Due to the Covid‐19 pandemic, National Taiwan University anatomy teachers adopted asynchronous online video teaching and reduced the size of anatomy laboratory groups in April 2020. The aim of this study was to investigate the impact of these changes on medical students’ learning. Before Covid‐19, the performance of the 2019–2020 cohort was significantly better than that of the 2018–2019 cohort. However, the implementation of modified teaching strategies significantly lowered the laboratory midterm score of the 2019–2020 cohort in the second semester. Conversely, the final laboratory examination score of the 2019–2020 cohort was significantly higher than that of the 2018–2019 cohort. Through correlation analysis, lecture and laboratory examination scores were highly correlated. Additionally, the difference in lecture and laboratory z‐scores between two cohorts, the Likert scale survey and free‐text feedback of the 2019–2020 cohort, were conducted to show the impact of modified teaching strategies. There were several important findings in this study. First, the change in teaching strategies may temporarily negatively influence medical students to learn anatomy. Besides, analyzing the performance of laboratory assessments could be a complementary strategy to evaluate online assessments. Applying lecture examination scores to predict laboratory performance was a feasible way to identify students who may have difficulty in learning practical dissection. Finally, reducing group size together with reduced peer discussion may have a negative effect on learning cadaver dissection for students with low academic performance. These findings should be taken into consideration when anatomy teachers apply new teaching strategies in anatomy courses.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9082485

The impact of asynchronous online anatomy teaching and smaller learning groups in the anatomy laboratory on medical students’ performance during the Covid‐19 pandemic

The COVID-19 pandemic presents specific challenges for cancer patients attending oncology treatment. Using a mixed-methods design (convergent parallel design), we aimed to assess the experience, perceptions, and reactions of cancer patients during the COVID-19 pandemic. Participants were cancer patients receiving treatment at the hospital during the pandemic (July to August 2020). In study 1, 95 participants filled out a questionnaire measuring COVID-19 experiences and perceptions, psychological distress, and intolerance of uncertainty. In study 2, in-depth interviews were conducted with 10 cancer patients, probing their experience during the COVID-19 period. Most participants experienced the COVID-19 pandemic as a major threat that would affect future health, most attended all or most of their scheduled treatments, and their mean level of psychological distress was low. A mild decrease in social support was reported, and remote contacts and support from the community had not compensated for decreased person-to person contacts. In addition, intolerance of uncertainty was related to higher psychological distress, which was partially mediated by perceptions of threat. The analysis of in-depth interviews strengthened the quantitative findings by elucidating the experience of fear of contagion alongside determination to continue treatment. The mixed-methods design enabled us to examine the responses of cancer patients attending treatment. The findings suggest that in times of extreme uncertainty such as COVID-19, health experts need to screen cancer patients and survivors for emotional and instrumental support needs and identify patients and survivors with high intolerance of uncertainty as a risk factor for psychological distress. 

/pdf/cancer-patients-attending-treatment-during-covid-19-18ut87sn.pdf

Cancer patients attending treatment during COVID-19: intolerance of uncertainty and psychological distress

Background: Studies abound regarding the views of faculty anatomists and medical students on the importance of anatomy and the dissection of human bodies, but very little is known about the views of practicing physicians. Methods: A survey was distributed among physicians and surgeons practicing in Spain in order to find out their views on the practice and consequences of human dissection by undergraduate students of medicine. The most relevant definition to qualify faculty anatomists of medical schools was also requested. Responses were repeatedly clustered into characteristic subgroups for analysis. Results: In total, 536 physicians and surgeons belonging to 36 different specialties in seven Spanish hospitals responded to the survey. The results highlighted two main facts. Firstly, faculty anatomists were perceived as teachers, above any other professional identity (namely: physician, biologist or scientist); nonetheless, the ascription of identities varied between specialties (p = 0.009); and it also depended on whether the respondents had dissected in their undergraduate degree (p = 0.03) and on the respondent's gender (p = 0.03). Secondly, physicians and surgeons confirmed that dissecting human cadavers serves the undergraduate student not only for acquiring anatomical knowledge, but also essential skills and attitudes, including professionalism. Conclusions: The results strongly suggest that dissection practice should be reinforced and enriched in undergraduate medical school. As this is important in itself, the results of the study could also help with the development of strategies to alleviate the current shortage of adequately trained anatomists for medical degrees.

Physicians' viewpoints on faculty anatomists and dissection of human bodies in the undergraduate medical studies.

