Plasma expansion and renal perfusion in critical COVID-19 with AKI

Introduction: We have previously described decreased renal perfusion in acute kidney injury (AKI) due to critical COVID-19 [1]. The objective of this study was to compare the effects of plasma expansion with a standardized fluid bolus on renal perfusion in patients with AKI compared to similar patients without AKI. Method(s): A case control study design was used to investigate group differences before and after a standardized intervention. ICU-treated COVID-19 patients without underlying kidney disease were assigned to two groups based on KDIGO Creatinine criteria for AKI. Renal perfusion was assessed by magnetic resonance imaging using phase contrast and arterial spin labeling before and directly after plasma expansion with 7.5 ml/kg Ringer's Acetate (Baxter). Mean arterial pressure (MAP) was recorded before plasma infusion and compared with maximum value after. Data was analyzed with a mixed model repeated measures ANOVA for all kidneys using a random effect to account for research subjects. Result(s): Nine patients with AKI and eight without were included in the study. Patients in both groups were of similar mean age and weight, 66 (SD 8) years and 94 (SD 22) kg in AKI group and 64 (SD 15) years and 93 (SD 20) kg in patients without AKI. The response to plasma expansion was similar with increased MAP by 18 (CI 8-28) mmHg and 20 (CI 10-31) mmHg respectively (Table 1). Total renal perfusion and cortical perfusion was not significantly changed by plasma expansion, however there was a reduction of medullary perfusion in patients without AKI (Table 1). Conclusion(s): Plasma expansion with a standardized fluid bolus did not increase renal perfusion in critically ill patients with ARDS due to COVID-19.

In-Person Versus Virtual Insulin Pump Training Experiences among People with Diabetes in 6 European Countries

Background and Aims: While insulin pump training has historically been conducted in person, the COVID-19 pandemic has necessitated a rise in virtual alternatives. The present study aims to examine the perceived effectiveness of in-person versus online pump training among people with diabetes in Europe. Method(s): From April-May 2022, 2,457 people with type 1 diabetes in France, Germany, Italy, Netherlands, Sweden, and UK took an online survey in which they indicated their use of pump therapy. Respondents who started using a new pump model in the last year indicated their pump training method (n = 366) and those who received training reported their confidence in pump use after training (n = 356). Confidence scores were calculated as the proportion of users selecting 9 or 10 on a 10-point scale. Result(s): The majority of pump users trained in person with an HCP or pump company representative (76%). One quarter of pump users trained virtually with a professional (24%), and 12% completed a self-guided training tutorial online. Those who completed a self-guided tutorial were significantly less confident using their pump than those who trained with a professional in person (34% vs. 51%, p = 0.021) or virtually (34% vs. 55%, p = 0.006). No differences in confidence were observed between those who trained with a professional in person or virtually (51% vs. 55%). Conclusion(s): These findings suggest that virtual training may be an effective alternative to in-person methods, though professional guidance is critical to building confidence in pump use. Further research is needed to identify improvements to online, self-led trainings to increase proficiency among new pump users.

Screen Media Modeling & Mentoring: Parents' Views

Screen media modeling and mentoring is an important factor of family media practices and for tech readiness of digital youth. The authors conducted a qualitative study to examine the media practices within families with children ages 5–11. Semi structured interviews with 51 parents revealed that parents and other significant people, such as grandparents, siblings, friends, and community members, mentor or model media practices with children but practices vary between families and within contexts. Further, there are direct and sustained impacts on children's screen media behaviors when parents actively participate in mentoring or modeling of screen media with their children. Findings also shed light on other influencing factors of screen media engagement, such as modeling styles, parent's prior experience and comfort with technology, personal backgrounds, and concerns about their own use of screen media. Findings are useful as information professionals engage with children when navigating the post-Covid digital landscape. 85th Annual Meeting of the Association for Information Science & Technology ;Oct. 29 – Nov. 1, 2022 ;Pittsburgh, PA. Author(s) retain copyright, but ASIS&T receives an exclusive publication license.

