharge, 6-month follow-up, and 12-month follow-up were estimated with adjustment for age, disease severity, and sampling days after symptom onset. For the association of change in cytokine (at discharge until 6-month follow-up) with categorical outcomes at 12-month follow-up, multivariable adjusted logistic regression models were used to estimate the odds ratios (ORs) and 95% CIs per IQR change of log10-transformed cytokine concentration. For the association between change in cytokine concentrations and continuous outcomes, multivariable adjusted linear regression models were used to calculate the β estimates and 95% CIs per IQR change of log10-transformed cytokine concentration. The results following log-transformation were calculated on the basis of geometric mean ratio of cytokines. Age, sex, and corticosteroids were adjusted. All significance tests were two-sided, and a p value of less than 0·05 was considered statistically significant unless stated otherwise. To correct for multiple comparison of demographic and clinical characteristics between two groups of study participants with different severity scale, we used a Bonferroni corrected α-threshold of 0·0167. To correct for multiple comparison of cytokine concentrations at the acute phase, discharge, 6-month follow-up, and 12-month follow-up, we used a Bonferroni corrected α-threshold of 0·0083. A stringent Bonferroni correction was also used for testing correlation of 351 cytokine pairs, using an α-threshold of 1·4 × 10−4 to determine statistical significance. All statistical analyses were done with SAS (version 9.4). The partial correlation plot was generated in R (version 3.5.2). Role of the funding sourceThe funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Results
2469 patients with COVID-19 were discharged from Jin Yin-tan Hospital between Jan 7 and May 29, 2020. The 6-month follow-up visit was done between June 16 and Sept 3, 2020, and the 12-month follow-up visit between Dec 16, 2020, and Feb 7, 2021. 1276 (58%) participants who attended both visits were included in final analysis (figure 1). The proportion of men and participants who received oxygen therapy during hospital stay were slightly higher in patients who were included in final analysis than in those who were not (appendix p 20). There was no significant difference in age, smoking status, comorbidities, and intensive care unit (ICU) admission between both groups (appendix p 20).
Table 1 shows the demographic and clinical characteristics of 1276 patients who attended both visits. Median follow-up time was 185·0 days (IQR 175·0–198·0) after symptom onset for 6-month visit and 349·0 days (337·0–361·0) after symptom onset for 12-month visit. The median age of patients was 59·0 years (IQR 49·0–67·0), and 681 (53%) were men. 864 patients (68%) received oxygen via nasal cannulae and mask during hospitalisation, and 94 (7%) required high-flow nasal cannula, non-invasive mechanical ventilation, or invasive mechanical ventilation. 54 (4%) patients were admitted to ICU, with a median length of ICU stay of 18·0 days (IQR 7·0–30·0). 307 (24%) patients received corticosteroids therapy during hospital stay.
Table 1Characteristics of COVID-19 patients who completed both 6-month and 12-month follow-up Data are median (IQR), n (%), or n/N (%) when data are missing. The differing denominators used indicate missing data. To correct for multiple comparison between two groups of study participants with different severity scale, a Bonferroni corrected α-threshold of 0.0167 was used. HFNC=high-flow nasal cannula for oxygen therapy. NIV=non-invasive ventilation. IMV=invasive mechanical ventilation. ECMO=extracorporeal membrane oxygenation. ICU=intensive care unit. NA=not applicable.
Table 2 shows the temporal trend in sequelae symptom, health-related quality of life, and exercise capacity. The proportion of patients with at least one sequelae symptom decreased from 68% (831/1227) at 6 months to 49% (620/1272) at 12 months (ptable 2). The proportion of patients with dyspnoea, characterised by mMRC score of 1 or more, slightly increased from 26% (313/1185) at 6-month visit to 30% (380/1271) at 12-month visit (p=0·014). Additionally, more patients had anxiety or depression (23% [274/1187] at 6-month vs 26% [331/1271] at 12-month visit, p=0·015), among whom mild anxiety or depression was predominant (appendix p 22) and only one patient visited the psychological department after discharge. The proportion of patients with 6MWD less than lower limit of the normal range was 12% (147/1248) at 12 months, which was statistically lower than 14% (174/1254) at 6 months (p=0·033). We noted no significant difference in median 6MWD between 6 months and 12 months (table 2). Within 12 months after symptom onset, three of 1276 patients developed ischaemic stroke, and one patient newly developed stable angina pectoris.
Table 2Sequelae symptom, exercise capacity, and health-related quality of life among COVID-19 patients at 6-month and 12-month follow-up Data are median (IQR), n (%), or n/N (%) when data are missing. The differing denominators used indicate missing data. p value indicates the comparison of consequences between 6 months and 12 months in total or each category of scale. HFNC=high-flow nasal cannula for oxygen therapy. NIV=non-invasive ventilation. IMV=invasive mechanical ventilation. mMRC=modified British Medical Research Council. EQ-5D-5L=EuroQol five-dimension five-level questionnaire.