Simple Summary The SARS-CoV-2 pandemic led to a significant disruption to healthcare. Cancer Trials Ireland is the national cooperative cancer trials organisation in Ireland. We analysed the impact of the pandemic on the conduct of cancer clinical trials over a 2 year period. Clinical trial accrual fell by 54%, with trials in radiotherapy being most affected, declining by 90%. This reduction was due to reduced staffing, delays in trial logistics and halting of accrual and initiations due to safety concerns. Remote monitoring of trials increased. Protocol violations increased due to interruption of visits and diagnostic testing. The impact on accrual persisted for at least 18 months. Significant central office staffing issues were evident with recruitment and retention. A retreat was conducted to identify the transformative changes that were needed to build resilience in clinical trial conduct. Adaptive strategies in trial conduct such as expanded telehealth and tele-monitoring, flexibility of trial scheduling, protected staff assignments, and mentoring of research staff were identified as priorities for the recovery stage of the pandemic. Abstract Background: Cancer Trials Ireland (CTI) is the national cooperative group in Ireland. The SARS-CoV-2 pandemic led to significant ongoing disruptive change in healthcare from March 2020 to the present day. Its impact and legacy on a national clinical trials organisation was assessed. Methods: A review was conducted of prospectively acquired communications, team logs and time sheets, trial activation, closure and accrual, for the period 2019 to September 2021. An online survey of the impact of the pandemic on clinical investigators and of clinical trials units was performed. A National Cancer Retreat was organised on 21 May 2021 to identify and address pandemic related disruption and develop adaptive strategies. Results: In the weeks after the pandemic was declared, remote working was initiated by all central office staff. Nationally, clinical trial accrual fell by 54% compared to the same period in 2019, radiotherapy trial accrual by 90%, and translational studies by 36%. Staff reassignment of research nurse staff occurred in 60% of units, trial monitoring was reduced in 42%, and trial initiations fell by 67%. Extreme fluctuations in monitoring hours were noted paralleling lockdown measures. Significant impact on all clinical trials units was noted including staff reassignments, reduced access to diagnostic imaging and reduced institutional supports. Remote clinic visits and remote monitoring was widely adopted. The National Cancer Retreat identified flexibility in trial conduct, staff recruitment and retention, the need for harmonisation of processes, and research staff support in the context of remote working as priorities. Conclusion: The pandemic has had a significant ongoing negative impact on cancer clinical trial activity in Ireland. Adaptive strategies including trial flexibility, expanded telehealth and remote monitoring, harmonisation of processes and staff support have been identified as priorities to ameliorate this impact, and develop a more sustainable clinical trial ecosystem.

/pdf/the-sars-cov-2-pandemic-and-cancer-trials-ireland-impact-w11d05yy.pdf

The SARS-CoV-2 Pandemic and Cancer Trials Ireland: Impact, Resolution and Legacy

https://doi.org/10.1016/j.tranon.2022.101605

Impact of coronavirus disease 2019 on lung cancer patients: A meta-analysis

Background The COVID-19 pandemic has impacted significantly on healthcare across the globe. It has been reported to have higher incidence and be associated with worse outcomes in patients with cancer. Aim To examine the characteristics of patients with cancer who were diagnosed with COVID-19 and to identify factors which may predict a poorer outcome. Methods Patients attending oncology services in Beaumont Hospital who were diagnosed with COVID-19 between March and May 2020 were included. Demographics and outcomes were determined by chart review. Results Twenty-seven patients were included in the study. The median age was 62; 59% were male. Ten patients (37%) died all of whom had metastatic or incurable locally advanced disease. Patients with lung cancer had a higher rate of COVID-19 and poorer outcomes. Those with a performance status (PS) ≥ 3 were more likely to die than those with PS ≤ 2. Compared to those who recovered, patients who died had a higher number of organs affected by cancer and a higher mean Palliative Prognostic Score. Conclusion Patients attending oncology services during the initial phase of the COVID-19 pandemic had an increased rate of SARS-CoV-2 infection and a higher mortality rate than the general population. Those who died had more advanced cancer as demonstrated by poorer performance status, a greater burden of metastatic disease and a higher Palliative Prognostic Score.

/pdf/covid-19-related-mortality-in-cancer-patients-in-an-irish-47md6jc8ww.pdf

COVID-19-related mortality in cancer patients in an Irish setting.

The role of physician assistant/associate (PA) has expanded from its inception in the United States over 50 years ago, to European countries including Ireland. While there is an increasing body of evidence exploring the role and training of PAs in clinical settings, there is a scarcity of research exploring PA students' perspectives in relation to their experience of anatomy dissection, or how these experiences may contribute to the development of their core professional identity. Students in the first two cohorts of PA Program at the Royal College of Surgeons in Ireland program were invited to interviews which solicited them to reflect and report on their own experiences of anatomical dissection during their course. Participants' responses were analyzed using a thematic inductive approach; common themes and patterns were organized into a hierarchical structure, which generated the final framework of themes. Ten participants took part in the study; only one had previous personal experience of dissection, while two further participants had some familiarity with prosected specimens. The first theme concerned the participants' expectation of anatomical dissection, with sub-themes of preconceptions, smell, and emotions. The second theme involves discussion of coping strategies that the participants used, including talking, viewing the cadaver as their first patient, and naming (or not naming) the cadaver. The third theme includes how the participants' talked about respect and compassion in the dissection room, development of team working skills, and awareness of bereavement and organ donation. A number of recommendations were also made for the experience and orientation of future students in such a program.

