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BINUS World-Class Equity Scholarship in Indonesia

For encouraging outstanding students to pursue higher education across Indonesia, the BINUS University is providing the BINUS World-Class Equity funding for the year 2020.

The program is open for domestic students who want to apply for the postgraduate degree coursework at the university.

Application Deadline: April 20, 2020

Founded in 1996, BINUS University is a private university in Indonesia. The university offers various undergraduate and postgraduate degree programs for students.

Why at BINUS University? The University provides a place where students can share a passion for learning and get opportunities for developing skills to be prepared for a career. Here students can also get the potential to become a success.

Benefits

  • 100% tuition-waiver for four years
  • Free standard double room at Binus Square – Hall of Residence
  • USD 60 registration fee waiver
  • Health insurance
  • Stay permit process

Short Description

  • University or Organization: BINUS University
  • Department: NA
  • Course Level: Post-graduate
  • Award: Full scholarship
  • Number of Awards: NA
  • Access Mode: Online
  • Nationality: Domestic
  • The award can be taken in Indonesia

BINUS World-Class Equity Scholarship in Indonesia Eligibility      

  • Eligible Countries: Applications are open from Indonesia.
  • Eligible Course or Subjects: The sponsorship will be awarded in any subject offered by the university.
  • Eligibility Criteria: To be eligible, the applicants must meet all the given criteria:
  • Non-academic achievements and/or relevant working experience
  • Proven financial need
  • Maximum 22 years old at enrollment

Application Procedure

  • How to Apply for BINUS World-Class Equity Scholarship in Indonesia: For being enlisted in the program, applicants have to take admission in the postgraduate degree program at the university.
  • Supporting Documents: Most attach your CV with motivation statement, two recommendation letters, proof of academic and non-academic achievements and relevant working experience, financial situation explanation and pledge letter.
  • Admission Requirements: Aspirants must have a minimum GPA of 2.5 in the previous degree
  • Language Requirement: For taking admission, students must have to provide a TOEFL score of

Apply Now

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PhD Positionsat University of New South Wales, Australia

Having a good education is essential to one’s success in life. Reviewing this importance of the study, the University of New South Wales is providing the multiple grants for AI/ML on “Self-aware Computing Systems” in Australia.

The program aims to support Australian students commencing in the PhD degree program at the university for the academic session 2020-21.

Application Deadline: September 18, 2020

Established in 1949, the University of New South Wales is one of the best public research universities in Australia. It has international exchange and research partnerships with over 200 universities around the world and ranked 2nd in New South Wales according to QS World University Rankings.

Why at the University of New South Wales? UNSW Sydney has strong regional and global engagement. They provide a wide range of opportunities for candidates to grow and pursue new directions in a vibrant, engaging environment.

Benefits

Candidates will receive the program which including a tuition fee waiver and $35,000 per annum living allowance (fix rate for three and half years).

Short Description

  • University or Organization: University of New South Wales
  • Department: NA
  • Course Level: PhD
  • Award: Tuition fee waiver and $35,000 per annum
  • Number of Awards: Multiple
  • Access Mode: Online
  • Nationality: Domestic
  • The award can be taken in Australia

PhD Positionsat University of New South Wales, Australia Eligibility      

  • Eligible Countries: Australian students can apply for the application.
  • Eligible Course or Subjects: PhD degree in Self-aware Computing Systems.
  • Eligibility Criteria: To be eligible, the applicants must meet all the following criteria:
  • Candidates must have a strong background in computer programming (ideally in Python) is essential for the success of the application.
  • Aspirants must know about machine learning.

Application Procedure

  • How to Apply for PhD Positionsat University of New South Wales, Australia: For grasping the opportunity, applicants have to take admission in the PhD degree program at the university.
  • Supporting Documents: Applications should include a research statement, CV, copy of undergraduate and postgraduate academic transcripts and send it to Dr Lina Yao (lina.yao@unsw.edu.au)
  • Admission Requirements: Candidate must have a Computer Science degree (Bachelor’s degree with honours or Master by Research degree) or a closely related discipline and has a strong interest in Artificial Intelligence and Machine Learning.
  • Language Requirement: When you come to study at UNSW, you will have to meet the English language requirements of the university.

Apply Now

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PhD Position for International Students at University of Southern Denmark, 2020

The University of Southern Denmark eagerly awaits applications from outstanding students for its PhD Position program for the academic year 2020/21.

The award program is available for highly motivated international students to apply for a 3-year PhD program at the University of Southern Denmark.

Application Deadline: April 20, 2020

The Department of Chemical Engineering, Biotechnology and Environmental Technology is located in Odense, the main campus of the University of Southern Denmark.

Why at the University of Southern Denmark? SDU provides world-class education and committed to an international perspective at all levels. Here students will get comfortable working both independently and within a team.

Benefits

The university will provide the amounts to approx. 3.378,- EURO per month incl. supplements

Short Description

  • University: University of Southern Denmark
  • Department: The Department of Chemical Engineering, Biotechnology and Environmental Technology
  • Course Level: PhD
  • Award: 3.378, – EURO
  • Access Mode: Online
  • Number of Awards: NA
  • Nationality: International
  • The award can be taken in Denmark

PhD Position for International Students at University of Southern Denmark, 2020 Eligibility            

  • Eligible Countries: Submissions are acceptable form all around the world
  • Acceptable Course or Subjects: The sponsorship will be awarded for PhD study in the material constraints of the energy and climate transition.
  • Admissible Criteria: To be eligible, the applicants are required to have a master’s degree (equivalent to a Danish master’s degree) at the time of enrollment and employment. The candidates are expected to be enthusiastic about working in an interdisciplinary and international academic environment.