We recruited 3383 community-dwelling adults without SARS-CoV-2 infection. The appendix p 23 shows the characteristics of 1164 matched pairs. We recorded no significant differences in age, sex, and comorbidities between both groups. 764 of 1164 (66%) COVID-19 patients had at least one prevalent symptom, which was significantly higher than for controls (383/1164 [33%], pappendix p 24). The proportions of each prevalent symptom and mMRC score of 1 or greater were all significantly higher in COVID-19 patients than in controls (all pappendix p 24). COVID-19 patients had more problems with mobility, pain or discomfort, and anxiety or depression and had lower self-assessment scores of quality of life than did controls (all pappendix p 24). 62 of 1160 (5%) COVID-19 survivors had a leucocyte count lower than 4 × 109 per L at 12 months, which was slightly higher than for controls (33/1091 [3%], p=0·023; appendix p 25). The proportion of patients with lymphocyte count lower than 0·8 × 109 per L or serum creatinine abnormality did not differ between COVID-19 survivors and controls. The appendix p 25 shows other results of laboratory tests. The appendix p 26 shows the detailed results of EQ-5D-5L questionnaire of matched COVID-19 survivors and controls.
Among 349 patients who had completed pulmonary function tests at 6-month visit, 254 attended the 12-month visit but ten were not able to complete the test (table 3). Spirometric and lung volume parameters of most patients were within normal limits at 12-month visit. Lung diffusion impairment, defined as diffusion capacity for carbon monoxide less than 80% of predicted, did not improve from 6 months to 12 months in the three groups of patients with variable severity at acute phase (all p>0·05; table 3). At 12 months, lung diffusion impairment was found in 23% (13/56) of patients in the severity scale 3 group, 31% (36/117) in the scale 4 group, and 54% (38/70) in the scale 5–6 group. The proportion of total lung capacity less than 80% of predicted in patients with scale 5–6 severity decreased significantly from 39% (27/69) at 6 months to 29% (20/70) at 12 months (p=0·021).
Table 3Lung function and chest CT among COVID-19 patients at 6-month and 12-month follow-up according to severity scale Data are absolute values, n (%), or n/N (%) when data are missing. HFNC=high-flow nasal cannula for oxygen therapy. NIV=non-invasive ventilation. IMV=invasive mechanical ventilation. FEV1=forced expiratory volume in 1 s. FVC=forced vital capacity. TLC=total lung capacity. FRC=functional residual capacity. RV=residual volume. DLCO=diffusion capacity for carbon monoxide. GGO=ground glass opacity. NA=not applicable.
Of 186 patients with abnormal lung CT at 6-month visit, 128 attended the 12-month visit but ten refused to do the test (table 3). The lung imaging abnormality gradually recovered during 1-year follow-up. The proportion of patients with abnormal CT decreased significantly from 6 months to 12 months in all three groups (table 3; all pvs 11% [four of 38] at 12 months, p=0·046). 105 patients completed both pulmonary function tests and CT at 12 months. The appendix p 27 shows the association between lung imaging pattern and lung diffusion impairment. When adjusting for age, sex, cigarette smoking, education, comorbidity, and disease severity, GGO and irregular lines were positively associated with risk of lung diffusion impairment. After further adjustment for corticosteroids, antivirals, and intravenous immunoglobulin, the point estimate of ORs did not change substantially although the statistically significant associations did not remain (appendix p 27).
1252 COVID-19 patients at the 12-month visit reported their health-care use after discharge and work status (table 4). After COVID-19 discharge from hospital, 228 (18%) patients visited the outpatient clinic, 13 (1%) visited the emergency department, and 161 (13%) were admitted to hospital, but no one was admitted to ICU. 11 patients visited the rehabilitation department and five participated in the professional rehabilitation programme because of physical dysfunction.
Table 4Health-care use after discharge until 12-month follow-up, and work status at 12-month follow-up among COVID-19 patients Data are n or n/N (%). ICU=intensive care unit.
Before COVID-19, 53% (658/1252) of patients had retired and 38% (479/1252) had a full-time or part-time job. At 12-month visit, of those 479 patients who had a job before COVID-19, 422 (88%) had returned to their original work and most of these patients (321/422, 76%) had returned to their level of work before COVID-19. 57 (12%) of 479 patients did not return to their original work: 32% (18/57) because of decreased physical function, 25% (14/57) because they were unwilling to do the previous work, and 18% (ten of 57) because of unemployment (table 4).
After multivariable adjustment, participants with severity scale 5–6 had higher risk of diffusion impairment at 12 months than did those with scale 3 (OR 3·59, 95% CI 1·36–9·50), but no significant difference in fatigue or muscle weakness (1·08, 0·59–2·00) and anxiety or depression (1·42, 0·80–2·52; figure 2). Compared with men, women had an OR of 1·43 (95% CI 1·04–1·96) for fatigue or muscle weakness, 2·00 (1·48–2·69) for anxiety or depression, and 2·97 (1·50–5·88) for diffusion impairment (figure 2). Corticosteroids therapy at acute phase was associated with increased risk of fatigue or muscle weakness (OR 1·51, 95% CI 1·05–2·16). Intravenous immunoglobulin therapy at acute phase decreased the risk of fatigue or muscle weakness (OR 0·65, 95% CI 0·43–0·98). We observed no significant association of corticosteroids therapy and intravenous immunoglobulin therapy with anxiety or depression, or diffusion impairment (figure 2). Age was positively associated with anxiety or depression and diffusion impairment, with the risk of anxiety or depression 18% higher (OR 1·18, 95% CI 1·05–1·32) and risk of diffusion impairment 30% higher (1·30, 1·01–1·68) per 10-year increase of age. There was no significant association between age and fatigue or muscle weakness (figure 2).
