ABSTRACT
Introduction: Virtual communication has become common practice during the COVID-19 pandemic due to visitation restriction. We aimed to evaluate overall family satisfaction in intensive care unit (FS-ICU) with virtual communication strategies during the COVID-19 pandemic period. Method(s): In this prospective multi-centre study involving three metropolitan hospitals in Melbourne, Australia, the next of kin (NOK) of all the eligible ICU patients between 07/01/2022 and 10/31/2020 were required to complete an adopted version of FS-ICU 24-Questionnaire. Group comparisons were analysed for family satisfaction scores: ICU/ care (satisfaction with care), FS-ICU/dm (satisfaction with information/ decision-making) and FS-ICU total (overall satisfaction with the ICU) were calculated. The essential predictors that influence family satisfaction were identified using quantitative and qualitative analyses. Result(s): Seventy-three out of the 227 patients' NOK who initially agreed, completed the FS-ICU questionnaire (response rate 32.2%). The mean (SD) FS-ICU/total was 63.9 (30.8). The mean score for satisfaction with FS-ICU/dm was lower than the FS-ICU/care (62.1 [30.30 vs. 65.4 [31.4];p 0.001) (Fig. 1). There was no difference in mean FS-ICU/ total scores between survivors (n = 65;89%) and non-survivors (n = 8, 11%). Higher patient APACHE-III score, female NOK and the patient dying in ICU were independent predictors for FS-ICU/total score while a telephone call at least once a day by an ICU doctor was related to higher family satisfaction for FS-ICU/dm. Conclusion(s): There was low overall family satisfaction with ICU care and virtual communication strategies adopted during the COVID-19 pandemic. Effort should be targeted for improving factors with virtual communication that cause low family satisfaction during the COVID-19 pandemic.
ABSTRACT
Background: The use of telepractice as an alternate method of delivering healthcare to people increased significantly after COVID-19 became a global pandemic. Objective(s): This study aimed to identify factors contributing to the accelerated adoption of telepractice during COVID-19 in Singapore. It also sought to examine whether there are differences in the perspectives of staff in nursing facilities and caregivers in personal homes towards telepractice. Method(s): A cross-sectional mixed method design was used. A survey with 20 items was adapted from the Telehealth Usability Questionnaire and translated into Mandarin. Anonymous responses were obtained from 70 patients and caregivers who had received speech therapy services via telepractice from a restructured hospital before and/or during Singapore's Circuit Breaker period. Analyses were conducted using descriptive statistics and content analysis. Result(s): Sociodemographic variables of age, gender, education level and language preference did not impact user satisfaction and the likelihood of using telepractice again. Service-related factors were more influential. Participants chose to use telepractice as it saved travelling time (24.0%), was easy to use (19.3%), improved healthcare access (17.5%) and reduced waiting time (17.5%). Although all respondents expressed satisfaction in telepractice, 35.5% from personal homes and 37.5% from nursing facilities were not keen to use it again. Amongst caregivers, 26.7% from personal homes and 37.5% from nursing facilities preferred not to continue telepractice use. Technical and logistical disruptions and the lack of 'personal touch' were contributing factors. Conclusion(s): Improving technological infrastructure, providing training for users and developing guidelines would help sustain telepractice as a form of service delivery beyond COVID-19. Copyright © The Author(s) 2022.