Application Procedure

  • How to Apply: In order to apply for the award, candidates are obligatory to apply through an online application form.
  • Supporting Documents: Completed TEK PhD application form for 5+3 applicants.
  • A motivational letter. Upload in the field called “Project description”.
  • Detailed Curriculum Vitae.
  • A research statement. Upload in the field called “Other relevant material”.
  • Verified copies of the official bachelor diploma and master’s diploma and transcripts of exams.
  • Completed TEK PhD form for calculation grade point average. Upload in one of the fields called “Publication”.
  • An official document describing the grading scheme of the awarding universities (if not Danish). Upload in one of the fields called “Publication”.
  • An official and verified written assessment of the thesis or dissertation project from the grade giving institution, if the thesis/examination project is evaluated by approved/passed. The statement must clearly state that the candidate has been among the top 30 pct. in the graduation class for the study programme.
  • Admission Requirements: For taking admission, applicants must meet all the entry requirements of the university.
  • Language Requirement: Candidates must be fluent in English, both spoken and written. Before applying, applicants must check all the English language requirements.

Apply Now

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BAICE Compare Fellowships for Students from Low-income Countries in the UK

British Association of International and Comparative Education (BAICE) is delighted to offer extremely beneficial fellowship programs for the academic year of 2020-21.

The BAICE Compare Fellowship program is scheduled to last from 1 December 2020 through 30 November 2021. It will grant full financial aid to deserving candidates to cover the expenses associated with attending the conference.

Application Deadline: June 1, 2020

British Association of International and Comparative Education in short BAICE is an association that holds membership of the Academy of Social Sciences. It is committed to promoting teaching, research, policy and development in all aspects of international and comparative education.

Why choose this program? If you want to be a part of upcoming UKFIET conference in Oxford, UK but you are not financially capable of doing so, then it is an excellent opportunity for you to fund your visit. Through this program, you can pay your expenses like a living, attending conference and workshop.

Benefits

The BAICE Compare Fellowship program will cover all expenses related to:

  • Attending and presenting at the UKFIET conference in Oxford, UK, in September 2021
  • Attending the Compare writers’ workshop at the conference
  • 2-4 week stay at an institution in the UK following the conference
  • Travel, accommodation and subsistence.

Short Description

  • University or Organization: BAICE
  • Department: N/A
  • Course LevelPhD
  • Award: Various
  • Number of Awards: Five
  • Access Mode: Online
  • Nationality: Candidates from low-income countries
  • The award can be taken in the UK

BAICE Compare Fellowships for Students from Low-income Countries in the UK Eligibility

  • Eligible Countries: Applications are open for students residing in low-income countries (according to the World Bank classification) as – Afghanistan; Benin; Burkina Faso; Burundi; Central African Republic; Chad; Congo, Dem. Rep; Eritrea; Ethiopia; the Gambia, The; Guinea; Guinea-Bissau; Haiti; Korea, Dem. People’s Rep.; Liberia; Madagascar; Malawi; Mali; Mozambique; Nepal; Niger; Rwanda; Sierra Leone; Somalia; South Sudan; Syrian Arab Republic; Tajikistan; Tanzania; Togo; Uganda; Yemen, Rep.
  • Eligible Course or Subjects: The sponsorship will be awarded for PhD candidates.
  • Eligibility Criteria: To be able to get this program, you will need to meet up the following requirements:
  • Must be based currently in a university in a low-income country
  • Must have completed their doctoral degree within the last six years
  • Must be teaching or researching in the field of education

Application Procedure

  • How to ApplyAll eligible applicants must send the required documents at compare@uea.ac.uk to be considered their candidacy for the BAICE Compare Fellowship program.
  • Supporting Documents: At the time of entry, you may be required to provide the following materials:
    • An excellent past academic record
    • Relevant work experience has shown on a strong CV/resume (including qualifications, professional experience and publications)
    • A personal statement: Supporting statement of 1000 words describing research interests, publication trajectory to date and plans, and potential benefits of the fellowship for themselves and their institutions/countries
    • Two letters of recommendation
    • Copy of passport
    • Abstract for a conference presentation on a research topic of their choice (300 words)
  • Entry Requirements: Candidates have completed their doctoral degree within the last six years that based currently in a university in a low-income country
  • Language Requirement: Candidates must have an excellent knowledge of the English language to attend the conference in the UK.

Apply Now

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Massey University Doctoral funding for Domestic and International Students in New Zealand, 2020

With the aim of encouraging and supporting students, the Massey University is offering the Doctoral funding for the high achieving candidates. The sponsorship will be awarded on the basis of academic excellence and strategic research priorities.

The purpose of the program is to attract full-time or part-time New Zealand and international students applying for doctoral research program for the session 2020/21.

Application Deadline: Applications close on 1 October for the following year tenure and 1 April for the current year tenure.

Massey University is one of New Zealand’s leading educational institutions. It is committed to the principles of environmental responsibility and sustainable resource management at local, national and international levels.

Why at Massey University?  At this university, students can expect a teaching and learning environment that will enable them to be creative, connected and innovative. The university offers a range of undergraduate and postgraduate degrees, diplomas and certificates to students from around the world.

Benefits

Massey University will provide the value of a doctoral support will be a stipend of $25,000 per annum and payment of tuition and non-tuition fees to a maximum of 36 months of full-time study.  Part-time study will include a stipend of $15,000 per annum and payment of tuition and non-tuition fees to a maximum of 60 months.

