ABSTRACT
Introduction/Aim: Home spirometry may improve respiratory disease monitoring and management and mitigate the decline in testing exacerbated by COVID-19. Smartphone-connected spirometers could allow patients to conduct spirometry independently without the need to travel to lung function clinics. This study assessed the accuracy of a personal spirometer and the feasibility of unsupervised home spirometry. Method(s): Subjects (19-88 years) with (n = 44) and without (n = 20) respiratory disease, were recruited and supervised to perform spirometry on a standard desktop spirometer (MGC Diagnostics) and a personal ultrasonic spirometer (SpiroHome) in the clinical laboratory. Unsupervised testing was subsequently conducted using the SpiroHome at the subjects' home (2 tests/week for 3 weeks). Subjects returned to the clinic to conduct an exit survey which assessed their willingness to adopt a personal spirometer into their long-term care plan. Comparisons between desktop and personal spirometry, as well as supervised and unsupervised spirometry, were compared by Bland-Altman analysis (%Bias +/- CI) and Pearson's correlation. Result(s): The proportion of tests meeting American Thoracic Society/European Respiratory Society criteria (80%) remained constant across clinic and home spirometry sessions for subjects who completed 3 weeks of home testing (p = 0.73, Fisher's exact test, n = 61). Supervised spirometry on the SpiroHome (n = 56) reliably measured FEV 1 (-3.12+/-27.01%;r=0.98, p < 0.0001) and FVC (-0.38+/-22.91%;r=0.99, p < 0.0001) producing a small underestimation compared to desktop spirometry. Unsupervised home spirometry (when performed <24 hrs from the clinic appointment) on the SpiroHome (n = 51) produced a small underestimation of FEV 1 (-2.41+/-35.57%;r=0.96, p < 0.0001) and a slight overestimation of FVC (0.08+/-24.70%;r=0.98, p < 0.0001) compared with supervised manoeuvres in the clinical laboratory. Conclusion(s): Findings indicate that lung function assessed by SpiroHome compares well with in-clinic standard desktop spirometry across a range of diseases and severities in both the clinic and home settings. A larger cohort of subjects are being recruited to confirm the accuracy and the overall utility of personal spirometry.
ABSTRACT
Introduction: Since the onset of the SARS-COV2 Virus, there's been rapid developments in our understanding of the disease and its management, such as antibiotics, steroids, advanced oxygen therapy (AOT), and vaccines. We aimed to determine the impact of these treatments over three consecutive waves. Method(s): Three patient cohorts were retrospectively analysed from Russells Hall Hospital, Dudley UK;wave 1 (23/3/20-1/5/20), wave 2 (1/11/20-31/1/21) and wave 3 (1/8/21-31/8/21). Data obtained from electronic records included length of stay (LoS), mortality and treatment given. For wave 3 data on vaccination status was also obtained. A multivariable analysis was conducted where appropriate and a p-value<0.05 was considered statistically significant. Result(s): 25 patients were analysed from wave 1 and 2 each, and 61 from wave 3. Table 1 outlines the interventions used per wave. When comparing wave 1,2 and 3;the mean age was 67, 66 and 59 years, LoS was 8, 12 and 6 days and mortality rate was 42.5%, 25.8% and 13.1% respectively. In wave 3, 41% of admitted patients were vaccinated. Advanced age was associated with an increase in mortality (p=0.016) and the use of AOT was associated with longer hospital admission (p=0.004). In wave 3, the mortality amongst vaccinated patients was less than those unvaccinated (12% vs. 20%, p=0.26). Table 1 shows the interventions used in each wave. Conclusion(s): Our small study shows improvement in mortality, likely a result of increased knowledge in disease management and the use of vaccinations. Larger studies are now needed to corroborate our findings.
ABSTRACT
Background: Older adults are afflicted more severely by COVID-19. SARS-CoV-2 can be complicated by myocarditis (MC), and the incidence of MC has been shown to correlate linearly with severity. However, data on comorbidities associated with MC in this population is scarce. Methods: Data were obtained from the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). The study used ICD codes to include patients hospitalized with a primary diagnosis of COVID-19, aged 65–75, and Elixhauser Comorbidity index(ECI)>4. Within this cohort, we identified patients diagnosed with MC 60 days after admission and compared their baseline comorbidities upon admission to those without MC. Pearson's chi-squared test was used to compare groups. The strength of association was reported by Risk Ratios (RR). A p-value < 0.05 was deemed significant. Results: 412,582 patients admitted with COVID-19 as the primary diagnosis were identified. 0.12% of this cohort developed MC over the following 60 days. The MC group was more likely to be male(57%, p=0.0001), with similar mean age(70.4, p=0.86) and mean ECI(9.4, p=0.07) to the no-MC group. Patients who developed MC have significantly higher rates of prior heart failure(RR= 1.30, CI95%=1.07–1.57, p=0.008). There was no difference between groups in terms of history of arrhythmias(p=0.36), cerebrovascular disease(p=0.09), chronic kidney disease(p=0.13), CAD(P=0.19), diabetes(p=0.48), ischemic heart disease(p=0.06), tobacco use(p=0.39), alcohol use(p=0.17), HIV(p=0.79), and severe liver disease(p=0.14). Conclusion: A history of heart failure increased the likelihood of developing MC in older adults.