Sensitivity analysis with inverse probability-weighted generalised estimating equations for risk factors with fatigue or muscle weakness, anxiety or depression, and diffusion impairment are shown in the appendix p 28. The associations of sex with three outcomes—age with diffusion impairment, corticosteroids with fatigue or muscle weakness, and disease severity with diffusion impairment—remained statistically significant. No significant effect of intravenous immunoglobulin therapy on fatigue or muscle weakness was observed, although the effect of age on fatigue or muscle weakness became statistically significant. Participants with scale 5–6 showed a higher risk of fatigue or muscle weakness and anxiety or depression than did those with scale 3 (appendix p 28).
We measured the plasma samples of 73 COVID-19 patients collected at the acute phase, discharge, 6-month visit, and 12-month visit. The concentrations of pro-inflammatory cytokines (IL-1β, IL-6, IL-12, GM-CSF, IFN-γ and TNF-α), anti-inflammatory cytokine (IL-10), and chemokines (IP-10, MCP-1, and MIP-1α) gradually decreased over time from onset of symptom until 12 months (appendix p 29). After adjusting for age, disease severity, and the sampling time after days of disease onset, we noted two intercorrelated cytokine clusters (IL-9, MIP-1β, and TNF-α in cluster one; IL-7, IL-17, and IFN-γ in cluster two; appendix p 33). The association of reduction of cytokines at discharge until 6 months with 12-month consequences is shown in the appendix pp 34–35. The greater reduction of IL-2, IL-5, IL-7, IL-12, and G-CSF was associated with lower risk of lung radiographic abnormality at 12 months (appendix p 34).
DiscussionTo our knowledge, this is the largest longitudinal cohort study of hospital survivors with COVID-19 so far to describe the dynamic recovery of health consequences within 12 months after symptom onset. We found that most patients had a good physical and functional recovery during follow-up, and the majority of study participants who were employed before COVID-19 had returned to their original work. However, sequelae symptoms, lung diffusion impairment, and radiographic abnormalities persisted to 12 months in some patients, especially in patients who were critically ill during hospital stay. The current health status in the COVID-19 cohort was still lower than that in the control population.
A previous study of SARS has showed that the health status of survivors at 1 year after symptom onset was significantly lower than that of the general population,
and lasted to 2 years. Fatigue was the most commonly reported symptom of patients with SARS, which could last as long as 4 years. We found that female sex and corticosteroid therapy at acute phase were risk factors for fatigue or muscle weakness at 12 months. The cause and pathogenesis of fatigue and muscle weakness after COVID-19 are unclear, but on the basis of previous evidence in SARS, lung diffusion capacity impairment and some extrapulmonary causes, including viral-induced myositis at initial presentation, cytokine disturbance, muscle wasting and deconditioning, or corticosteroids myopathy, or a combination of these factors, could have contributed to the condition. , , , ,
That dyspnoea and anxiety or depression were more frequently reported at 12 months than 6 months is worrying, although the increased proportion in our cohort is relatively low. COVID-19 survivors are at increased risk of psychiatric outcomes, and new-onset respiratory and cardiovascular disease during convalescence.
, Al-Aly and colleagues reported that COVID-19 survivors had a high burden of incident use of bronchodilators, antitussives, expectorants, antidepressants, and anxiolytics after COVID-19. The chronic or late-onset psychological symptoms after COVID-19 could be driven by a direct effect of virus infection and might be explained by several hypotheses including aberrant immune response, hyperactivation of the immune system, or autoimmunity. , Additionally, indirect effects including reduced social contact, loneliness, incomplete recovery of physical health, and loss of employment could affect psychiatric symptoms.
At 12 months, we recorded high prevalence of lung diffusion impairment in patients with varying disease severity. Lung diffusion impairment could be attributable to lung epithelial damage, or interstitial or pulmonary vascular abnormalities.
