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Background:High-flow nasal cannula (HFNC) is a recent respiratory support technique used for patients with hypoxemic respiratory failure; its use usually takes place in critical care wards. During the second wave of Covid-19, almost 400 000 people were hospitalized in France, and intensive care units were overwhelmed. For patients who did not meet criteria for admission to an intensive care unit because of their age or their medical background, we proposed HFNC in non-critical care unit instead of standard oxygen therapy to improve patient survival and comfort.Objectives: To describe characteristics and outcomes of patients infected with SARS-CoV-2 with HFNC in non-critical care wards between September 2020 and June 2021.Methods: This was a single-center, retrospective cohort study conducted between September and June 2021 in Clamart Hospital, France. Patients infected with SARS-CoV-2 confirmed, who were not suitable for intensive care unit escalation, and who were proposed HFNC because of respiratory failure were assessed.Results:Thirty-one patients with SARS-CoV-2 were included, median age 87.0 years (interquartile range (IQR), 82.0-91.0), 52% men. Nineteen (61%) patients were OMS score 0, i.e. no disability in daily-life activities. HNFC was started a median of 3 days (IQR, 1-5.5) after hospitalization. Overall, median duration of HNFC was 6 days (IQR, 4-10). Eleven patients (35.5%) survived and were discharged from hospital.Conclusions:Our experience of HFNC for patients with COVID-19 outside of a critical care environment because of their age and comorbidities is positive allowing survival of 35% of old patients not admitted to an intensive care unit. Trial registration:Not applicable

Introduction: Clinical education is the basic pillar and heart of medical education. In fact, it is one of the most important manifestations of teaching and learning in professions related to medical sciences, which leads to the clinical competency of learners. Assessing new physicians before entering the field of clinical activities can be a reliable criterion for evaluating the quality of their clinical skills.The current study was done to investigate the knowledge, practice, and general clinical competency of general medicine graduates before entering the field of clinical activities. The study was in line with according to the document of the minimum competency expected from general practitioners in Iran. Methods In this descriptive cross-sectional study, the scores of different stations of the national Objective Structured Clinical Examination (OSCE), which be held at the end of the general medicine course in Iran, were collected at Mashhad University of Medical Sciences. These scores were subdivided into four specific areas and two critical and non-critical indicators of capability were gathered from the exam assessors' checklists. Totally, 266 students who participated in six periodicities of clinical competency tests at the end of the general medicine course at Mashhad University of Medical Sciences were included in the study by the census method. The clinical competency of general medicine graduates assessed in the areas of problem-solving, communication skills, practical action (procedures and critical skills), taking the history, performing physical examinations, and critical and non-critical indicators by the OSCE. Data were analyzed using descriptive statistics (frequency, mean and standard deviation) and inferential statistics including independent t-test, one-way and two-way analysis of variance by using SPSS. Results The results showed that the effect of different areas of the OSCE (F(3,5652) = 7.022 and P = 0.001) and participants' performance based on their critical and non-critical indicators (T = 1.976 and P = 0.04) are significant with 95% confidence interval. Conclusion The OSCE improves the standards of clinical competencies of new physicians and can make beneficial changes in clinical education at medical schools.

INTRODUCTION. Emerging evidence associates COVID-19 to an increased risk of acute pulmonary embolism (APE). The present study aimed to assess the prevalence of APE in patients admitted to internal medicine department wards for non-critical COVID-19 who presented clinical deterioration, and to investigate the association of clinical and biochemical variables with a confirmed diagnosis of APE in these subjects. METHODS. All consecutive patients admitted to the internal medicine department of a general hospital with a diagnosis of non-critical COVID-19, who performed a Computer Tomography Pulmonary Angiography(CTPA) for respiratory deterioration in April 2020, were included in this retrospective cohort study. RESULTS. Study populations: 41 subjects, median(IRQ) age: 71.7(63-76) years, CPTA confirmed APE=8(19.51%,CI95%:8.82%-34.87%). Among patients with and without APE, no significant differences were found with regards symptoms, comorbidities, treatment, Wells score and outcomes. The optimal cut-off value of D-dimer for predicting APE was 2454 ng/mL, sensitivity(CI95%):63(24-91), specificity:73(54-87), Positive Predictive Value:36(13-65), Negative Predictive Value: 89(71-98) and AUC:0.62(0.38-0.85). The standard and age-adjusted D-dimer cut-offs, and the Wells score > 2 did not associate with confirmed APE, albeit a cut-off value of D-dimer=2454 ng/mL showed an RR:3.21;CI95%:0.92-13.97;p=0.073.CONCLUSION. Among patients presenting pulmonary deterioration after admission to internal medicine wards for non-critical COVID-19, the prevalence of APE was high. The traditional diagnostic tools to identify high APE pre-test probability patients does not seem to be clinically useful. These results support the use of a low threshold of suspicion for performing CTPA to exclude or confirm APE as the most appropriate diagnostic approach in this clinical setting.

Background: Ultrasound is used to observe the imaging manifestations of COVID-19 in order to provide reference for real-time bedside evaluation.Purpose: To explore the ultrasonic manifestations of peripulmonary lesions of non-critical COVID-19, so as to provide reference for clinical diagnosis and efficacy evaluation.Materials and Methods: The clinical and ultrasonic data of 20 patients with clinically diagnosed non-critical COVID-19 treated in Xi'an Chest Hospital during January and February 2020 were retrospectively analyzed. Conventional two-dimensional ultrasound and color Doppler ultrasound were used to observe the characteristics of lesions. Results: All 20 patients (40 lungs and 240 lung areas) had a history of travel, residence or close contact in/with Wuhan, and 5 of them caught COVID-19 after family gatherings. Lesions tended to occur in both lungs. Lesions in the lung areas: 14 in L1+R1 area (14/40), 17 in L2+R2 area (17/40), 17 in L3+R3 area (17/40), 17 in L4+R4 area (17/40), 20 in L5+R5 area (20/40), and 28 in L6+R6 area (28/40). Lesion types: rough and discontinuous pleural line (36/240), subpleural consolidation (53/240), air bronchogram sign or air bronchiologram sign in subpleural peripleural consolidation (37/240), visible B lines (91/240), localized pleural thickening (19/240), localized pleural effusion (24/240), poor blood flow in the consolidation detected by color Doppler ultrasound (50/53).Conclusion: The non-critical COVID-19 has characteristic ultrasonic manifestations, which are visible in the posterior and inferior areas of the lung. The lesions are mainly characterized by a large number of B lines, subpleural pulmonary consolidation and poor blood flow. Lung ultrasound can provide reference for the clinical diagnosis and efficacy evaluation. Chinese Clinical Trial Registry: ChiCTR2000030032Approval for Scientific Research Project: No. 2020-S0001