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The COVID-19 pandemic had major impact on the training of Infectious Diseases (ID) residents across the globe. They were part of the frontline staff, while at the same time training to be ID physicians. This study focused on identifying their capability, i.e. the ability to adapt existing competencies to new situations, which is now recognised as an essential element of professional practice. This study explored what ID residents learnt and how they learnt as they adapted to working in this unpredictable and challenging COVID-19 pandemic. This qualitative explorative study was based in the Infectious Diseases Senior Residency Programme across three training institutions in Singapore. Individual semi-structured interviews were conducted. Data were analysed using a template analysis technique. Nine ID residents participated in this study. They learnt to engage with uncertainty in a meaningful way by relying on prior training and rapidly learning how to most effectively learn (metacognition). Learning was enhanced by collaboration between multidisciplinary health professionals, strong leadership and intrinsic motivation from personal interest in ID. They learnt through observing how senior faculty approached and managed the COVID-19 situation. When learning for future capability in a rapidly evolving situation, role-modelling and mentoring are essential as available information resources may still not provide the learning from skilled doctors with actual experiences managing complex, uncertain situations. [ABSTRACT FROM AUTHOR]

Objective: Metabolic bariatric procedures are potentially efficacious treatment options in patients with type 2 diabetes mellitus (T2DM). Previous meta‐analyses focused on individual operative approaches rather than the mechanistic pathways behind different bariatric procedures. This updated network meta‐analysis aimed to synthesize new evidence and comparatively evaluate the efficacy of metabolic surgery against restrictive procedures and standard first‐line treatment for patients with T2DM. Methods: Embase, MEDLINE, and trial registries were searched for randomized controlled trials on bariatric surgeries in patients with T2DM on September 3, 2021. A Bayesian network meta‐analysis was conducted. The primary outcome was T2DM remission. Secondary outcomes included changes in BMI, lipoprotein levels, and blood pressure. Results: Thirty‐two articles were included. Metabolic surgery was statistically superior to restrictive procedures (risk ratio [RR]: 2.57, 95% credibility intervals [CrI]: 1.36‐5.43), medical therapy (RR: 35.29, 95% Crl: 10.56‐183.23), and lifestyle intervention (RR: 40.51, 95% Crl: 5.32‐402.59) in T2DM remission. Metabolic surgery significantly lowered BMI and blood pressure compared with other interventions. Restrictive procedures significantly increased high‐density lipoprotein compared with metabolic surgery. Lifestyle intervention and metabolic surgery were statistically superior to restrictive procedures in reducing low‐density lipoprotein. Conclusions: The superiority in diabetes remission and favorable metabolic profile support the choice of metabolic surgery over restrictive bariatric procedures. [ABSTRACT FROM AUTHOR]

Background: Off-label testosterone prescribing for androgen deficiency (AD)-like sexual and energy symptoms of older men without pathologic hypogonadism has increased dramatically without convincing evidence of efficacy.Methods: In a randomized, double-blind, placebo-controlled study with three phases, we entered 45 men aged at least 40 years without pathologic hypogonadism but with AD-like energy and/or sexual symptoms to either daily testosterone or placebo gel treatment for 6 weeks in a cross-over study design with a third, mandatory extension phase in which participants chose which previous treatment they preferred to repeat while remaining masked to their original treatment. Primary endpoints were energy and sexual symptoms as assessed by a visual analog scale (Lead Symptom Score [LSS]).Results: Increasing serum testosterone to the healthy young male range produced no significant benefit more than placebo for energy or sexual LSS. Covariate effects of age, body mass index, and pretreatment baseline serum testosterone on quality-of-life scales were detected. Only 1 out of 22 indices from seven quality-of-life scales was significantly improved by testosterone treatment over placebo. Participants did not choose testosterone significantly more than placebo as their preferred treatment in the third phase.Conclusions: Six-week testosterone treatment does not improve energy or sexual symptoms more than placebo in symptomatic men without pathologic hypogonadism. [ABSTRACT FROM AUTHOR]

Introduction: Near-peer teaching is gaining popularity as a teaching modality, as it improves the learner's understanding, is targeted at an appropriate level and promotes familiarisation. This study was initiated to evaluate the effectiveness of incorporating near-peer instruction into simulation-based training within a junior residency programme.Methods: 42 first-year residents from an internal medicine junior residency programme were recruited. Participants underwent a simulation-based training programme conducted over five weeks. Each week involved either an emergency or acute clinical scenario. A structured questionnaire was administered prior to and after the course to compare participants' perceived knowledge, experience and confidence in managing the clinical scenarios.Results: In our study, 83% of participants agreed/strongly agreed that the scenarios were realistic. There were improvements in perceived knowledge, experience and confidence after the course. The greatest improvement was seen for experience (post-simulation: median 7.00 [interquartile range (IQR) 6.00‒8.00] vs. pre-simulation: median 5.00 [IQR 3.00-6.25]). 65% of participants were keen to help with future training.Conclusion: Near-peer simulation training was found to be a viable and valuable method of instruction for first-year residents for increasing experience, instilling confidence and improving perceived knowledge. Integration of such programmes within medical education curricula shows good promise of continuity, with many first-year residents inspired to organise subsequent sessions. [ABSTRACT FROM AUTHOR]

Background: Inpatient hypoglycemia (H) [<4 mmol/L] is associated with adverse clinical outcomes. In 2019, we implemented a program in three non-critical-care wards in a tertiary hospital, targeting inpatients near hypoglycemia (NH) [4-5 mmol/L]. Aim: To assess if proactive intervention in patients with NH was associated with reduced conversion to H and determine factors associated with conversion to H. Method: Patients with NH in the last 24h were identified at the beginning of the next workday for review by a diabetes pharmacist followed by treatment change recommendations to prevent H. All patients with NH in the pre- and post- intervention period (T0, T1 respectively) were identified and conversion to H was assessed via difference in proportions. Multivariate analysis was used to assess factors associated with conversion to H. Results: T0 had 924 NH events, where 15.2% converted to H, while T1 had 808 NH events, where 15.4% converted (p=0.908). Median conversion time was 11.07 and 14.95 hours for T0 and T1 respectively. Multivariate analyses showed that intervention was associated with fewer conversions, while ethnicity, polypharmacy and occurrence of NH between 8pm to 12am were associated with greater likelihood of conversion to H. Conclusion: While NH conversion was reduced with current measures, other potential factors were identified. Future adoption of real-time measures may help to further reduce H occurrence. Disclosure: M. L. S. Tan: None. S. Kao: None. K. Ng: None. S. Fan: None. X. Tan: None. Q. Peng yan megan: None. S. Soh xin ni: None. S. Mok: None. [ABSTRACT FROM AUTHOR]