, , Lung structural abnormality during late recovery of SARS was associated with the lung diffusion impairment; however, the association during convalescence after COVID-19 was unclear. We undertook an initial exploratory analysis on the basis of a small group of patients and found that lung imaging patterns at 12 months might be associated with lung diffusion impairment, which should be confirmed in a larger sample study. Previous SARS follow-up studies have shown that persistent lung diffusion impairment could last for months or even years. , , , Hence, a longitudinal study is needed to describe the natural history of lung structural and functional abnormality after COVID-19, and to explore the effect of these persistent abnormalities on physical function and quality of life. Our study had several limitations. First, the moderate response rate could have introduced bias to our study. Fortunately, we recorded no significant difference in most baseline characteristics between COVID-19 patients who were included in final analysis and those who were not. The sensitivity analyses for risk factors associated with primary outcomes that used generalised estimating equations to reduce the effect of bias also showed similar results. Second, this is a single centre study focused on previously hospitalised COVID-19 patients in the early stage of the pandemic, which limits the representativeness of this cohort. Moreover, a low proportion of patients with ICU admission in our cohort limits the generalisability of the study findings to this particular population. Future large sample studies are needed to evaluate the long-term consequences of COVID-19 in patients with varying severity, including outpatients, inpatients, and patients requiring admission to ICU. Third, we did not have the health status of COVID-19 survivors before acute infection. However, the health status of matched non-COVID-19 controls could represent the baseline state of COVID-19 patients, although residual confounders cannot be excluded. The comparison between COVID-19 patients and controls indicated whether COVID-19 patients completely recovered at 12 months. Finally, the small sample size of participants with cytokines tests could have affected the reliability of the association between change in cytokines concentrations and 12-month outcomes. These findings should be interpreted as exploratory and need to be validated in a future study with a lager sample. Within 1 year after acute infection, most hospital survivors with COVID-19 had a good physical and functional recovery over time, and had returned to their original work and life, but current health status was still lower than that in the control population. Lung diffusion impairment and radiographic abnormalities were still common in critically ill patients at 12 months. Ongoing longitudinal follow-up is needed to better characterise the natural history and pathogenesis of long-term health consequences of COVID-19. BC, XW, and JW had the idea for and designed the study. They had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. LH, BC, XG, YW, JXu, XZ, LR, and LG drafted the paper. BC, XG, LH, LR, and LG did the analysis, and all authors critically revised the manuscript for important intellectual content and agreed to submit the final version for publication. QY, QW, PH, YQ, YF, XL, CL, TY, JXia, MW, LC, YL, FX, DL, XG, and LH completed the follow-up work. YQ, YF, XL, CL, TY, JXia, MW, LC, YL, FX, DL, XG, LH, LG, LR, and ML collected and verified the data. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The post 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study recently appeared on Medical Update News. Once it has spread (metastasized), uveal (intraocular or eye) melanoma – an unusual form of cancer – has a very high mortality rate. In a study published in Nature Communications, researchers and doctors at the University of Gothenburg and Sahlgrenska University Hospital show that, in a small group of patients with metastatic uveal melanoma, a new combination treatment can bring about tumor shrinkage and prolonged survival. Uveal melanoma, an infrequent form of malignant melanoma, starts in the pigment cells of not the skin, but the eye. For skin melanoma, immunotherapy using “checkpoint inhibitors” has proved effective in many cases, but this has not applied to intraocular melanoma. Some 80 people get uveal melanoma in Sweden annually, and half of them get metastases, often in the liver. Patients with metastatic uveal melanoma frequently die shortly after diagnosis. Clinical trialThis is a Phase II trial in which 29 patients with metastatic eye melanoma received a combination of two inhibitor drugs that target HDAC (histone deacetylase) and PD-1 (a checkpoint protein on T cells) respectively. In four of these patients, the tumors shrank significantly, and for several patients the course of the disease was slowed down. Unusually, some of the patients are still alive today, three years after the study began. “Our hope was that the HDAC inhibitor would reprogram hidden cancer cells so that they could be detected by the immune cells, thus making the immunotherapy with PD-1 inhibitors effective,” explains Lars Ny, senior lecturer at the University of Gothenburg and physician specializing in oncology at Sahlgrenska University Hospital. Resistance with a genetic explanation“On the whole, the clinical trial met our expectations, although this doesn’t seem to be a curative treatment either. To find out why there were such major differences in how well patients responded, we performed genetic analyses. These showed that the treatment worked better against the tumors where the BAP1 gene was active and intact. This gene is often inactivated in metastases, but now we find that it’s associated with a better response to immunotherapy,” says Jonas Nilsson, professor at Sahlgrenska Academy at the University of Gothenburg, who is active at both the Sahlgrenska Center for Cancer Research and the Harry Perkins Institute of Medical Research in Perth, Australia. The research team is now continuing to investigate why loss of the BAP1 gene causes resistance to immunotherapy, and what other changes in blood components may predict improved survival after immunotherapy in uveal melanoma patients. Title: The PEMDAC phase 2 study of pembrolizumab and entinostat in patients with metastatic uveal melanoma