ABSTRACT
Background: Reports of thrombosis post COVID-19 mRNA vaccination have sparked concerns about safety. Aim(s): We prospectively evaluated blood samples of 18 participants who had received 2 doses of the BNT162b2 mRNA vaccine to determine if vaccination results in endothelial activation or hypercoagulability. Method(s): 18 participants who received the BNT162b2 vaccine were enrolled. Participants completed a questionnaire on their cardiovascular and thrombotic risk factors. Blood samples were collected at three time points: Pre-vaccination (day of vaccination), a median of 17 (IQR 16-18) days after the first dose and a median of 9 (IQR 7.5-14.5) days after the second dose of BNT162b2 vaccine. Endothelial markers included ICAM-1, VCAM-1 and P-selectin. Coagulation tests included PT and aPTT with clot waveform analysis, von Willebrand factor levels, Factor VIII and D-dimer levels. Statistical tests of association between endothelial and coagulation parameters were performed with repeated measures ANOVA and Mauchly's test of sphericity. Result(s): The median age of the participants was 35 years (IQR 31 -44), and 14 (78%) were female. 15 did not have any cardiovascular risk factors. There was a statistically significant increase in median ICAM levels post first (66.1ng/ml) and second dose of vaccination (69.5ng/ml)(p = 0.04), although this remained within the normal limit of ICAM levels. A statistically significant decrease in median PT (p = 0.005) and aPTT (p = 0.03) was observed post vaccination, with a corresponding statistically significant increase in aPTT clot waveform analysis (CWA) for maximum acceleration (max2)(p = 0.03) and maximum deceleration (max2)(p = 0.04) post first and second dose of vaccination. However, all evaluated endothelial and coagulation parameters remain within the reference ranges (Table 1). Conclusion(s): Our findings provide reassuring preliminary data that BNT162b2 vaccination does not result in endothelial activation or hypercoagulability. Mild variations in endothelial markers and coagulation parameters, though statistically significant, remain within the reference ranges and may be related to an inflammatory immune response to vaccination. (Table Presented).
ABSTRACT
Introduction: The respiratory mechanics, particularly static compliance of the respiratory system ( CRS) in COVID-19 acute respiratory distress syndrome (CARDS) is poorly understood. Whether or not distinct ARDS phenotypes based on CRS exist is still widely debated. Methods: We conducted a systematic review and meta-analysis, searching three international databases from 1st December 2019 to 15th July 2021 for studies reporting on the respiratory mechanics of patients with CARDS. The primary outcome was the CRS of both COVID-19 ARDS. Secondary outcomes included the mortality rates, lengths of stay, and ventilator free days. Random-effects (DerSimonian and Laird) meta-analyses were conducted. Results: 45 studies (13,334 patients) were included for analysis. The pooled CRS in patients mechanically ventilated for COVID-19 was 34.6 (95%-CI: 33.4-35.8), and displayed a normal distribution (Shapiro- Wilk test: p = 0.35). CRS was significantly associated with an PaO2/FiO2 ratio, positive end-expiratory pressure, and tidal volume;driving pressure was negatively associated with CRS. The pooled mortality rate was 36.2% (95%-CI: 30.3-42.4%, ICU) and 38.9% (95%- CI: 32.3-45.7%, 28-day). Conclusions: The respiratory mechanics of CARDS at the time closest to the initiation of invasive mechanical ventilation was normally distributed and did not reveal any distinct CRS- based phenotypes. However, to what extent the proposed unique pathophysiology of CARDS affects the current definition of ARDS and “exposes” its potential limitations remains a question for a high-quality, large prospective dataset to answer. Nonetheless, from our study-level analysis, CRS appears to be a heterogenous metric affected by both disease and intervention factors (Fig. 1) and physicians should treat patients with personalised and precise interventions in this context. (Table Presented).
ABSTRACT
Introduction: Coronavirus Disease (COVID-19) is a highly infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which has infected many people all over the world. One of the best ways to lessen its spread is through early detection and diagnosis. Various serological tests are now being used as a surveillance tool in the detection of antibodies as a response to SARS-CoV-2. The aim of this study is to evaluate the diagnostic accuracy and performance of the available COVID-19 antibody tests authorized by the Food and Drug Administration (FDA) Philippines that make use of Enzyme-Linked Immunosorbent Assay (ELISA), Chemiluminescence Immunoassay (CLIA) and Lateral Flow Immunoassay (LFIA). Method: Complete published journal articles relevant to the diagnostic accuracy of the three antibody tests were collected using trusted medical journal search engines. The quality of journals was assessed using QUADAS-2 to determine the risk of bias and assess the applicability judgments of diagnostic accuracy studies. Forest plots were used to summarize the performance of LFIA, ELISA and CLIA according to their specificity and sensitivity in detecting various antibodies. Pooled sensitivity and specificity were also done using bivariate random-effects models with its log-likelihood, a corresponding chi-square test statistic, and area under the summary Receiver-Operating Characteristic curve to see the potential heterogeneity in the data and to assess the diagnostic accuracy of the COVID-19 antibody tests.
