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Background COVID-19 poses many challenges to healthcare systems and workers. Responding to medical emergencies in patients with suspected COVID-19 will require new guidelines and protocols. Simulation can support their development. Methods We organised seven simulations involving patients with suspected COVID-19 for staff at Brighton and Sussex University Hospitals. Participants completed pre- and post-simulation questionnaires. Results Fifty-six staff participated and they reported being significantly less prepared to respond to an emergency in a patient with suspected COVID-19 than in one in whom it is not suspected. The simulations significantly improved the participants9 confidence in responding to emergencies in patients with suspected COVID-19. Numerous challenges were identified along the themes of equipment, personnel, communication and procedures. Conclusions Low-fidelity simulation can provide relevant and timely information on how prepared health systems and their workforce are to respond to emergencies. We urge NHS trusts nationally to implement simulations to identify problems and develop effective solutions.

Objectives\ud To describe the impact that the COVID-19 pandemic has had on HIV testing in Brighton and Hove, United Kingdom.\ud \ud Methods\ud All HIV tests performed in Brighton and Hove from January 2016 to June 2021 were extracted, de-duplicated and anonymized. Analysis was performed to compare the monthly numbers of tests and diagnoses before and during the pandemic across different services.\ud \ud Results\ud The number of patients having tests for HIV in sexual health services (SHS) decreased by 64% in April 2020, followed by a recovery to baseline levels by the start of 2021. Similarly, the monthly number of diagnoses decreased drastically after April 2020, with almost half of diagnoses made by SHS in 2020 occurring in the three pre-pandemic months of the year. ‘Self-sampling’, used more by women and younger patients, has contributed significantly to the recovery.\ud \ud The number of patients tested in secondary care was seemingly unaffected by the pandemic. However, testing numbers were reduced in specialist services, whereas in the emergency department (ED) testing increased four-fold (most notably in the elderly) without finding any cases.\ud \ud General practice saw decreases in both the number of HIV tests performed and the number of new diagnoses made, which had not returned to baseline by June 2021.\ud \ud Discussion\ud The COVID-19 pandemic has had a large impact on the number of HIV tests performed in Brighton and Hove with sizeable decreases in the number of patients tested likely leading to ‘missed’ diagnoses. By June 2021 testing had still not returned to normal across the city.

We describe the case of a 30-year-old care home employee diagnosed with COVID-19 and acute untreated HIV-1. He was unable to return to work for 119 days due to concerns over transmission risk as his SARS-CoV-2 PCR remained detectable. This highlights the uncertainty in interpreting SARS-CoV-2 PCR results post-infection in acute untreated HIV.

Summary Background Exposure to SARS-CoV-2 was widespread in hospitals during 2020. The risk of infection after in-hospital exposure has not yet been quantified and effective strategies to prevent it remain unclear. Methods All incidences of patient-to-patient exposure to SARS-CoV-2 on non-COVID wards between October and December 2020 at a UK hospital trust were identified. Patient contacts were traced, and data collected on SARS-CoV-2 testing, symptoms, and outcomes. Factors associated with acquiring infection and mortality were investigated. Results Of 575 patients exposed, 118 (19.5%) tested positive within 14 days of their exposure, with secondary attack rates (SAR) ranging from 0 to 72%. 68.6% (81/118) of secondary cases had not been in the same bay as the index case. For exposed patients, sharing a bay with the index case and having spent longer on the ward with them were associated with acquiring infection (ORs of 3.8, 95% CI: 1.89, 7.74, and 1.08, 95% CI: 1.01, 1.15 respectively). 71% of secondary cases tested positive while asymptomatic and 94.6% had tested negative earlier in their admission. Conclusions This is the first study to describe the outcomes of a cohort of patients exposed to COVID-19 in hospital. Exposure to COVID-19 in hospital commonly leads to transmission that is not confined to the index case's bay. This study confirms that asymptomatic testing is important and suggests that an increased frequency of testing may be beneficial. Moreover, we provide factors that can be used to identify the contacts at the greatest risk of acquiring infection.

Introduction Infective endocarditis (IE) is associated with a protracted inpatient stay, prolonged intravenous antimicrobial therapy and significant morbidity and mortality. Methods All patients with a diagnosis of IE at the Sussex Cardiac Centre (SCC) between 2016 and 2020 were included. Demographics, clinical characteristics, management, complications and outcomes were analysed. Logistic EuroSCORE, EuroSCORE II and Risk-E Scores were calculated for patients undergoing operative management. Results In the 5-year period 202 patients had 209 diagnoses of IE. Seven patients had recurrent IE; 3 with the same organism but with persistent risk factors after initial treatment (Intravenous drug users [IVDUs] n = 2 and colonic polyps n=1). IE cases increased yearly by approximately 4 cases per year (p Conclusions There has been an increase in IE cases managed at the SCC over the last 5 years, with more transfers from other hospitals. This could be due to an increase in absolute IE numbers as well as better awareness of the need for early surgery and the involvement of an IE MDT. We report a previously unidentified male predominance in IE across all major organisms and a significant increase in oral streptococci infection; both require further exploration. In this population the Risk-E Score tended to overestimate in-hospital mortality. Larger multi-centre studies are required to explore these trends in sub-grouped populations. Conflict of Interest None

Fungal endocarditis is associated with a very poor prognosis (mortality in excess of 50%) and the incidence is increasing due, in part, to the increased implantation of intra-cardiac devices and valve replacements. Diagnosis and treatment remain challenging, with the need for prolonged courses of dual, parenteral anti-fungal therapy that have several drug-drug interactions and side effects that require protracted monitoring. Moreover, there is uncertainty on the optimal management strategy for fungal endocarditis as, given its rarity, much of the evidence comes from small observational studies. We report a case of Candida parapsilosis prosthetic valve endocarditis and aortic graft infection necessitating a high-risk redo aortic valve replacement. This case illustrates the important role of the multidisciplinary Endocarditis Team in achieving a good outcome, despite year-long treatment and geographical separation of patient from the regional centre and Endocarditis Team expertise.

Background: Patients with titanium cranioplasties can develop skin defects and plate exposure requiring revision surgery to prevent infection. The management of these patients has historically been...

Introduction International medical electives, whereby undergraduates visit an institution in a country other than their own, are a common part of medical training. Visiting students are often asked to provide local teaching, which may be acceptable where the visitor is acting within the bounds of their own competency and the normal practices of both their home and host institutions. However, the extent to which teaching is an accepted student activity globally has not previously been described. This study aims to address this using an international survey approach. Methods A voluntary electronic survey, created using the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) framework, was distributed across established international medical student networks. This assessed the involvement of medical students in teaching and the educator training they receive, with the intention of comparing experiences between high-income countries (HICs) and low/middle-income countries (LMICs) to gauge the engagement of both “host” and “visiting” students. Results 443 students from 61 countries completed the survey, with an equal proportion of respondents from LMICs (49.4%, 219/443) and HICs (50.6%, 224/443). Around two thirds of students reported providing teaching whilst at medical school, with most reporting teaching numerous times a year, mainly to more junior medical students. There was with no significant difference between LMICs and HICs. Around 30 per cent of all medical students reported having received no teacher training, including 40 per cent of those already providing teaching. Conclusion This study suggests that students are engaged in teaching globally, with no difference between HIC and LMIC contexts. However, students are underprepared to act as educators in both settings. Providing teaching as part of an elective experience may be ethically acceptable to both host and home institutions, but needs to be supported by formal training in delivering teaching.