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The post Increased survival with eye melanoma in clinical trial recently appeared on Medical Update News. Standing before a local school board in central Indiana this month, Dr. Daniel Stock, a physician in the state, issued a litany of false claims about the coronavirus. He proclaimed that the recent surge in cases showed that the vaccines were ineffective, that people were better off with a cocktail of drugs and supplements to prevent hospitalization from the virus, and that masks didn’t help prevent the spread of infection. His appearance has since become one of the most-viewed videos of coronavirus misinformation. The videos — several versions are available online — have amassed nearly 100 million likes and shares on Facebook, 6.2 million views on Twitter, at least 2.8 million views on YouTube and over 940,000 video views on Instagram. His talk’s popularity points to one of the more striking paradoxes of the pandemic. Even as many doctors fight to save the lives of people sick with Covid-19, a tiny number of their medical peers have had an outsize influence at propelling false and misleading information about the virus and vaccines. Now there is a growing call among medical groups to discipline physicians spreading incorrect information. The Federation of State Medical Boards, which represents the groups that license and discipline doctors, recommended last month that states consider action against doctors who share false medical claims, including suspending or revoking medical licenses. The American Medical Association says spreading misinformation violates the code of ethics that licensed doctors agree to follow. “When a doctor speaks, people pay attention,” said Dr. Humayun Chaudhry, president of the Federation of State Medical Boards. “The title of being a physician lends credibility to what people say to the general public. That’s why it is so important that these doctors don’t spread misinformation.” Dr. Stock joined physicians including Dr. Joseph Mercola and Dr. Judy Mikovits, and a group that calls itself America’s Frontline Doctors, in generating huge audiences for their bogus claims. The statements by them and others have contributed to vaccine hesitancy and a resistance to masks that have exacerbated the pandemic in the United States, public health officials say. The doctors often stand in lab coats and use simplified medical jargon, lending an air of authority. They often take advantage of a ready audience online by livestreaming news conferences, and keep interest alive by promising new evidence that will expose corruption and support their arguments. Some state medical boards have disciplined doctors for their conduct during the pandemic. In December, the Oregon Medical Board ordered an emergency suspension of the medical license of a doctor after he violated a state order by not wearing a mask, or requiring patients to wear masks. The ruling bars the doctor from practicing medicine in Oregon until the governor lifts the state of emergency issued for the pandemic. In January, a San Francisco doctor who had been falsely claiming that 5G technology caused the pandemic volunteered to surrender his license to the California Medical Board. “Publicly spreading false Covid-19 information may be considered unprofessional conduct and could be grounds for disciplinary action,” Carlos Villatoro, a spokesman for the Medical Board of California, said in a statement. But Dr. Chaudhry said it was impossible to know how many states had opened investigations into doctors spreading misinformation. Such investigations are typically not publicized until a decision is reached, and the process can take many months. Dr. Stock, 59, did not respond to several requests for comment for this article. He has been a licensed doctor in Indiana since 1989, a year after he graduated from the Indiana University School of Medicine. He has worked in several hospitals, urgent care centers and private practices in the state, according to a profile on LinkedIn. On Dr. Stock’s website he sets himself apart from conventional medicine. “By presenting patients with all of their treatment options — whether that’s a pill, lifestyle change, therapy, or supplements — I help patients choose the option that works best for them,” the website reads. “This results in permanent healing, not merely the temporary relief found in the traditional system.” He sells dozens of vitamins and supplements on the site. In the video that spread widely this month, Dr. Stock is shown speaking to a Mt. Vernon Community School Corporation board meeting in Fortville, just east of Indianapolis. Standing with his back to the camera, and speaking at a rapid, nearly monotone clip, he opens his statement with the line, “Everything being recommended by the C.D.C. is actually contrary to the rules of science.” Then he selectively cites academic studies to give the impression that widely held medical advice, such as wearing a mask and getting vaccinated, does not work. YouTube, which forbids videos that spread false information about the virus, said it would not take down the full video of the meeting that the school board had put online. “While we have clear policies to remove harmful Covid-19 misinformation, we also recognize the importance of organizations like school boards using YouTube to share recordings of open public forums,” Elena Hernandez, a YouTube spokeswoman, said. The original video of the meeting has over 620,000 views. Previous videos by the Mount Vernon school board on YouTube each collected only a few hundred views. Understand Vaccine and Mask Mandates in the U.S.
YouTube has taken down videos of the meeting that have been edited to show only Dr. Stock’s talk. But some of those versions spread widely before YouTube made that decision, with views climbing as fast as 15,000 an hour in the days after the meeting, according to a New York Times analysis of available YouTube data. People shared his talk on alternative video platforms like Bitchute and Rumble, and on blogs like “Hancock County Patriots” and “DJHJ Media.” One version of the video on Twitter, shared by a onetime adviser to former President Donald J. Trump, collected over six million views. Another was shared by Representative Jim Jordan, Republican of Ohio. Dr. Stock also appeared on “Tucker Carlson Tonight” on Fox News, repeating the false claim that there is not “any consensus that masks work — the data is very murky on this.” Eric Sears, a spokesman for the Indiana Professional Licensing Agency, which oversees the granting of medical licenses in the state, said the Indiana attorney general’s office was responsible for investigating the public’s complaints about doctors spreading Covid-19 misinformation. The attorney general’s office sends its findings from those investigations to the Indiana Medical Board. “As of yet, we have not been informed by the attorney general’s office of an investigation pending” into Dr. Stock, Mr. Sears said. “The board would likely not take action until an investigation had been completed by the attorney general’s office.” David A. Keltz, a spokesman for the Indiana attorney general, said the office could not discuss whether any complaints against Dr. Stock were under investigation. Mr. Keltz said the state would issue a public statement about any such investigation only if the office decided to file a formal complaint with the Indiana Medical Board. Doctors spreading coronavirus misinformation “leverage the credibility of their titles and medical expertise to make their arguments appear more authoritative,” said Rachel E. Moran, a researcher at the University of Washington who studies online misinformation, including about the Covid-19 vaccines. “What’s most frustrating about this is how anti-vaccination advocates typically spread mistrust in medical professionals until it’s no longer a useful strategy for them,” Ms. Moran said, noting how they regularly cast doubt on Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases. “Then a ‘doctor’ comes along that aligns with their values,” Ms. Moran said, “and suddenly that institutional expertise is credible.” Jacob Silver and Michael H. Keller contributed research. The post Calls Grow to Discipline Doctors Spreading Virus Misinformation recently appeared on Medical Update News.
