ABSTRACT
The Interdisciplinary Cardiac Arrest Research Review (ICARE) group was formed in 2018 to conduct an annual search of peer-reviewed literature relevant to cardiac arrest. Now in its fourth year, the goals of this review are to highlight annual updates on clinically relevant and impactful clinical and population-level studies in the interdisciplinary world of cardiac arrest research from 2021. To achieve these goals, a search of PubMed using keywords related to clinical research in cardiac arrest was conducted. Titles and s were screened for relevance and sorted into seven categories: Epidemiology & Public Health;Prehospital Resuscitation;In-Hospital Resuscitation & Post-Arrest Care;Prognostication & Outcomes;Pediatrics;Interdisciplinary Guidelines;and Coronavirus disease 2019. Screened manuscripts underwent standardized scoring of methodological quality and impact by reviewer teams lead by a subject matter expert editor. Articles scoring higher than 99t h per-centile by category were selected for full critique. Systematic differences between editors' and reviewers' scores were assessed using Wilcoxon signed-rank test. A total of 4,730 articles were identified on initial search;of these, 1,677 were scored after screening for relevance and deduplication. Compared to the 2020 ICARE review, this represents a relative increase of 32% and 63%, respectively. Ultimately, 44 articles underwent full critique. The leading category was In-Hospital Resuscitation, representing 41% of fully reviewed articles, followed by Pre-hospital Resuscitation (20%) and Interdisciplinary Guidelines (16%). In conclusion, several clinically relevant studies in 2021 have added to the evidence base for the management of cardiac arrest patients including implementation and incorporation of resuscitation systems, technology, and quality improvement programs to improve resuscitation. © 2023 Tehran University of Medical Sciences.
ABSTRACT
Introduction: Recent publications showed an unfavourable outcome of patients (pts.) with COVID-19 and a preexisting malignant disease. However, little is known about the fears of tumor pts. in the face of the corona pandemic. To increase knowledge, we conducted a 5-item questionnaire in our hematology/oncology unit. Method(s): 887 pts. answered the questionnaire in a 4-week time period (May-June 2020). Additional data for subsequent statistical analyses were recorded (age, gender, diagnosis, active treatment or not, first or last 2 weeks of survey, later referred to as early or late phase). Here we present the data of question 1 (Q1: fear of COVID-19 in general as patient with a malignant disease) and question 2 (Q2: fear of an unfavourable outcome in case of SARS-CoV2 infection). Result(s): Fear of COVID-19 was present in 34.2% of all pts., fear of a personal unfavourable course in case of an infection in 50.1%. Subgroup analyses (see fgure) showed signifcantly more positive answers for Q1 in inpatient pts. (51.5 vs. 32.0% in outpatient pts., p< 0.0002) and for Q2 in pts. with active treatment (54.8 vs. 41.0% in pts. with no current therapy, p< 0.0001). We also noted a trend towards female gender in Q1 and Q2 (Q1: 37.0% vs. 31.2% in male pts., p=0.07. Q2: 52.9% vs. 47.1% in male pts., p=0.09), and towards actively treated pts. in Q1 (36.4 vs. 30.0% in pts. with no current therapy, p=0.06). No diferences were seen in various age groups or tumor types. Positive answers both for Q1 and Q2 were signif-cantly decreasing in the late phase (Q1: 29.5% vs. 38.1% in the early phase, p< 0.007. Q2: 44.2% vs. 55.0% in the early phase, p< 0.002). Conclusion(s): Fear of SARS-CoV2 and COVID-19 is present in a relevant number of patients with malignant disease and should be part of the regular patient-doctor communication. However, fears seem to diminish over time, possibly due to the easing of the corona restrictions and the clearly decreasing COVID-19 numbers in Germany.