Short Description

  • University: Massey University
  • Department: NA
  • Course Level: Doctoral
  • Award: $25,000 per annum
  • Access Mode: Online
  • Number of Awards: To be determined
  • Nationality: New Zealand and international students
  • The award can be taken in New Zealand

Massey University Doctoral funding for Domestic and International Students Eligibility            

  • Eligible Countries: Applications from all nationalities
  • Acceptable Course or Subjects: The sponsorship will be awarded in the Doctor of Philosophy (PhD), Doctor of Clinical Psychology (DClinPsych) or Doctor of Social Work (DSW).
  • Admissible Criteria: To be eligible, the applicants should have a conditional or unconditional admission offer of place in a doctoral programme at Massey University, or, be enrolled in the provisional year of a doctoral degree at the time of application closing date (prior to confirmation of registration). Full-time and part-time candidates are eligible to apply.

Application Procedure

  • How to Apply: To apply, the applicants must download the application form and submit to scholarships@massey.ac.nz
  • Supporting Documents: Applications should include a full CV, a cover letter outlining your interests in relation to this research, and the names and contact details of two academic referees.
  • Admission Requirements: Candidates are required to be enrolled in their approved course of research as a full-time or part-time candidate at Massey University.
  • Language Requirement: International applicants must meet the Massey University English language requirement for postgraduate studies.

Apply Now

ICASE PhD Studentship for UK and EU Students at University of Exeter, 2020

The University of Exeter is proud to announce its ICASE PhD Studentship for UK and EU Students. The studentship is funded via the EPSRC Industrial Cooperative Awards in Science & Technology (CASE) scheme, via a grant awarded to DSTL.

The program aims to undertake world-leading research, while training scientists and engineers with the relevant research skills and knowledge, and professional attributes for industry and academia.

Application Deadline: April 30, 2020

Founded in 1955, the University of Exeter has six academic colleges that provide undergraduate, masters and research level programs for the students. It offers a wide range of subjects across science, humanities and social sciences.

Why at the University of Exeter? The university offers world-class facilities and small enough to nurture a community based on the pursuit of academic excellence. Here, candidates can come to the forefront in the professional world and get employment opportunities.

Benefits

The studentships are of value around £110,000, which includes £25,000 towards the research project (travel, consumables, equipment, etc.), tuition fees, and an annual, tax-free stipend of approximately £16,500 per year.

Short Description

  • University or Organization: University of Exeter
  • Department: Departments of Physics and Engineering
  • Course Level: PhD
  • Award: £110,000
  • Access Mode: Online
  • Number of Awards: 1
  • Nationality: UK&EU Students
  • The award can be taken in the UK

ICASE PhD Studentship for UK and EU Students at University of Exeter, 2020 Eligibility

  • Eligible Countries: Applications from UK and EU countries are eligible to apply for the studentship.
  • Acceptable Course or Subjects: The studentship is part of the UK’s Centre of Doctoral Training in Metamaterials (XM2) based in the Departments of Physics and Engineering. Prospective students can consider projects from a wide variety of fields: Acoustic and Fluid-dynamical Metamaterials, Biological and Bio-inspired Metamaterials, Graphene and other 2D Materials, and Related Devices, Magnonics, Spintronics, and Magnetic Metamaterials, Microwave Metamaterials, Nanomaterials and Nanocomposites, Optical, Infra-red, and THz Photonics and Plasmonics, Quantum Metamaterials, Wave Theory, and Spatial Transformations.
  • Admissible Criteria: To be eligible, applicants must have to meet the following criteria:
  • Undergraduate degree in a relevant discipline (minimum 2:1).
  • Vision and motivation (for research & professional development).
  • Evidence of the ability to work collaboratively and to engage in a diverse community.

Application Procedure

  • How to Apply for ICASE PhD Studentship for UK and EU Students at University of Exeter, 2020: Applications are made to the Metamaterials program for a PhD in Physics/Engineering. Please send your application consisting of ALL items listed below to metamaterials@exeter.ac.uk.
  • Supporting Documents: Candidates must submit degree transcript(s) giving information about the qualification awarded, the modules are taken during the study period, and the marks for each module taken, an academic CV, A cover letter outlining your research interests in general, the title of the project(s) you are applying for, a personal statement and contact details of two academic referees.
  • Admission Requirements: For taking admission, candidates are required to meet the academic requirements of the university.
  • Language Requirement: Applicants from outside the home country will often need to meet specific English language requirements in order to be able to study at the university.

Apply Now

ECU-SCIA PhD funding for International Students in Australia, 2020

The Edith Cowan University is taking a wonderful initiative of helping motivated students through the ECU-SCIA PhD funding for International Students. The grant is available for the academic year 2020-2021.

The funding program supports students who want to undertake a PhD at EDU in partnership with Spinal Cord Injuries Australia in the realm of exercise medicine and neurological disorders.

Great chance for international students.

Application Deadline: June 30, 2020

Founded in 1991, the Edith Cowan University is an Australian public university and has a number of research centres within its areas of research. It has grown rapidly into a quality university with excellent student satisfaction and internationally recognized research.

Why at Edith Cowan University? The university offers innovative and practical courses across a variety of disciplines and they have a vibrant research culture. It provides varied pathways for career advancement and professional development. Here you can find a degree that suits your interests, strengths and career goals.

Benefits

The scholarship provides includes a full tuition fee sponsorship up to $35,000 per annum to undertake a PhD program at Edith Cowan University.

