Overcoming Communication Barriers: An evaluation of communication devices for healthcare providers wearing powered air-purifying respirators (PAPRs).

Introduction: The COVID-19 pandemic has resulted in an increased use of Powered Air Purifying Respirators (PAPRs), by health care providers to mitigate the risk of viral transmission, especially for aerosol-generating procedures. In this study, we evaluate communication devices that could be used concurrently with PAPRs to promote improved communication. Methods: We tested two devices, a Bluetooth earpiece and a throat microphone that operated over mobile networks, against a control scenario in a simulated operating room environment with participants donning PAPRs. Participants read a short paragraph to each other, transcribed short phrases, and evaluated the scenarios according to speech intelligibility, ease of use, and comfort. Results: There were 30 participants of varying PAPR experience. The Bluetooth headset had the most accurate transcriptions, followed by control, and lastly the neckpiece (94.7%vs 88.4%vs 76%, p<0.001). Conclusion: Communication devices have the potential to bridge but also worsen communications barriers between providers donning PAPRs.

Hospital-Based Healthcare Worker Perceptions of Personal Risk Related to COVID-19: One Year Follow-Up.

BACKGROUND: The COVID-19 pandemic has significantly impacted health care workers (HCW). Most research focused on the adverse mental health effects during the initial surge of cases; and yet little is known about approximately how workers are faring 1 year into the pandemic. The objective of this study is to examine stress, burnout, and risk perception in an academic medical system, 1 year after the start of the pandemic. METHODS: HCW across care specialties participated in online surveys in Spring 2020 and Spring 2021. The surveys included questions related to workplace stress and risk perception related to COVID-19. Correlates of stress and burnout were explored using multivariable linear regression models. Professional Quality of Life Scale (PROQOL) questions were added to the second survey. RESULTS: While HCW reported significantly fewer concerns about the risk of COVID-19 transmission to themselves and their families during the 2021 survey (compared with 2020), the percentage of workers who reported feeling excess stress at work or considered resigning stayed the same. One year into the pandemic, 57% of study participants met criteria for moderate or high levels of traumatic stress and 75% met criteria for moderate or high levels of burnout. As compared with participants who cared for no COVID-19 deaths, participants who cared for COVID-19 patients who died had significantly higher traumatic stress (1 to 10: Coef. = 2.7, P = .007; >10: Coef. = 6.7, P < .001) and burnout scores (1 to 10: Coef. = 2.7, P = .004; >10: Coef. = 2.6, P = .036). CONCLUSION: While Although perceptions of risk declined over the course of the year, levels of stress still remained high despite high vaccination rates. Those who witnessed more COVID-19 deaths were more likely to report increased burnout and post-traumatic stress. As our nation continues to grapple with the COVID-19 pandemic and new variants emerge it is imperative to focus on recovery strategies for high burnout groups to ensure the wellbeing of our health care workforce.

THE HIDDEN WORKFORCE: A ONE-YEAR COMPARISON OF ADVANCED PRACTICE PROVIDER STRESS IN COVID-19

Questions evaluated workplace stress, burnout, and risk perception related to COVID;vaccination status and Professional Quality of Life Scale (PROQOL) were added in 2021. B Background: b The COVID-19 pandemic has killed more than 600,000 people in the United States. We aimed to compare levels of stress, burnout, and risk perception one year into the pandemic for APPs. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

OCCUPATIONAL HAZARD: ONE-YEAR COMPARISON OF STRESS RELATED TO COVID-19 IN THE INTENSIVE CARE UNIT

B Background: b The COVID-19 pandemic has psychological impacts on healthcare workers (HCW), especially those in the intensive care unit (ICU). We hypothesized that HCWs in the ICU treating COVID-19 patients would have high levels of risk perception, stress, and burnout one year into the pandemic. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

IMAGING FINDINGS IN COVID-19: RELATIONSHIP AMONG INITIAL CHEST IMAGING, ICU ADMISSION, AND MORTALITY

Patients with diffuse or bilateral opacities, or pleural effusion on initial imaging should be considered high risk for ICU admission and mortality. The purpose of this study is to determine whether there is an association between initial chest imaging findings and ICU admission and/or mortality in COVID-19 positive patients. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

A PANDEMIC WITHIN AN EPIDEMIC: EVALUATION OF COVID-19 IN THE OBESE POPULATION

B Conclusion: b This supports the growing body of evidence that obesity has the potential to serve as an independent predictor for outcomes of COVID-19 patients. Evidence has shown increased morbidity and mortality among obese COVID-19 patients. Patients were stratified into healthy weight (BMI < 25), overweight (BMI 25 - 29.9), obese (BMI 30 -39.9), and morbidly obese (BMI > 40) categories. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