Stressful experiences impact clinical symptoms in people with endometriosis

Endometriosis is a chronic condition that affects ~10% of women globally. Its symptoms include chronic pelvic pain, heavy periods and tiredness/fatigue, which have been associated with poorer quality of life and mental health. We aim to explore the impact of the COVID-19 pandemic on pain and fatigue symptoms and their interactions with the impact on mental health in people with endometriosis. This global cross-sectional online survey study collected data from 4717 adults with self-reported surgical/radiological diagnosis of endometriosis between May and June 2020. The survey included questions on the current status and changes of endometriosis symptoms (pelvic pain, tiredness/fatigue, and bleeding patterns), mental health, pain catastrophising, and the impact of the COVID-19 pandemic on the respondents’ lives. Compared to 6 months earlier, Respondents reported a marked worsening of their endometriosis symptoms (endometriosis-associated pain (39.3%;95% CI: 37.7, 40.5), tiredness/fatigue (49.9%;95% CI: 48.4, 51.2) and bleeding patterns (39.6%;95% CI: 38.2, 41)) and mental health (38.6%;95% CI: 37.2, 39.9). Those with a pre-existing mental health diagnosis (38.8%) were more likely to report their symptoms worsening. Worsening of pain and tiredness/fatigue was significantly correlated with worsening of mental health (P < 0.001). The relationship between changes in mental health and (a) change in pain and (b) change in fatigue was found to be weakly mediated by pain catastrophising scores (pain: B = 0.071, lower limit of confidence interval (LLCI) = 0.060, upper limit of confidence interval (ULCI) = 0.082, tiredness/fatigue: B = 0.050, LLCI = 0.040, ULCI = 0.060). This study demonstrates that stressful experiences impact the physical and mental health of people with endometriosis. The findings highlight the need to consider psychological approaches in the holistic management of people with endometriosis.Lay summary: Endometriosis is a chronic condition in which tissue similar to that of the lining of the womb grows outside it. It affects around 10% of women globally, and the symptoms often include persistent pelvic pain, heavy periods and tiredness/fatigue. These symptoms are associated with impaired mental health and life quality. This study used an online questionnaire to assess the experiences of people with endometriosis during the first months of the pandemic. Results from 4717 adults revealed that pelvic pain, tiredness/fatigue and bleeding worsened in more than 39% of the participants. Poor mental health was also exacerbated and associated with worsening in tiredness/fatigue. Further analysis revealed that this relationship could be partially explained by ‘pain catastrophising’, which measures how participants think about their pain. Our results suggest that stressful experiences like the pandemic negatively impact the already burdened mental health of people with endometriosis, who could benefit from psychological interventions.

Trough anti-Xa activity after intermediate dose nadroparin for thrombosis prophylaxis in critically ill patients with COVID-19 and acute kidney injury.

Our objective was to assess the incidence of drug bioaccumulation in critically ill COVID-19 patients with AKI receiving intermediate dose nadroparin for thrombosis prophylaxis. We conducted a Prospective cohort study of critically ill COVID-19 patients. In patients on intermediate dose nadroparin (5700 IU once daily) we assessed the incidence of bioaccumulation (trough anti-Xa level > 0.2 IU/mL) stratified according to presence of AKI. We quantified this association using multilevel analyses. To assess robustness of our observations, we explored the association between AKI and anti-Xa activity in patients receiving high dose nadroparin (> 5700 IU). 108 patients received intermediate dose nadroparin, of whom 24 had AKI during 36 anti-Xa measurements. One patient with AKI (4.2% [95%CI 0.1-21%]) and 1 without (1.2% [95%CI 0.03-6.5%]) developed bioaccumulation (p = 0.39). Development of AKI was associated with a mean increase of 0.04 (95%CI 0.02-0.05) IU/ml anti-Xa activity. There was no statistically significant association between anti-Xa activity and AKI in 51 patients on high dose nadroparin. There were four major bleeding events, all in patients on high dose nadroparin. In conclusion, Bioaccumulation of an intermediate dose nadroparin did not occur to a significant extent in critically ill patients with COVID-19 complicated by AKI. Dose adjustment in AKI may be unnecessary.

Virtual Care in the COVID-19 Era: Assessing Telemedicine Experiences among Diabetes Care and Education Specialists