Short Description

  • University or Organization: Edith Cowan University
  • Department: NA
  • Course Level: PhD
  • Award: Up to $35,000
  • Access Mode: Online
  • Number of Awards: Not Known
  • Nationality: International
  • The award can be taken in Australia

ECU-SCIA PhD funding for International Students in Australia, 2020 Eligibility

  • Eligible Countries: Applications are accepted from around the world.
  • Acceptable Course or Subjects: award is awarded to undertake PhD degree program at ECU in partnership with Spinal Cord Injuries Australia in the realm of exercise medicine and neurological disorders.
  • Admissible Criteria: To be eligible, applicants must have to meet the following criteria:
  • Applicants must have submitted a course application for L61 within the School of Medical and Health Sciences.
  • Applicants must be proposing a thesis in spinal cord injuries.

APPLICATION PROCEDURE

  • How to Apply for the ECU-SCIA PhD funding for International Students in Australia : To be considered for the opportunity , candidates must have take admission in the PhD (Doctor of Philosophy) program at the university. After that, students must submit an online application for the opportunity.
  • Supporting Documents: Applicants must submit copies of their academic transcripts, certificates, and CV.
  • Admission Requirements: For taking admission, candidates are required to meet the academic entry requirements of the university.
  • Language Requirement: If your education has not been conducted in the English language, you will be expected to demonstrate evidence of an adequate level of English proficiency.

Apply Now

Kraft Heinz PhD Fellowship in International Business in Ireland

Cork University Business School has an exciting opening for PhD fellowship in international business within its Department of Management and Marketing. This program is being offered with the support of H.J. Kraft Heinz Company Foundation.

This prestigious award is available for high calibre PhD students to belong to any part of the world. The perks of this program include four years of funding, covering doctoral program tuition fees and an annual stipend of €16,000 per year.

A fice chance to receive financial help to support higher education in Ireland.

Application Deadline: April 30, 2020

The Cork University Business School at University College Cork (UCC) is located in Ireland. It brings together diverse students that come from different part of the world. It offers a range of degree program that helps you gain education and skills to succeed in this competitive world.

Why at Cork University Business School? At CUBS, they provide not only financial assistance but also a chance to gain experience in teaching. The school committed to offering high-quality education to prepare students for a successful career.

Benefits

Successful candidates will be award with four years of funding, doctoral program tuition fees and an annual stipend of €16,000 per year.

Short Description

  • University or Organization: Cork University
  • Department: Department of Management and Marketing
  • Course Level: Graduate or PhD
  • Award: Stipend of €16,000 per year
  • Number of Awards: Three
  • Access Mode: Online
  • Nationality: International
  • The award can be taken in Ireland

Kraft Heinz PhD Fellowship in International Business Qualification

  • Eligible Countries: Applications are open for international students.
  • Eligible Course or Subjects: PhD in international business will be considered.
  • Eligibility Criteria: Take a deep look at the given criteria:
  • Must be the highest caliber of PhD student from across the globe
  • Must have obtained a standard of at least Second Class Honors, Grade I in a relevant Masters degree.

APPLICATION PROCEDURE

  • How to Apply for the Kraft Heinz PhD Fellowship in International Business in IrelandApplicants must complete an online application form to grab this award opportunity at Cork University. After being part of the CUBS, applicants can be eligible to apply this Kraft Heinz PhD Fellowship.
  • Supporting Documents: Evidence of satisfying the English language requirements where required as well as will be needed in the application at the time of admission.
  • Admission Requirements: For taking admission, candidates meet all the entry requirements of the university.
  • Language Requirement: If English is not your first language, then you will need to meet the English language requirement:
    • IELTS: 6.5 but not lower than 5.5
    • TOEFL: 90 not lower than Listening- 17, Reading – 18, Speaking -20, and Writing – 17

Apply Now

Covid-19: a remote assessment in primary care

  1. risha Greenhalgh, professor of primary care health sciences1,  
  2. Gerald Choon Huat Koh, professor of public health and family medicine2,  
  3. Josip Car, director, reader in primary care and e-health3 4
  4. Correspondence to: T Greenhalgh

What you need to know

  • Most patients with covid-19 can be managed remotely with advice on symptomatic management and self isolation
  • Although such consultations can be done by telephone in many cases, video provides additional visual cues and therapeutic presence
  • Breathlessness is a concerning symptom, though there is currently no validated tool for assessing it remotely
  • Safety-netting advice is crucial because some patients deteriorate in week 2, most commonly with pneumonia

A 37 year-old healthcare assistant develops a cough. Next day, she wakes with a fever (which she measures at 37.4°C) and shortness of breath. She manages her condition at home for several days, experiencing increasing tiredness, loss of appetite, and a persistent dry cough. On the fifth day of her illness, she develops mild diarrhoea, and her chest feels quite tight. She takes her temperature, which has gone up to 38.1°C. Feeling unwell, she contacts her GP surgery for advice. She would like someone to listen to her chest, but the receptionist tells her not to come to the surgery and offers her the choice of a telephone or video consultation. She was previously well apart from mild asthma (on occasional salbutamol). Five years ago, she took citalopram for anxiety. She is a single parent of three children.

Novel coronavirus disease 2019 (covid-19) is an urgent and spreading threat whose clinical and epidemiological characteristics are still being documented. With a view to containing covid-19, a shift from in-person to remote consulting is occurring. Clinicians are thus faced with a new disease and a new way of interacting with patients.

This article will present some guiding principles on how to choose between telephone and video appointments, how to conduct a “query covid” consultation remotely, and considerations when arranging follow-up and next steps. It does not cover remote triage or how to set up video consulting in your practice. This article is intended as a broad orientation to a COVID-19 consultation. It does not cover every clinical eventuality, and should not be used as an official guideline for the management of a COVID-19 patient. National and local guidance are being urgently produced, and further research is being undertaken on specific aspects of management such as use of antibiotics.