Alaska’s medical education program and scholarships to attend college will be funded this year, announced Gov. Mike Dunleavy on Wednesday. Dunleavy said he ordered his Office of Management and Budget to release funding for the WWAMI medical education program plus 17 other programs. Kathryne Mitchell is a second-year WWAMI student. She’s glad about the announcement. “We’re very excited that the funding for our program is secure for this year,” Mitchell said. Without WWAMI, Mitchell would have to take on an extra $120,000 for four years of medical school — plus student loan interest. She wants Dunleavy and the Legislature to secure long-term funding for the program. “When this battle for funding for WWAMI comes up every year, we lose students — students who will go on to become excellent physicians. We lose them and they go train in other programs, where there’s more certainty as to funding. And then we don’t get them back as physicians in Alaska,” she said. She’s originally from North Pole and wants to practice family medicine in rural Alaska. She says the program benefits the whole state. “For Alaska, it’s really, really important that we train home-grown students to become physicians here, because they’re the physicians that are going to stay,” she said. The announcement allows more than $42.8 million to be spent on WWAMI and other programs that include funding to attend college through both $11.8 million in Alaska Performance Scholarships and $6.4 million in Alaska Education Grants. Oil spill prevention also received $3 million in additional funding. WWAMI received $3.3 million. And reimbursements to municipalities to pay off their debt to build schools received $4.2 million. Dunleavy’s administration previously had said that these programs could not be funded without the agreement of three-quarters of both chambers of the Legislature. But Dunleavy said Wednesday that his administration reviewed this funding after a recent decision by a Superior Court judge. And this review led him to OK the spending. That judge’s decision said that money in the Power Cost Equalization Endowment Fund was not subject to the three-quarters vote. The administration said these programs received funding for this year’s budget before the money in the accounts used to fund them was swept into the Constitutional Budget Reserve. The post Dunleavy announces Alaska medical school, state scholarships will be funded recently appeared on Medical Update News.
RALEIGH, N.C. (AP) — A bill legalizing marijuana for medical use in North Carolina and developing a system to grow and sell it cleared two more legislative hurdles this week in the Senate. The Senate Health Care Committee voted for the measure on Thursday, two days after the judiciary committee approved an updated version compared to what it originally recommended in late June. The measure could be on the Senate floor as soon as next week. The measure would let patients purchase and use marijuana from medical cannabis centers if their physician declares in writing they have one of more than a dozen “debilitating medical conditions” listed and that cannabis could bring health benefits. An amendment approved Thursday increases the amount of a prescribing physician’s required training from three to 10 hours. A new state commission would issue 10 medical cannabis supplier licenses, each of which would allow the opening of four sales centers. Additional restrictions would prevent centers from locating near churches or schools and operating late at night. The state would collect monthly fees from suppliers equal to 10% of gross revenues. Public speakers at committee meetings have featured war veterans with post-traumatic stress and others with severe illness who say marijuana will ease pain or help them lead more normal lives. Representatives of conservative Christian groups have said the safety and efficacy of cannabis isn’t settled, and that medical marijuana would ultimately lead to the legalization of recreational use. The House has yet to consider the measure. The post Medical marijuana legalization keeps advancing in NC Senate recently appeared on Medical Update News.
Justin Hogle of Hogle Eyecare Center talks about the importance of eye care. WHAT DREW YOU TO THE FIELD OF HEALTH CARE? “I love helping others and what better way than to help people see better!” WHAT CHALLENGES DO YOU FACE IN YOUR FIELD? “Educating the population that we as optometrists do more than help your vision, we also care for your ocular health and can also diagnose systemic conditions such as high blood pressure and diabetes.” WHAT’S THE NO. 1 THING YOU WANT PATIENTS TO KNOW? “It is important to get your eyes checked yearly even if you are not having any vision issues so that we can check on your ocular health.” NOMINATE SOMEONE: Know somebody who is making a difference in the area through their health care job? Let us know so we can feature them in a spotlight. Send email to [email protected] or call (918) 684-2929 and speak to Executive Editor Elizabeth Ridenour. — Ronn Rowland NAME: Justin Hogle. AGE: 44. YEARS IN PRACTICE: 18. DEGREES: Doctor of Optometry. JOB: Owner of Hogle Eyecare Center. WORK ADDRESS: 2500 Chandler Road. WORK PHONE: (918) 683-3937. HOURS: 8 a.m.-5 p.m. Monday, Wednesday; 9 a.m.-7 p.m. Tuesday, Thursday; 7 a.m.-noon Friday. The post Health Spotlight — Justin Hogle | Lifestyles recently appeared on Medical Update News. This article is based on research findings that are yet to be peer-reviewed. Results are therefore regarded as preliminary and should be interpreted as such. Find out about the role of the peer review process in research here. For further information, please contact the cited source. The OCTAVE study – a multi-centre UK-wide trial led by the University of Glasgow and co-ordinated by the University of Birmingham’s Cancer Research UK Clinical Trials Unit – is evaluating the immune responses to COVID-19 vaccination in patients with immune-mediated inflammatory diseases such as cancer, inflammatory arthritis, diseases of the kidney or liver, or patients who are having a stem cell transplant. The OCTAVE trial is one of the largest studies in the world so far into post-SARS-CoV-2 vaccination in immunocompromised patients and is funded by the Medical Research Council (MRC). OCTAVE is a collaborative research project involving groups in the Universities of Glasgow, Birmingham, Oxford, Liverpool, Imperial College London and Leeds Teaching Hospitals NHS Trust. The study used a variety of state-of-the-art immune tests performed on blood samples taken before and/or after COVID-19 vaccination