Objective: The rapid rise of telemedicine, necessitated by the COVID-19 pandemic, has changed how care is administered and created additional burdens for healthcare professionals. This study investigated how Diabetes Care and Education Specialists (DCES) have implemented telemedicine in their practices to identify possible areas for improvement. Method: 350 DCES from an opted-in US research panel were surveyed. Respondents were asked about their expected and present use of telemedicine, satisfaction with telemedicine versus in-person appointments, and perceived changes in the frequency of treatment decisions made over telemedicine compared to in-person. Result: On average, respondents reported that 57% of appointments were conducted using telemedicine this year and estimated a decrease in telemedicine use during 2021 (41%). While 67% of respondents were satisfied with in-person visits (selecting a 9 or 10 on a 10-point scale), just 25% were satisfied with telemedicine visits. Analysis of verbatim comments revealed dissatisfaction with telemedicine stems from difficulty with teaching patients virtually (20%), technology use (18%), establishing personal connections with patients (16%), and obtaining patient device data (11%). DCES indicated that larger treatment decisions like starting new therapies/devices occur less often over telemedicine whereas adjusting patient's settings occurs more often. For example, relative to in-person visits, 64% report starting patients on new insulin pumps less often while 62% report adjusting pump settings just as often. Conclusion: Telemedicine has become a regular part of DCES's practices despite notable gaps in satisfaction and ability to make certain treatment decisions when compared with in-person visits. Although telemedicine may be a useful tool for adjusting doses and device settings, these findings emphasize the need for improvements surrounding virtual diabetes care to alleviate the challenges experienced by providers.

A regional approach to COVID-19 recovery: lessons from the West Midlands

Recovery from a societal 'shock' should not mean returning to a pre-existing state. Whilst shocks - which range from acute and unexpected to chronic and anticipated - are disruptive, they also provide opportunities to create better societies, places and economies. The COVID-19 pandemic has cut through entrenched ways of living and working, resulting in some positive outcomes, including reduced air and noise pollution, increased active travel and falling carbon emissions (Leach et al., 2020). Many organisations have had to rethink how they operate, with expensive business premises downsized, creating new possibilities for how cities and towns are organised. At the same time, established ways of thinking about places are having to change. For example, car-free cities are predicated upon extensive use of public transport and dense, vibrant streetscapes - neither of which are feasible during a pandemic. Taking a place-based and participatory approach to recovery has the potential for progress beyond what existed before. Societies involve unique combinations of social, technical and institutional elements that work together in particular ways to create socio-technical systems. The systems evolve in response to endogenous drivers (such as the adoption of new technologies), new thinking emerging and behaviours changing. The systems are also affected by exogenous factors, such as COVID-19, that accelerate change: technological developments are incentivised;behaviour change is mandated. As such, all places are engaged in a continual process of recovering from different levels of shock (Deverteuil, 2016). Some changes may be temporary in their full embodiment, but even so they cause ripples that persist across the system, making it impossible to recover to 'what was', or to 'bounce back' (Matyas and Pelling, 2014). Elected representatives and policy makers have promoted the concept of a postpandemic 'recovery' (HM Government, 2020). The nuance, however, is in recognising the transient state of our societies. If there is talk of recovery it should not be in relation to a static point. Rather, 'recovery' should aim for an improved state that also provides better preparedness and a greater ability to respond to shocks. As such, a key focus of recovery should be on developing the tools needed to respond to future shocks.

Chest radiograph features of the covid-19 Infection: Comparison of the initial and Follow-up changes

Objectives In December 2019, an outbreak of coronavirus (COVID-19) started in Wuhan, China, and quickly spread across the world. We describe the features seen on chest radiograph (CXR) at disease onset, the natural history of these changes after an approximate two-month follow-up period, and the further respiratory investigations requested following discussion with patients who recovered from the illness. Materials and Methods From March 16, 2020, to June 4, 2020, the CXR features of 86 patients (23-87 years, 50 males) who were admitted to the medical take with COVID-19 were analysed. The initial and follow-up CXRs, obtained a mean of 7.9 days and 63.8 days from illness were retrospectively assessed for the severity and progression of changes. Patients were then contacted by telephone to discuss any ongoing respiratory symptoms, and further investigations requested using the BTS guidelines for COVID-19 follow-up. Results 65 of the 80 (83%) patients with abnormal initial CXRs had more than 1 lobe affected, with most (53/80, 66%) having changes in the lower lobes. A diffuse distribution was most common (37/80, 46%), followed by peripheral (28/80, 35%). These abnormalities were predominantly consolidation (61/80, 76%). At follow-up, just over half of CXRs (44/80, 55%) were reported as normal. Of those with ongoing changes, the dominant features were pneumonitis (5/36, 14%), inflammatory change, and atelectasis (4/26 each, 11%). 74 patients have been reviewed, and around half (35/74, 47%) have been discharged from our service. Of the 25 requiring further investigation with cross-sectional imaging, we have identified 1 pulmonary embolus and 4 cases of fibrosis (2 of which look to be asbestos-related and likely pre-date the diagnosis of COVID-19 pneumonia). Conclusions We observed an even split between patients demonstrating complete resolution of initial CXR changes and the persistence of radiological features at six weeks. At follow-up, a significant proportion of patients continued to feel symptomatic despite an improvement in radiological features or a lack of positive findings with cross-sectional imaging. This underlines the importance of adopting a holistic approach and the need to exclude other causes of breathlessness in patients with no CXR or CT evidence of cause.