ABSTRACT
What life lessons emerge from a group of older Puerto Ricans concerning their experiences with COVID-19. We will review study participants' reports of how they spent their time during the pandemic, what they found most difficult to cope with, and life lessons they learned as a result. We will use Erickson's life course theory of psychosocial development to frame their responses to these questions, including the crises (and strengths) of generativity versus stagnation (care) and ego integrity versus despair (wisdom). We will report evidence of care and wisdom as core ego strengths resulting from their lived experience. We will also review how isolation, sense of community, and key mental and physical health factors seemed to influence how their responses suggest coping strengths. We will discuss our findings in the context of social and cultural norms of current cohorts of older Puerto Ricans, highlighting the salience of community and family relations. (150 words)
ABSTRACT
Loneliness is a well-established risk factor for poor mental health. During COVID-19, loneliness and mental health have been exacerbated by widespread disease-related mortality, suggesting that loss of a loved one may influence this relationship. Using data from 187 older adults in Puerto Rico, we assessed the association between loneliness and mental health and the potential moderating role of loss. Moderated multivariable linear regression results indicated that loneliness was significantly, positively associated with mental health (B = 1.58, p < .001). Although loss due to COVID-19 was not significantly associated with mental health (p = .473), it did moderate the relationship between mental health and loneliness (B = −1.00, p = .048). The lack of significant association of loss and mental health contrasts with previous research on COVID-19 and warrants further investigation. Nevertheless, the statistically significant interaction suggests that grief should be considered when assessing individual and community support during the pandemic.
ABSTRACT
To better understand the dynamics of their health behaviors during the pandemic, we examined older adults' COVID-related knowledge, attitudes, and practices (KAP). KAP theory postulates that individuals acquire knowledge about a health condition which influences their attitudes and beliefs and that these, in turn, lead to health practices. We used hierarchical regression to examine the influence of knowledge and attitudes (Step 1) on practices, controlling for health and relevant covariates (Step 2). The Step 1 association between increased knowledge and better practices (B = 0.14, p = .046) became nonsignificant in Step 2. Greater worry about contracting COVID-19 remained significant throughout (Step 2: B = 0.15, p = .043). We further explored subgroup differences within KAP measures via bivariate analyses. For instance, women had significantly higher overall knowledge (p = .013), while men had significantly better overall attitudes (p = .044). We will discuss implications of such subgroup differences for practice and policy interventions.
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Objectives: Substance use (SU) in minors has become an increasing public concern over the past decade. We hypothesized that SU would increase over time, particularly affecting minors with a history of trauma, suicide attempt, or violence. Method(s): Variables (such as sociodemographics, psychiatric treatment, urine toxicology report, and self-report of substance use) were extracted from the charts of all unique child and adolescent patients admitted to a 17-bed metropolitan inpatient psychiatry unit between June 2018 and November 2021. Statistical analyses included descriptive statistics, chi2 tests, independent t tests, Pearson correlations, and logistic regression. Result(s): Of the 1101 patients admitted, 30% (n = 330) were found to have SU by positive urine toxicology (n = 147) or self-report. Patients with SU were older than those without use (mean age 15.4 vs 13.4 years;p <.001). Significant racial differences were found, with White participants making up 21.8% of the SU population but only 14.1% of the non-SU group (p <.01), and Asian participants making up only 1.2% of the SU group (vs 4.2% without;p <.01). SU patients were more likely to have a history of self-harm (nonsuicidal self-injurious behavior [NSSIB]) or suicide attempt (NSSIB: 64.8% vs 52.%, p <.001;suicide attempt: 41.5% vs 25.7%, p <.001). Patients with SU were less likely to be admitted for aggression (14.5% vs 22.8%;p <.01) and more likely to be admitted for mania (2.4% vs 0.8%;p =.03). Positive predictors of SU were older age (OR = 1.41;95% CI, 1.15-1.72;p <.001), White race (OR = 1.98;95% CI, 1.19-3.29;p <.01), history of an impulsive/behavioral disorder (OR = 1.69;95% CI, 1.03-2.79;p <.04), history of suicide attempt (OR = 1.44;95% CI, 1.04-2.00;p =.03), history of violence (OR = 1.86;95% CI, 1.26-2.75;p <.01), and history of Administration of Children's Services (ACS)/Child Protective Services (CPS) involvement (OR = 1.45;95% CI, 1.03-2.03;p =.03). Gender, other races, history of other diagnoses, trauma history, or history of NSSIB were not found to be significant predictors. Conclusion(s): Our findings are consistent with emerging literature that SU in minors has had a slow increase in the COVID-19 era, particularly seen among White patients, patients of older age, and patients with a history of NSSIB or suicide attempt. While some of our analyses did control for potential confounding factors (logistic regression), further analyses are required to formulate a preventative plan for SU in youth. SUD, ICP, ALC Copyright © 2022