ABSTRACT
Background/Purpose: The global coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in significant mortality, social disorder and economic hardships. We set out to understand why certain individuals could resolve the disease successfully without serious complications by immune profiling of PBMCs from convalescent COVID-19 patients (n = 14) with mild disease trajectory. Methods: We designed 7 peptides targeting the receptor binding region (RBD) of the spike protein of SARS-CoV-2, that encompass broad HLA class I / II alleles, with the aid of the Immune Epitope Database and Analysis Resource (IEDB) website. The RBD site was chosen as it was shown to be protective when neutralising antibodies against this region could negate binding of viral spike protein to host cell ACE-2 receptor. Convalescent COVID-19 patients enrolled in this study were screened and selected for positive antibody titre against the RBD region. PBMCs from convalescent COVID-19 patients were stimulated with/without the peptides for 72hrs and immune profiled (n = 70 markers across two panels) with the high dimensional single cell mass cytometry platform (CyToF). Results: Convalescent COVID-19 patients elicited a robust recall memory T follicular helper response (CD3 + CD4 + CD45RO + CXCR5 + Tigit + ;∗∗∗∗ p < 0.0001) demonstrating peptide efficacy. Unsupervised clustering (FlowSOM) of the CD4 T cell immune landscape reaffirmed increase in memory T follicular subsets and additionally CD4 + CD45RO + CXCR5 -subsets. Further gating of antigen specific memory cells (CD45RO + CD69 + ) revealed an increase in Tbet + CXCR3 + T effectors in both CD4 and CD8 compartments. Strikingly we detected a parallel increase in CD4 + Treg (CD25 + FoxP3 + ) CXCR3 + Tbet + CD45RO + CD152 + Tigit + expression. Conclusions: COVID-19 patients that successfully resolve the viral infection not only mount a robust T effector and follicular response but also in tandem a similar T regulatory profile.
ABSTRACT
Background: The Coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving and affecting healthcare systems across the world. Singapore has escalated its alert level to Disease Outbreak Response System Condition (DORSCON) Orange, signifying severe disease with community spread. Objectives: We aimed to study the overall volume of AIS cases and the delivery of hyperacute stroke services during DORSCON Orange. Methods: This was a single-centre, observational cohort study performed at a comprehensive stroke centre responsible for AIS cases in the western region of Singapore, as well as providing care for COVID-19 patients. All AIS patients reviewed as an acute stroke activation in the Emergency Department (ED) from November 2019 to April 2020 were included. System processes timings, treatment and clinical outcome variables were collected. Results: We studied 350 AIS activation patients admitted through the ED, 206 (58.9%) pre- and 144 during DORSCON Orange. Across the study period, number of stroke activations showed significant decline (p =0.004, 95% CI 6.513 - -2.287), as the number of COVID-19 cases increased exponentially, whilst proportion of activations receiving acute recanalization therapy remained stable (p = 0.519, 95% CI -1.605 - 2.702). Amongst AIS patients that received acute recanalization therapy, early neurological outcomes in terms of change in median NIHSS at 24 hours (-4 versus -4, p = 0.685) were largely similar between the pre- and during DORSCON orange periods. Conclusions: The number of stroke activations decreased while the proportion receiving acute recanalization therapy remained stable in the current COVID-19 pandemic in Singapore. (Figure Presented).