Physician Associate Students' Experience of Anatomy Dissection

The first confirmed case of COVID-19 in Ireland was on February 29th 2020. From March until late April, the number of cases increased exponentially. The delivery of anti-cancer therapy during the COVID-19 pandemic was extremely challenging. In order to balance the benefits of continuing anti-cancer therapy with the associated increased hospital visits, combined with the risk of COVID-19 infection, we undertook a series of system changes in the delivery of cancer care. Patients who attended our dayward over a 4-month period were included. Data were obtained from patient and chemotherapy prescribing records. Patients were screened for symptoms of COVID-19 at two separate timepoints: prior to their visit via telephone, and using a symptom questionnaire on arrival at the hospital. If patients displayed COVID-19 symptoms, they were isolated and a viral swab arranged. A total of 456 patients attended from January 1st to April 30th. The numbers of visits from January to April were 601, 586, 575, and 607, respectively. During this period, there were 2369 patient visits to the dayward and 1953 (82%) intravenous regimens administered. Of the 416 visits that did not lead to treatment, 114 (27%) were scheduled non-treatment review visits, 194 (47%) treatments were held due to disease-related illness, and 108 (26%) treatments were held due to treatment-related complications. Screening measurements were implemented on March 18th due to rising COVID-19 prevalence in the general population. Overall, 53 treatments were held due to the screening process: 19 patients (36%) elicited COVID-19 symptoms via telephone screening; 34 patients (64%) were symptomatic in our pre-assessment area and referred for swabs, of which 4 were positive. Those with a negative swab were rescheduled for chemotherapy the following week. With careful systematic changes, safe and continued delivery of systemic anti-cancer therapy during the COVID-19 pandemic is possible.

/pdf/delivery-of-systemic-anti-cancer-therapy-during-the-covid-19-5gecnlcwi3.pdf

Delivery of systemic anti-cancer therapy during the COVID-19 pandemic.

Editors, Gillespie et al provide an excellent overview of portal hypertension pathophysiology, nonselective betablocker (NSBB) mechanisms of action and their clinical indications in the management of patients with cirrhosis.1 This is of great relevance to clinicians in the light of several referenced recent studies supporting an expanded role for NSBBs, particularly carvedilol, in patients with compensated cirrhosis and clinically significant portal hypertension (CSPH).2– 6 As highlighted, the therapeutic window for NSBB use is broadening as are the modes by which we identify these patients. NSBB prescribing is shifting from the endoscopy suite to the outpatient clinic following the identification of patients with compensated cirrhosis and CSPH using transient elastography as opposed to variceal surveillance.7 This increasing body of evidence prompted a review of our own service to identify the actual ‘significant proportion’ of additional patients who may benefit from NSBB therapy (Hospital Clinical Governance Department approval no CA2022/160). Patients' hospital records were reviewed to ascertain clinical data. Patients' community pharmacies (or where not known, primary care physicians) were contacted to determine recent (within 2 months) betablocker provision. 283 individual patients were identified with transient elastography score (TE) ≥25 kPa from the local TE database. Of those 56 had died, 15 were decompensated, 53 had subsequent TE <25 kPa, 2 had undergone liver transplant, and there were 20 for whom inadequate data were available. Of the 137 remaining, 53% (74) were on no beta blocker, 26% (36) were on a NSBB (carvedilol was most frequently used (35/36) with a median total daily dose of 6.25 mg), and 19% (26) were on a cardioselective beta blocker (CSBB) (bisoprolol was most frequently used (19/26) with a median total daily dose of 5 mg). See Figure 1. Approximately half the number of patients with likely CSPH were not on a NSBB, indeed a significant proportion. Our results also highlight the extent of an additional clinical dilemma which was not addressed by Gillespie et al.1 Almost a fifth of patients with CSPH were on a CSBB. The additional benefits achieved with β2 and α1 adrenoceptor antagonism in concert with β1 antagonism are outlined both theoretically and practically,1,6 making for a seemingly simplistic answer to switch from a CSBB to carvedilol. The issue here is that the dose equivalents of carvedilol to CSBBs such as bisoprolol are high. The median dose of bisoprolol used is equivalent to a total daily dose of 50 mg carvedilol, eightfold higher than the median carvedilol dose in this cohort.8 Switching poses a risk of systemic side effects and thus doselimited cardiac efficacy and likely compliance. The use of tandem beta blockers seems clinically precarious. In the era of precision medicine in patients with cirrhosis, guidance on this issue for a significant proportion of patients is needed in consultation with our cardiology colleagues.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/apt.17482

Letter: practical considerations for nonselective beta‐blocker therapy in portal hypertension

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COVID-19-related mortality in cancer patients in an Irish setting.

Physician Associate Students' Experience of Anatomy Dissection

Delivery of systemic anti-cancer therapy during the COVID-19 pandemic.

Letter: practical considerations for nonselective beta‐blocker therapy in portal hypertension