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Background: Deep vein thrombosis (DVT) is a common diagnosis with a worldwide incidence of 10 million cases per year. The diagnosis requires treatment with anticoagulation that can have both high cost and high risk for bleeding and has traditionally been managed with an inpatient admission. Recent guideline updates from the American Society of Hematology have demonstrated that patients meeting certain criteria can be managed as an outpatient. A retrospective chart review of patients presenting for acute DVT in 2019 demonstrated 58.1% of patients who met criteria for outpatient management were admitted. In order to improve value of care for UF Health patients presenting to the Emergency Department (ED) for acute DVT, a multidisciplinary team consisting of physicians from the departments of Hematology and Emergency Medicine developed a step-by-step ED treatment pathway for the management of acute DVT based on evidenced-based guidelines. The project goal was to achieve less than a 25% admission rate for patient's meeting outpatient management criteria within 1 year. Methods: Recent American Society of Hematology anticoagulation management guidelines supporting outpatient management of DVT presented an opportunity to reduce cost to patients while maintaining safety and improving resource utilization and evidence-based practice. To identify patients that are safe for outpatient management, the HAS-BLED risk stratification tool was implemented. To improve both quality of outpatient treatment and patient compliance, recommended treatment options were updated to reflect current practice standards with an appropriate emphasis on direct oral anticoagulants (DOACs). Finally, a standard documentation template was created for patients being discharged to reduce variation in post-discharge recommendations. A cause-and-effect diagram and interviews were utilized to determine the reasons for patient management decisions including disposition and choice of anticoagulation. These quality improvement tools were added to the ED treatment pathway, which was published in the standard location for similar clinical tools for ED clinicians at our institution. Furthermore, lectures were given at the Emergency Medicine residency conference to educate clinicians on the updates and answer questions. We subsequently reviewed charts of applicable ED encounters. A run chart was utilized to monitor admission and discharge rates over time. ED encounters with assigned ICD codes for acute and acute-on-chronic lower extremity DVT were reviewed for data collection. Outcomes: Chart review of ED patient encounters for acute DVT in 2019 demonstrated 255 cases. Of those, 93 patients were identified as meeting criteria for outpatient management. Only 41.9% (n=39) of patients who met criteria for outpatient management were discharged. Unexpectedly, 92% of all encounters did not document bleeding risk. Review of data from January through October 2020 demonstrated an overall decreased incidence of encounters for acute DVT. This is likely a reflection of decreased ED encounters in the setting of the COVID-19 pandemic. Over a 10-month period, 38 patients met criteria for outpatient management. Of these, 76.3% (n=29) of patients meeting criteria for outpatient management for DVT were discharged and 23.7% (N=9) were admitted. This demonstrates a significant improvement in admission rates (59.2% relative reduction) compared to a 58.1% admission rate in 2019 and met our goal of less than 25% admission rate. Furthermore, 89.7% (N=26) of patients who were discharged were prescribed direct oral anticoagulants. Similar to 2019, bleeding risk was documented in only 6.9% of discharged patients. This was an unexpected finding and while not the primary objective of the project, certainly demonstrates a significant opportunity for further care improvements. Conclusions: The next PDSA cycle will focus on appropriate use of bleeding risk stratification tools and documentation of bleeding risk. Of note, 37.3% of admitted patients who did not meet outpatient management criteria ere not discharged because of a concomitant pulmonary embolism. This may present an additional future opportunity for improving value of care for patients with different types of venous thromboembolism. [Formula presented] Disclosures: No relevant conflicts of interest to declare.