What you should cover

Telephone or video?

The telephone is a familiar and dependable technology, which is adequate for many covid-19 related conversations. Patients who just want general information about covid-19 should be directed to a telephone message or online symptom checker such as NHS 111 online or other online resources. Those with mild and uncomplicated symptoms and those consulting for administrative reasons can generally be managed by telephone. In the UK, sickness certificates can be downloaded directly from NHS 111 online. However, video can provide additional visual information, diagnostic clues, and therapeutic presence.345 Hence, video may be appropriate for sicker patients, those with comorbidities, those whose social circumstances have a bearing on the illness, and those who are very anxious. Patients who are hard of hearing may prefer video to telephone.

Note that many countries, including the US,6 are formally relaxing privacy and data protection regulations for video and other communications technologies during the crisis; the General Data Protection Regulations which apply in the UK and European Union already include a clause excepting work in the overwhelming public interest.

Before you connect

Open the patient’s medical record, preferably on a second screen if using video. Check for risk factors for poor outcome in covid-19, including immunocompromised states (such as frailty, diabetes, chronic kidney or liver disease, pregnancy, or taking chemotherapy, steroids, or other immunosuppressants), smoking, cardiovascular disease, asthma, or chronic obstructive pulmonary disease (COPD). Enter a code for a video or telephone consultation and perhaps also “in the context of covid-19 pandemic.” Have your current “stay at home” covid-19 guidance on hand.78

Establishing a technical connection for a video consultation

Research shows that if the technical connection is high quality, clinicians and patients tend to communicate by video in much the same way as in an in-person consultation.3 When you are ready to connect, follow your local procedure (in some cases, for example, the link will be via a fixed URL and in others, a new URL will be generated for each appointment). When connected, check video and audio (“Can you hear/see me?”) and ask the patient to do the same. If necessary, prompt the patient to unmute and adjust their microphone (you may need to call them on an ordinary telephone to troubleshoot this). Make sure you have a record of their phone number in case you need to call them.

Beginning the consultation

Check the patient’s identity (for example, if they are not known to you, ask them to confirm their name and date of birth). Speak to the patient if possible rather than their carer or family member. Ask where they are right now (most patients will be at home, but they may be staying somewhere else). Then, begin with a ballpark assessment (very sick or not so sick?). What are they currently doing (lying in bed or up and about)? Do they seem distressed? Too breathless to talk? If you are using video, do they look sick? If the patient seems sick, go straight to key clinical questions as appropriate. Otherwise, take time to establish why the patient has chosen to consult now (for example, are they or a family member very anxious, or are they concerned about a comorbidity?). Find out what the patient wants out of the consultation (for example, clinical assessment, certification, referral, advice on self isolation, reassurance).

Taking a history

Note the approximate incidence of key symptoms and signs listed in the infographic (right hand column), with the caveat that this list was generated in a different population and may not reflect your own case mix. The infographic guidance should be used flexibly to take account of the patient’s medical history and issues that emerge during the conversation. The vignette describes a typical mild to moderate case of this disease; more serious cases typically develop worsening respiratory symptoms, which may indicate pneumonia. Elderly and immunocompromised patients may present atypically.

Figure1

Note the date of first symptom to date-stamp the onset of disease. Many but not all patients will have a thermometer at home. Ask how high their temperature is currently, how long the fever has lasted, and what the highest reading so far has been. The fever in covid-19 is often but not always >38.0°C and tends to persist beyond five days. Note that up to half of all patients with covid-19 have no fever at initial presentation.

Most but not all patients with covid-19 have a cough. It is usually dry, though a substantial proportion of patients have sputum production, and typically persists for more than five days. Fewer than half of patients with covid-19 have shortness of breath or difficulty in breathing,2 but if they do this tends to indicate more serious disease (especially pneumonia). It is therefore important to assess respiratory symptoms carefully, though the evidence base on how to do this is weak and expert opinion divided (box 1). If the patient has asthma, ask how many puffs of their reliever they are currently taking per day and whether this has increased recently. Systemic symptoms include fatigue and muscle pain, though many patients have neither.Box 1

Remote assessment of breathlessness

There are no validated tests for the remote assessment of breathlessness in an acute primary care setting. A rapid survey of 50 clinicians who regularly assess patients by telephone revealed some differences of opinion. For example, most but not all rejected the Roth score (which times how long it takes for a patient to take a breath while speaking) on the grounds that it has not been validated in the acute setting and could be misleading.

However, there was consensus among respondents around the following advice:

  1. Ask the patient to describe the problem with their breathing in their own words, and assess the ease and comfort of their speech. Ask open ended questions and listen to whether the patient can complete their sentences:
    • “How is your breathing today?”
  2. Align with the NHS 111 symptom checker, which asks three questions (developed through user testing but not evaluated in formal research):
    • “Are you so breathless that you are unable to speak more than a few words?”
    • “Are you breathing harder or faster than usual when doing nothing at all?”
    • “Are you so ill that you’ve stopped doing all of your usual daily activities?”
  3. Focus on change. A clear story of deterioration is more important than whether the patient currently feels short of breath. Ask questions such as
    • “Is your breathing faster, slower, or the same as normal?”
    • “What could you do yesterday that you can’t do today?”
    • “What makes you breathless now that didn’t make you breathless yesterday?”
  4. Interpret the breathlessness in the context of the wider history and physical signs. For example, a new, audible wheeze and a verbal report of blueness of the lips in a breathless patient are concerning.
    • There is no evidence that attempts to measure a patient’s respiratory rate over the phone would give an accurate reading, and experts do not use such tests. It is possible, however, to measure the respiratory rate via a good video connection. More generally, video may allow a more detailed assessment and prevent the need for an in-person visit.