in around 600 people recruited across the UK. OCTAVE’s early data show that 40% of people in the patient groups studied mounted a low serological immune response after two SARS-CoV-2 vaccines. In addition to this, the initial data shows that approximately 11% of immunocompromised patients fail to generate any antibodies 4 weeks after two vaccines. Failure to generate antibodies is found at higher proportion in some specific patient sub-groups; in particular, in patients with ANCA-Associated Vasculitis who have received Rituximab treatment. Looking in detail at patient vaccine response within each of the disease subgroups included in the study, researchers found that a significant proportion of patients studied as part of OCTAVE generate lower levels of SARS-CoV-2 antibody reactivity, when compared with healthy subjects after two SARS-CoV-2 vaccines. The proportion of patients with lower levels of antibody reactivity as per disease cohort compared to the baseline for healthy subjects:
Importantly, however, the significance of these findings in terms of what they can tell us about vaccine protection from exposure to COVID-19 is not currently known, as there is no current agreed clinical cut off to measure COVID-19 vaccination response. Professor Pam Kearns, Director of the University of Birmingham’s Cancer Research UK Clinical Trials Unit which is co-ordinating OCTAVE, said: “A significant number of people in the UK were advised to shield because they have conditions or long term illnesses which place them at greater risk of severe illness and death from COVID-19. “The rapid development of vaccines for COVID-19 has been a major step forward in the battle against this global pandemic, and the most clinically-at-risk people were among the first in the UK to be offered one. However, while we know COVID-19 vaccines are highly effective in healthy individuals, questions have remained as to how effective they are in protecting the chronically ill. “These preliminary results of OCTAVE and the results of our continuing and forthcoming research will be instrumental in helping inform how best to vaccinate patients with chronic conditions and protect them from COVID-19 infection in the future.” Professor Iain McInnes, lead of the OCTAVE trial, and Vice Principal and Head of the College of Medical, Veterinary & Life Sciences at the University of Glasgow, said: “The roll-out of the vaccine programme was extremely important for these vulnerable groups of patients, however due to their underlying medical conditions and treatments, which can weaken their immune systems, we were concerned that people with these medical conditions may not receive optimal protection, so it was, and remains, extremely important to investigate this unanswered question. “While 40% of these clinically at-risk patent groups were found to have a low or undetectable immune response after a double dose of the vaccine, we are encouraged that this figure isn’t higher. However, it is possible even partial protection may be clinically beneficial, and this is something we will closely monitor. “There are also imminent plans in place to investigate the effects of administrating an alternate vaccine dose to the group with an undetectable or low vaccine immune response; and we hope these findings will support the role out of an immunological screening programme for vulnerable patients to identify those who will benefit from a subsequent vaccine boost. We would continue to encourage all people and especially those patients within these clinically at-risk groups to make sure they receive their vaccine doses if they haven’t done so already.” Dr Rob Buckle, Chief Scientist of the Medical Research Council, part of UKRI, which co-funded the trial, said: “Today’s results will be of concern for the subset of people within those who are immunosuppressed for whom the vaccine didn’t trigger a large protective response. We’re funding an extension to the OCTAVE study to give third jabs to this group, which we hope will deliver a much-needed immunity boost, or identify those who could benefit from other interventions. One of the real strengths of the UK’s scientific response to the pandemic has been the way that we’ve assembled teams of experts to lead cutting-edge and responsive studies like this, to inform our vaccine roll-out and government decision-making in real time.” The OCTAVE (Observational Cohort Trial-T-cells Antibodies and Vaccine Efficacy in SARS-CoV-2) study looks at those with immune mediated inflammatory diseases including rheumatoid arthritis, psoriatic arthritis, ANCA-Associated Vasculitis, inflammatory bowel disease, as well as hepatic disease and renal failure. So far more than 2,500 patients have been recruited to the trial making it one of the largest global studies in which detailed immune response is being assessed post-SARS-CoV-2 vaccination. Reference: Kearns P, Siebert S, Willicombe M, et al. 2021. Examining the immunological effects of COVID-19 vaccination in patients with conditions potentially leading to diminished immune response capacity – The OCTAVE trial. Preprints with The Lancet. doi: 10.2139/ssrn.3910058. This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source. The post Low Immune Response to COVID-19 Vaccines in Patients With Impaired Immune Systems recently appeared on Medical Update News. For Moira Smith and her mother, July promised a glimmer of normalcy after months of isolation. The two flew from Alaska to Houston and visited family, celebrating the first birthday of their cousin’s granddaughter. Ms. Smith’s mother bought a patterned pink onesie to give as a gift, and they all snapped photos of the baby’s face smeared with chocolate. Ms. Smith, 46, knew that her cousin’s family was not vaccinated but tried not to dwell on that. She and her mother had both received their Pfizer shots months earlier. In the hotel room one evening, Ms. Smith’s mother made an offhand comment to her relatives: “You can take your masks off but you have to promise to get vaccinated,” she chided them. The next morning Ms. Smith and her mother were headed home, on a layover in the Seattle airport, when they got the phone call: Their relative’s baby had come down with a fever and tested positive for Covid-19. Two days later, Ms. Smith woke up feeling like she had been “hit by a Mack truck,” with body aches and a sore throat, and tested positive for the coronavirus. The next week, her mother, who is 76 and has lung cancer, texted her an emoji of a thermometer indicating she, too, had spiked a fever, and she later wound up in the emergency room with