WASHINGTON DC REGIONAL ECMO OUTCOMES IN COVID-19

B Introduction: b COVID-19 mortality has disproportionately impacted racial and ethnic minorities in the United States. This disparity is particularly notable in Washington D.C. where African Americans make up 44% of the population, but 51% of COVID-19 infections and 75% of COVID-19 mortalities. To future explore socioeconomic status (SES) as a corollary to ECMO cannulation, we merged patient zip codes with zip code median household income from the American Community Survey. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Exploring the unmet needs facing individuals with Alzheimer’s disease and related dementias during the COVID-19 pandemic

Background Many adults with ADRD rely on support from friends, family members, social service agencies, and their communities to meet their basic needs. It is unclear if COVID-19 mitigation policies have made it more difficult for individuals with ADRD to receive this support. The objective of this study was to explore the types of unmet needs experienced by adults with ADRD in the United States during the COVID-19 pandemic as well as the characteristics of adults with ADRD that are experiencing unmet needs. Method We performed a cross-sectional analysis of the Medicare Current Beneficiary Survey (MCBS) summer and fall 2020 COVID-19 supplemental surveys. The MCBS uses complex survey design to provide a nationally representative sample of Medicare beneficiaries. There were 20,800 survey participants in total and 4.07% have received a diagnosis with ADRD. Logistic regression was used to examine the characteristics of those reporting one or more unmet need. Result 16.61% Medicare beneficiaries with ADRD reported having one or more unmet needs during the COVID-19 pandemic (vs. 16.52% Medicare beneficiaries without ADRD, p=0.956). While beneficiaries with and without ADRD had no difference in unmet needs surrounding rent/mortgage, food, supplies, and medications, adults with ADRD had higher rates of unmet need for healthcare services (8.86% vs. 5.77%, p=0.008). Adults with ADRD were more likely to report having an unmet need between March-June than between July-November (18.10% vs. 7.84%, p<0.001). Among those with ADRD, individuals with depression (AOR=2.25, p=0.001) and multimorbidity (AOR=1.79, p=0.030) reported significantly higher unmet need, after controlling for age, sex, race/ethnicity, insurance, and geographic location. As compared with individuals without ADRD, individuals with co-existing ADRD and depression (p<0.001) or co-existing ADRD and multimorbidity (p<0.001) reported higher likelihood of having unmet needs. Conclusion Many adults with ADRD experienced unmet need during the first 4 months of the COVID-19 pandemic. We also found that the ADRD patients with depression and complex health needs who require greatest number of healthcare services were more likely to voice unmet needs. The residual impact of unmet needs during the early pandemic months and on-high risk subpopulations is currently unknown.

Impact of COVID-19 Mitigation Efforts on Adults With Serious Mental Illness: A Patient-Centered Perspective.

ABSTRACT: In response to COVID-19 mitigation policies, mental health and social service agencies have had to rapidly change their operations, creating challenges for patients with serious mental illness (SMI). This study aimed to explore the experiences of adults with SMI navigating these altered systems during the pandemic. In-depth interviews were conducted with 20 hospitalized adults with SMI in the fall of 2020; they were coded using thematic analysis. Most participants found the new systems effective at meeting their essential needs. However, several reported significant unmet needs, including inability to access mental health care and public benefits. These participants lacked identification documents, housing, and/or a personal device. Although none of the participants used telemedicine before COVID-19, most reported no or minimal problems with telemental health. Those reporting difficulties did not have personal devices, were receiving audio-only services, or viewed telemedicine as less personal or too distracting.

Disparities in Audio-only Telemedicine Use Among Medicare Beneficiaries During the Coronavirus Disease 2019 Pandemic.