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Ask about a history of contact with a case of covid-19 (laboratory confirmed or clinically suspected), especially one who had been closer than 1 metre for 30 minutes or more. The incubation period for covid-19 is 2-14 days, on average 5-6 days. Ask if anyone else in the immediate family is unwell. Other risk groups include healthcare workers, others working in a healthcare environment (such as cleaners), and transport workers. Travel to a known hotspot is less relevant as the virus is now widespread (type “WHO Situation Report” into Google for the latest worldwide incidence).

Features that generally indicate a condition other than covid-19 include nasal congestion (present in only 5% of cases), conjunctival congestion (1%), and other allergic symptoms such as itchy eyes. A preliminary report suggests that, although conjunctival involvement is rare in covid-19, it is a poor prognostic sign if present.9 Distinguishing seasonal influenza from covid-19 can be difficult, but, as a rule of thumb, the former is more likely to produce body aches and the latter shortness of breath. Gastrointestinal symptoms such as diarrhoea were initially said to be rare in covid-19, but there is emerging evidence that they may be commoner than previously thought.10 Loss of appetite occurs in many patients, and there are widespread anecdotal reports that anosmia (loss of sense of smell) is a common and early symptom.

Red flags

Red flag symptoms which indicate that the patient needs urgent assessment (either in person or by a good video link, depending on the clinical circumstances) include severe breathlessness or difficulty breathing, pain or pressure in the chest, blue lips or face, and a story suggestive of shock (such as cold and clammy with mottled skin, new confusion, becoming difficult to rouse, or significantly reduced urine output). Haemoptysis occurs in about 1% of covid-19 patients and seems to be a poor prognostic symptom.

Remote physical examination

A physical examination will be almost impossible by phone and difficult by video, so you will have to make compromises. In a video consultation, assess the patient’s demeanour, whether they are lying in bed or up and about, skin features (such as flushing, pallor, cyanosis—though note that if lighting is suboptimal this can be difficult to assess), and oropharynx. Congestion of the throat and tonsillar swelling are both rare (present in about 2% of covid-19 cases2). When making records, note what you can and cannot see. You may or may not get a view of the patient’s throat, for example. Assess respiratory function as best you can (box 1).

It may be possible to get the patient to take readings from instruments they have at home—for example, temperature, pulse, blood pressure, blood glucose, peak expiratory flow rate, and oxygen saturation. If you are using video, you can check whether the patient is using their equipment correctly (they may have purchased it only recently). Bring your own device into camera view to show them how to use it if necessary. Fitbit-type gadgets and smartphone apps can measure biomarkers such as pulse (and rarely, oxygen saturation), but there are many such products and their accuracy can be hard to judge. Rarely, patients may have a home oximeter. If you record a reading made by a patient with such a device, also note your confidence in its accuracy, especially if it seems out of line with your wider assessment.

Assess pre-existing conditions and medications taken. Asthma and cardiovascular disease are particularly relevant, and it is important to ensure that these are well controlled and the patient has adequate medication. Attend to mental health. Does the patient sound or appear upset or distressed? Formal mental health assessment instruments are unlikely to be useful in this setting. Are there relevant family issues (which may be within earshot or camera view) such as small children whose care will be affected if the patient becomes more unwell?

What you should do

Managing mild or moderately severe illness

Most community based patients with covid-19 can be managed by remote advice (infographic). Covid-19 is a frightening illness even if the patient only has mild symptoms. Explain that the condition is managed in a similar way to the flu and often takes a similar course, though it can deteriorate. About four out of five patients will have a relatively mild form of the illness. They should rest and take fluids and symptomatic remedies such as paracetamol. People already taking non-steroidal anti-inflammatory drugs should continue these, but others should avoid remedies such as ibuprofen as some anecdotal reports have raised concerns about its safety in covid-19. Regular medication, including ACE inhibitors and angiotensin receptor blockers,11 should be continued.

Adjust your advice depending on clinical features, comorbidities, and social support. The patient in the vignette, for example, has asthma so will need advice to step up treatment if her peak flow drops. Those with COPD may need antibiotics for an infective exacerbation.12 A social safety net will be important in patients living alone.

Explain any arrangements for self swabbing (not currently being offered in the UK, but this may change), dropping off specimens, and picking up medication. If the patient has covid-19 symptoms, remind them to get someone without symptoms and who has not been a close contact to attend the pharmacy on their behalf, and leave the medication at the doorstep and not enter the house. All paperwork, including prescriptions and sick certificates, should be sent electronically. If covid-19 is a presumptive diagnosis, self isolation should occur for seven days, but all household members should self isolate for 14 days from when the index case became ill. If circumstances allow, the person with symptoms should also self isolate within the home and stay as far as possible from vulnerable family members (see risk factors above). All family members should wash their hands regularly with soap and water, and follow the stay at home guidance for advice on cleaning and disposal of waste.7

Patients who cannot confidently be classified as having mild illness on the basis of the remote consultation may need to be followed up remotely or seen in person, and you should follow your local protocol for home treatment and monitoring. Comorbidities such as asthma or diabetes may need active management, and serious differential diagnoses such as bacterial pneumonia, meningitis, or sepsis should be considered. Not all acutely sick patients have covid-19.