Covid. Ms. Smith and her mother are part of a wave of Americans falling sick with Covid even though they are fully immunized, in what are known as breakthrough infections. Public health experts continue to believe that breakthrough infections are relatively uncommon, and rarely result in severe illness or hospitalizations. The vaccines available in the United States offer powerful protection from serious Covid illness, hospitalization and death. A recent analysis of state-reported data from the Kaiser Family Foundation found that more than nine in 10 Covid-19 cases that resulted in hospitalization and death occurred among people who were not fully vaccinated. “We always anticipated that there would be some breakthrough infections because the vaccines at their very best were 95 percent effective,” said Dr. William Schaffner, professor of infectious disease at Vanderbilt. “The vaccines were designed to prevent severe illness, and they’re spectacularly successful at that.” But as the more transmissible Delta variant becomes dominant in the United States, rising numbers of breakthrough cases are being reported, although most are mild. “Delta is vastly more contagious, so as it is spreading among the unvaccinated there is spillover into the vaccinated population,” Dr. Schaffner said. “The unvaccinated are a big highway of transmission. The vaccinated are a little side street.” Because people infected with the Delta variant have far more of the virus in their nose and upper respiratory tract, the importance of mask-wearing has become paramount. After the Centers for Disease Control and Prevention shifted its guidance on masking, recommending that vaccinated people in hot-spot areas resume wearing masks in public indoor spaces, millions of Americans who are fully immunized struggled to adjust their expectations for autumn months that had seemed to offer some semblance of festivity. And a small subset of Americans has already seen their routines upended by breakthrough infections. Spurred by concerns about breakthrough infections, federal health officials recently recommended that Americans who received the Pfizer or Moderna vaccines receive a third dose in the coming months. This week Johnson & Johnson reported that a booster shot of its vaccine raised levels of antibodies against the coronavirus. For some, breakthrough infections have felt like mild allergies, coming with symptoms including a cough, sniffles and a scratchy throat. Others have had more severe cases, where they are bedridden with body aches, fevers and chills. And still others have had some of the telltale signs of Covid such as loss of taste and smell, “Covid rash” and brain fog. “We were calling it floaty-head syndrome,” said Molly O’Brien-Foelsch, 47, a marketing executive in Pennsylvania who tested positive for Covid after a trip to the British Virgin Islands with her husband last month. “It felt like there was a huge marshmallow on my head.” Scientists believe that breakthrough infections rarely result in severe illness, but there have been cases of prolonged hospitalizations. Elaina Cary-Fehr’s father Isaac, a 64-year-old Uber driver in Austin, was transferred to a long-term care facility after being hospitalized with Covid pneumonia in June and later receiving a tracheotomy tube. He was released from the facility this week. “I believe in the vaccine, I kept holding on to hope that it would work and it did,” Ms. Cary-Fehr said. “But I hate that this had to happen to my family.” Dr. Rebecca Hughes, 32, works as an emergency medicine resident in Boston, so she had spent the last year with a simmering sense of anxiety about Covid exposure. She can still recall the fear she felt the first time she treated a coding Covid patient and wondered for hours whether her mask might have slipped and put her at risk. But all year she was kept safe by her protective equipment. Then, last month, her family took a vacation to visit her grandparents in Utah. It was a trip they had hoped to take last February but postponed as Covid case rates rose. Four days after they landed, Dr. Hughes felt her throat becoming scratchy. She was certain it was allergies but took a Covid test just in case; it came back positive. Shortly afterward her newborn, who was 9 weeks old, started sneezing and tested positive too, along with Dr. Hughes’s three other children, ages 8, 6 and 3. “It felt ironic after I spent so long caring for Covid positive patients on every single shift since the pandemic started,” Dr. Hughes said. “My 8-year-old knows I’ve been seeing people die from this. She looked at me and said, ‘Am I going to be OK?’” Although some breakthrough infections like Dr. Hughes’s are difficult to trace to a precise exposure event, other Americans have found their vacation plans intersecting with well-known outbreaks. Understand Vaccine and Mask Mandates in the U.S.
Jimmy Yoder, 25, felt no trepidation as he and his boyfriend, both vaccinated, packed their bags to spend a weekend in Provincetown in July. And because their days and nights there were a blur of clubs and dancing, he assumed that the Monday morning fatigue that greeted him back in Brooklyn was just a bad hangover. “I was feeling a little rundown but attributed it to a weekend of partying,” Mr. Yoder said. “In the back of my mind I was like, ‘There is no way I’m going to get Covid, I’m immune.’ ” By Wednesday morning, Mr. Yoder no longer felt so confident. “I felt like I had a really bad flu,” he said, with a high fever and congested sinuses. He and his boyfriend both tested positive that day. Mr. Yoder slept for the next 18 hours, and when he and his boyfriend were both starting to feel better they ordered a celebratory pizza. They realized then that they had both lost their sense of taste and smell. Mr. Yoder was relieved to find that of all the people he had exposed — friends who had driven him home from Provincetown, an office full of colleagues — only one tested positive. “Obviously it shows the vaccines are still working a lot,” he added. As many Americans begin the familiar exercise of questioning and calling off plans, scientists are stressing the continued importance of mask-wearing to reduce transmission and infection. “If you get infected and breathe virus out, it will get trapped by your mask,” said Dr. John Moore, a professor of microbiology and immunology at Weill Cornell. “These viruses don’t have pairs of scissors that can cut through masks.” The post Breakthrough Covid Cases: Uncommon and Often Mild, But Not Always recently appeared on Medical Update News. |
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