BACKGROUND: Under emergency coronavirus disease 2019 pandemic regulations, Medicare granted temporary payment parity with in-person visits for audio-only (telephone) telemedicine visits. This policy was designed to expand telemedicine to patients without camera-equipped devices and broadband internet. However, audio-only telemedicine use has been substantial. OBJECTIVE: The aim of this study was to explore whether the rate of audio-only telemedicine during the pandemic is related to patient access to technology or provider behavior. DESIGN: Cross-sectional analysis of the Summer and Fall 2020 Medicare Current Beneficiary Survey coronavirus disease 2019 supplements, using multivariable logistic models and accounting for complex survey design. SUBJECTS: A total of 3375 participants in the summer survey and 2633 participants in the fall 2020 were offered a telemedicine visit to replace a scheduled in-person visit by their usual care provider. MEASURES: We compared beneficiaries who were exclusively offered audio-only telemedicine to beneficiaries who were offered video telemedicine or both audio and video. RESULTS: We found that among Medicare beneficiaries who were offered telemedicine to replace a scheduled in-person appointment, ~35% were exclusively offered audio-only. 65.8% of beneficiaries exclusively offered audio-only reported having a smartphone/tablet and home internet. After controlling for personal access to technology, Hispanic [adjusted odds ratio (AOR)=2.09, P<0.001], dually eligible (AOR=1.63, P=0.002), nonprimary English speaking (AOR=1.64, P<0.001), and nonmetro beneficiaries (AOR=1.71, P=0.003) were more likely to be offered audio-only during July-November 2020. CONCLUSIONS: These findings suggest audio-only telemedicine use during the pandemic is only partially related to patient access to technology. Policymakers must work to both expand programs that provide smartphones and broadband internet to disparity communities and telemedicine infrastructure to providers.

Aspirin Use Is Associated With Decreased Mechanical Ventilation, Intensive Care Unit Admission, and In-Hospital Mortality in Hospitalized Patients With Coronavirus Disease 2019.

BACKGROUND: Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk in critically ill patients. To our knowledge, no studies have evaluated whether aspirin use is associated with reduced risk of mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality. METHODS: A retrospective, observational cohort study of adult patients admitted with COVID-19 to multiple hospitals in the United States between March 2020 and July 2020 was performed. The primary outcome was the need for mechanical ventilation. Secondary outcomes were ICU admission and in-hospital mortality. Adjusted hazard ratios (HRs) for study outcomes were calculated using Cox-proportional hazards models after adjustment for the effects of demographics and comorbid conditions. RESULTS: Four hundred twelve patients were included in the study. Three hundred fourteen patients (76.3%) did not receive aspirin, while 98 patients (23.7%) received aspirin within 24 hours of admission or 7 days before admission. Aspirin use had a crude association with less mechanical ventilation (35.7% aspirin versus 48.4% nonaspirin, P = .03) and ICU admission (38.8% aspirin versus 51.0% nonaspirin, P = .04), but no crude association with in-hospital mortality (26.5% aspirin versus 23.2% nonaspirin, P = .51). After adjusting for 8 confounding variables, aspirin use was independently associated with decreased risk of mechanical ventilation (adjusted HR, 0.56, 95% confidence interval [CI], 0.37-0.85, P = .007), ICU admission (adjusted HR, 0.57, 95% CI, 0.38-0.85, P = .005), and in-hospital mortality (adjusted HR, 0.53, 95% CI, 0.31-0.90, P = .02). There were no differences in major bleeding (P = .69) or overt thrombosis (P = .82) between aspirin users and nonaspirin users. CONCLUSIONS: Aspirin use may be associated with improved outcomes in hospitalized COVID-19 patients. However, a sufficiently powered randomized controlled trial is needed to assess whether a causal relationship exists between aspirin use and reduced lung injury and mortality in COVID-19 patients.

Hospital-Based Health Care Worker Perceptions of Personal Risk Related to COVID-19.

BACKGROUND: Health care workers treating Coronavirus disease 2019 (COVID-19) patients face significant stressors such as caring for critically ill and dying patients, physically demanding care requiring new degrees of personal protective equipment use, risk of contracting the disease, and putting loved ones at risk. This study investigates the stress impact from COVID-19 exposure and how nurses and medical providers (eg, physicians, nurse practitioners, physician assistants) experience these challenges differently. METHODS: An electronic, self-administered questionnaire was sent to all hospital staff over 6 weeks surveying exposure to COVID-19 patients and degree of stress caused by this exposure. Responses from medical providers and nurses were analyzed for significant contributors to stress levels, as well as comparing responses from medical providers versus nurses. RESULTS: Stress levels from increased risk of disease contraction while on the job, fear of transmitting it to family or friends, and the resulting social stigma were highest in medical staff during the COVID-19 pandemic. Compared with medical providers, nurses had nearly 4 times the odds of considering job resignation due to COVID-19. However, most health care workers (77.4% of medical providers and 52.9% of nurses) strongly agreed or agreed with the statements indicating high levels of altruism in their desire to treat COVID-19 patients. CONCLUSION: The significant stress burden placed on nurses likely contributes to increased thoughts of job resignation. However, health care providers displayed high levels of altruism during this time of extreme crisis, despite their personal risks of caring for COVID-19 patients.