Safety net advice

Covid-19 can produce rapid deterioration in respiratory function, especially in the second week, so safety-netting advice is important for all patients, even if they are currently well (document that you have done this). Those living alone should identify someone to check in on them regularly. They should maintain a high fluid intake (see infographic), and seek medical help if they deteriorate. In particular, if they have difficulty breathing, feel faint, stop passing urine, or are unable to keep down fluids, they should call their GP or out of hours service as appropriate (or follow your local protocol). Ask them to write this advice down or send a patient information leaflet electronically.

The sick patient

Patients who are very unwell, and especially those with possible pneumonia, need to be urgently assessed either by video or in person, depending on the clinical circumstances. The clinical criteria for hospital admission in covid-19 pneumonia are the same as for any other pneumonia, but in the current crisis there may be additional restrictions. The best clinical signs to predict community acquired pneumonia in an adult are a temperature above 38°C, respiratory rate above 20 breaths/minute, and heart rate above 100 beats/minute with new confusion; low urine output is also a concerning symptom.13 Anecdotal reports from UK secondary care suggest that hypoxia is often used as a cut-off for admission. Both the World Health Organisation and a guide based on the China experience recommend a cut-off level of 93% for classifying pneumonia as severe.1415 Current UK NHS guidance recommends hospital admission if saturation on air is below 94%.16 Additional features in children include grunting, central cyanosis, and inability to breastfeed.1415

We recommend that, in the case of patients with a very poor prognosis (for example, multimorbidity and other risk factors), a “ceiling of treatment” conversation is considered.17 If the patient is very sick and death almost inevitable whether ventilated or not, some people may prefer to stay home and opt for palliative management. Many such patients will already have an advance care plan and DNACPR (do not attempt cardiopulmonary resuscitation) flag, and in those who do not, urgent efforts should be made to put these in place to avert unwanted emergency intervention.

Notification

Covid-19 is a notifiable disease in the UK. Laboratory confirmed cases should be notified immediately; current professional consensus is that clinically suspected cases should also be notified.

At the time of writing, the situation is changing rapidly. This article will be updated as new evidence emerges. National and local protocols are likely to emerge for the topics covered in this article and other aspects of care in covid-19.

How this article was created

The article was produced at speed to address an urgent need for guidance. Advice on management of covid-19 was captured in real time from published12 and unpublished research findings (much of it from China) and official guidance.1415 In the absence of direct research evidence on how to assess breathlessness over the phone, we also sought expert opinion through a brief straw poll survey of 50 people (mostly doctors) who do this in their job. Advice on telephone consultations is based on a previous BMJ review18 and a fast-track grey literature paper on telephone advice in covid-19.19 Advice on video consulting is based on research by TG’s group and others (including an extensive narrative review of the literature, various empirical studies, and data currently being written up for publication)34520 and guidance produced by the Scottish Government and an English NHS trust to which TG’s team contributed.2122

Education into practice

  • How would you feel if you or a close relative were unwell with suspected covid-19 and wanted to see a doctor, but you were offered a phone call instead?
  • There are many available tools for video consulting, which are not difficult to set up. What will you need (hardware and software) to get one up and running in your surgery now?
  • Do you know your local protocol for arranging emergency admission of a patient with covid-19?

How patients were involved in the creation of this article

Patients with covid-19 or possible covid-19 were not involved in the writing of this paper for practical reasons.

Acknowledgments

We thank Fan-Shuen Tseng (medical student) who assisted with the search and data extraction for this paper, and Dr Eleanor Barry, Dr Michelle Drage, Dr Helen Salisbury, and Professor Simon de Lusignan along with BMJ editors (Tom Nolan, Will Stahl-Timmins, Anita Jain) and three peer reviewers (Jonty Heaversedge, Jessica Watson, Rachel Hopkins) for helpful comments on earlier drafts. TG thanks the Wellcome Trust (grant number WT104830MA), National Institute for Health Research (grant number BRC-1215-20008 and HS&DR 13/59/26), Health Foundation, and Scottish Government for funding her video consultation research.

Covid-19 and long term conditions: what if you have cancer, diabetes, or chronic kidney disease?

When the UK prime minister, live on national TV with the chief medical officer Chris Whitty, advised vulnerable patients—including those with chronic kidney disease—to minimise their social contact, it should have been a welcome surprise for Tess Harris, chief executive of the Polycystic Kidney Disease (PKD) charity. But recognition of this often unseen group provided no pleasure. Instead, it led to confusion.

Chronic kidney disease covers people with a wide range of symptom severity. Those at stage one usually have no obvious symptoms, or possibly blood in their urine. Those with stage five disease, like Harris, have lost nearly all kidney function. Yet Whitty’s comments had people at stage one unnecessarily worried that they’d have to go into self-isolation, Harris told The BMJ. They were asking whether they should go to work, or let their children go to school, she explains. “That’s been a big challenge—trying to interpret for patients.”

Harris receives peritoneal dialysis at home. “It’s life saving that I get my home dialysis fluids delivered along with everything else I need to stay safe,” she explained. Because she has a tube protruding from her stomach, it’s important for her to avoid infection, including maintaining good hand hygiene. Her deliveries come every two weeks, with her most recent arriving two days after Whitty’s announcement. “Luckily, there was hand gel,” she says. “In two weeks’ time, however, I don’t know.” She has a routine appointment on 23 March but doesn’t know if that’s going ahead.

PKD is an inherited condition, meaning that several family members can have it, adding extra complications for self-isolation. As the disease advances, dialysis or a kidney transplantation becomes necessary. Harris notes that some living transplantations are being cancelled because of covid-19, in part because they would take up intensive care beds that will now be needed for patients with the virus. Her brother is currently waiting for a transplantation. “If they delay that for several months, he may well have to start emergency dialysis. That will require hospitalisation and surgery. It’s bringing a lot of stress.”