P10 Chest radiograph features of the COVID-19 infection: comparison of the initial and follow-up changes

ObjectivesIn December 2019, an outbreak of coronavirus (COVID-19) started in Wuhan, China, and quickly spread across the world. We describe the features seen on chest radiograph (CXR) at disease onset, the natural history of these changes after an approximate two-month follow-up period, and the further respiratory investigations requested following discussion with patients who recovered from the illness.Materials and MethodsFrom March 16, 2020, to June 4, 2020, the CXR features of 86 patients (23–87 years, 50 males) who were admitted to the medical take with COVID-19 were analysed. The initial and follow-up CXRs, obtained a mean of 7.9 days and 63.8 days from illness were retrospectively assessed for the severity and progression of changes. Patients were then contacted by telephone to discuss any ongoing respiratory symptoms, and further investigations requested using the BTS guidelines for COVID-19 follow-up.Results65 of the 80 (83%) patients with abnormal initial CXRs had more than 1 lobe affected, with most (53/80, 66%) having changes in the lower lobes. A diffuse distribution was most common (37/80, 46%), followed by peripheral (28/80, 35%). These abnormalities were predominantly consolidation (61/80, 76%). At follow-up, just over half of CXRs (44/80, 55%) were reported as normal. Of those with ongoing changes, the dominant features were pneumonitis (5/36, 14%), inflammatory change, and atelectasis (4/26 each, 11%). 74 patients have been reviewed, and around half (35/74, 47%) have been discharged from our service. Of the 25 requiring further investigation with cross-sectional imaging, we have identified 1 pulmonary embolus and 4 cases of fibrosis (2 of which look to be asbestos-related and likely pre-date the diagnosis of COVID-19 pneumonia).ConclusionsWe observed an even split between patients demonstrating complete resolution of initial CXR changes and the persistence of radiological features at six weeks. At follow-up, a significant proportion of patients continued to feel symptomatic despite an improvement in radiological features or a lack of positive findings with cross-sectional imaging. This underlines the importance of adopting a holistic approach and the need to exclude other causes of breathlessness in patients with no CXR or CT evidence of cause.

Job security and the promotion of workers’ wellbeing in the midst of the covid-19 pandemic: A study with canadian workers one to two weeks after the initiation of social distancing measures

Background: Due to the current coronavirus (COVID-19) crisis, workplaces have had to make significant alterations in the way they conduct business. This, in addition to the current financial instability, may put workers at risk of experiencing job insecurity and, in turn, lower wellbeing. Job insecurity is a key determinant of wellbeing, but little is known on how it is impacted by public health crises, and more specifically how it relates to workers’ positive and negative wellbeing in the midst of a pandemic. Research is lacking on resilience levers that workplace interventions should target to support wellbeing in times of insecurity. Objective: Framed from a multidisciplinary perspective (public health, positive and organizational psychology), the study explores (1) workers’ job (in)security during the COVID-19 pandemic one to two weeks after social distancing measures were implemented by Canadian governments, (2) how job (in)security relates to wellbeing during the pandemic, and (3) the potential positive effects of workplace-related resilience levers. Method: 1,073 Canadian workers working full-/part-time or who were temporarily laid off completed an online survey, including measures of wellbeing at work or in general, job security and potential resilience levers (workplace disaster preparedness, policy, social capital). Results: Multiple regression findings highlight that marginalized workers (e.g., women, migrants, people facing financial hardships) reported lower job security, and having temporarily lost one’s job was negatively associated with job security. Low job security was related to lower scores across measures of wellbeing. Distress was high in the sample. Workplace disaster preparedness, policy and social capital were associated with higher wellbeing. The effects of these resilience levers tended to be stronger at higher job security levels. Discussion: Recommendations include a systemic, collaborative approach that includes policies fostering job security as well as resilience-promoting interventions in the workplace to protect/increase the wellbeing of workers during COVID-19. © 2020, International Journal of Wellbeing Charitable Trust. All rights reserved.