Meanwhile, Harris’ younger sister received a transplantation six years ago, and now lives alone. She takes immunosuppressant drugs and had been practising social distancing to lower infection risk. “One PKD patient with a transplant told us they’d had a letter telling them to self-isolate. We’re checking with others,” she said. “I’m hoping that my sister gets support.”

Overall, Harris sees communication as the most important factor for patients with chronic kidney disease. She noted that the international nephrology community is doing well at providing clinicians with the best guidance. “Getting it to filter down to the patients in their own language, however, is the hardest thing. It’s challenging to explain the guidance to people who are scared, stressed, worried about work, worried about whether they’re going to get paid, and if their children with PKD will be affected.”

Diabetes

On 17 March, Sarah Blake, who is doing a doctorate in digital health technology for vulnerable patient groups at the University of Bristol, took her four year old out of school. Blake has type 1 diabetes and is an at-risk patient who has been told to self-isolate for 12 weeks. She discovered and shared infographics on Twitter about how to manage diabetes while ill. Her advice covers points like the need to monitor and manage blood glucose levels, even if a person isn’t eating, and never to stop taking diabetes drugs.

Yet Blake still has many worries. Not least, she is not sure how the virus impacts diabetes, how sick she needs to be to call a paramedic, what she should do if the emergency services are overwhelmed, or about access to food and medication now that she is isolated. “People living alone may be at increased risk, especially if extra demand means no access to online shopping,” she said. “Free priority online groceries would be good for high risk groups.”

Emma Cartwright, The BMJ’s patient editor, also has type 1 diabetes and is now self-isolating. She said that the need for food and medication is especially great because diabetics treat low blood sugar with sweets or sugary juice. “I have heard of people who are struggling to get the supplies they might need or are being restricted to how much they can buy which causes large amounts of worry within the community,” Cartwright said. Diabetics are advised not to stockpile, while deliveries of insulin pump supplies are delayed and ordering a month in advance is now advised.

This is typical of the confusion that is causing concern in the diabetes community, including whether people should be self-isolating, social distancing, or whether they should be at work. A lack of clarity over whether hospital appointments are happening is also “a huge concern.”

“People don’t want to burden the NHS with routine check-ups but also don’t know when they might next be able to see someone if they don’t attend,” Cartwright says. The ideal solution, she says, would be to access health professionals through teleconferencing or phone calls.

Cancer

Currently, a quarter of calls to the support line run by UK cancer charity Macmillan Cancer Support are about covid-19, according to its chief medical officer Rosie Loftus. People living with cancer are more anxious than ever before, she told The BMJ.

While cancer services will continue despite the pandemic, in the NHS, less urgent activities may be curtailed, according to guidelines released on 17 March.1 It offers advice on how to prioritise treatment for patients with cancer. The guidelines are sensible, Karol Sikora, former clinical director for cancer services at Hammersmith Hospital in London, now chief medical officer at private oncology provider Rutherford Health, told The BMJ. But he warned that the provisions it offers amount to rationing. “If you’ve got cancer, you’re worried your treatment will stop,” Sikora said, “We’ve not faced that in Britain before.”

Loftus expressed a similar concern. “We recognise that these are exceptional circumstances for the NHS, but there must be a clear plan for continuing essential chemotherapy and radiotherapy treatment so that we don’t see people with cancer missing out,” she said.

Several classes of cancer treatment, including chemotherapy and immunotherapy, can suppress immune systems and make patients more susceptible to covid-19 infection. The UK government introduced stringent shielding guidelines for such “extremely vulnerable” people on 21 March. It has sent letters to those affected, advising them more strongly than previous guidance to stay at home at all times and avoid any face-to-face contact for a period of at least 12 weeks.

Sikora noted practical challenges, however. “Can we have a chemo suite just for coronavirus patients? The most serious challenge is getting patients to move around the system. Even if you can do a lot by telephone, many cancer centres are in big cities. If they shut down the cities, that would be a disaster for many patients with cancer.”

Rationing of cancer care “is a reflection of the NHS being at full capacity,” Sikora suggested. Covid-19 is now adding an extra burden, with a surge of patients and a reduced workforce as staff and their families are affected by the virus. Consequently, Rutherford Health is offering its spare capacity to take on some of the cancer treatment burden. Sikora stressed that between his company and others there are around 20 private day care centres available. Rutherford Health’s capacity would be available at the same prices and under the same contracts it has already agreed for NHS patients in Northumbria.

“If we thought imaginatively, we could alleviate the potential for interruption of cancer treatment,” Sikora said. “Patients with cancer have to live with uncertainty as the disease unfolds. This is just another uncertainty—whether to have treatment, whether to delay, whether to stop, whether to reduce the dose. All these possibilities are very frightening for people.”

BREAKING: Immigration boss tests positive for COVID-19

Blessing Olaifa, Abuja

The Comptroller General of Nigeria Immigration Service Muhammad Babandede has tested positive for COVID-19.

According to a WhatsApp message from the public Relation officer of Immigration, Sunday, James, the CG had gone on self isolation since he returned from UK.

James said: “As a top official of government he has adhered to the NCDC instructions to self isolate and undergo test.

“The result of the test came out positive, hence the need to make it public. He conveys his goodwill to all and he is in stable condition responding to treatment.

“The Comptroller General is active and directing as expected the affairs of the service online while the Deputy Comptroller General Overseeing the administration of the service is in touch online to keep service activities running within this period.

“The Nigeria Immigration Service community will continue to deliver on its mandate for the nation even in this trying times as we pray the whole world get over it, Nigeria inclusive.”

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