ABSTRACT
Background: Age, atrial fibrillation (AF), and COVID-19 infection predispose patients to hypercoagulability and poor outcomes. It is unclear if older adults with AF and COVID-19 infection would benefit from oral anticoagulants (OACs). Methods: A retrospective study was conducted using the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). Using ICD-10 codes, adults aged 65–75 and Elixhauser Comorbidity index(ECI) >4 with a history of AF admitted for COVID-19 were identified. The use of OACs for 6 months before the index event was used to split the cohort into two propensity score-matched groups considering age, gender, and ECI. Records from both groups were reviewed for multiple outcomes during the same admission. Pearson's chi-squared test was used to compare groups. The strength of association was reported using Risk Ratios (RR). A p-value < 0.05 was deemed significant. Results: We compared 16,967 individuals in both anticoagulated and non-anticoagulated groups. Anticoagulated patients had a lower risk of mortality (RR=0.11, p=0.026), and a higher risk of 30-day all-cause readmission(RR=1.12, p < 0.0001). However, there were no differences in ICU admission, gastrointestinal bleeding, intracranial hemorrhage, thromboembolic events, or length of hospitalization. Conclusion: Compared to non-anticoagulated patients, older adults with a history AF on chronic oral anticoagulants had a lower risk of all-cause mortality, and higher risk of 30-day all-cause readmission. This information would help clinicians decide whether to prescribe OACs to this population of patients.
ABSTRACT
Background: Data suggest an increased incidence of myocarditis (MC) associated with the COVID-19 virus. However, the risk factors for COVID-19-related MC remains poorly understood and debated. Therefore, we sought to evaluate the correlation of a history of coronary artery disease (CAD) with MC in older adults admitted for COVID-19. Methods: Data were obtained from the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). The study included patients aged 65–75, hospitalized with a primary diagnosis of COVID-19, and Elixhauser Comorbidity index(ECI) >4. History of CAD upon admission was used to split the cohort into two propensity score-matched groups considering age, gender, other cardiovascular diseases, and ECI. Records from both groups were reviewed to identify patients diagnosed with MC during and up to one month after admission. Pearson's chi-squared test was used to compare groups. The strength of association was reported using Risk Ratios (RR). A p-value < 0.05 was deemed significant. Results: 182,556 patients with and 218,729 without a history of CAD admitted for COVID-19 were identified. Patients with a history of CAD were more likely to be male(54.7% vs. 42% p < 0.0001), older(mean age 70.62 vs. 70.30, p < 0.001), and had more comorbidities(ECI=11 vs. 8, p < 0.0001). After propensity score matching, 0.13% of patients with CAD and 0.12% without CAD developed MC within one month of admission(RR= 1.05, CI95%=0.87–1.26, p=0.61). Conclusion: One month following admission for COVID-19, the risk of MC was not significantly higher in older persons with a history of CAD.
ABSTRACT
Background: According to the CDC, approximately 30% of hospitalizations for COVID-19 infection between the onset of the pandemic and November 2020 were attributed to obesity. However, there is limited data on how obesity affects the overall outcome of COVID-19 in hospitalized older adults. Methods: A retrospective study was conducted using the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). Using ICD-10 codes, a cohort of patients aged 65–75 and Elixhauser Comorbidity Index (ECI) >4 with a history of obesity admitted for COVID-19 was identified. This cohort was matched with a group of patients with no history of obesity, considering age, gender, and ECI. Records from both groups were reviewed for multiple outcomes over 30 days following admission. Pearson's chi-squared was used to compare groups. The strength of association was reported using Risk Ratios (RR). A p-value < 0.05 was deemed significant. Results: There were 151,429 members in each group. Obese individuals had a higher risk of 30-day all-cause readmission (RR=1.10, CI95% 1.07–1.11, p < 0.0001), ICU admission (RR=1.11, CI95% 1.08–1.15, p < 0.0001), acute thromboembolic events (RR=1.14, CI95% 1.07–1.2, p < 0.001), and deep venous thrombosis (RR=1.21, CI95% 1.12–1.32, p < 0.00001). There was no difference in length of hospitalization. Conclusion: Obesity is a modifiable risk factor that negatively affects COVID-19 outcomes in the older population. Given the prevalence of obesity in our population, primary and secondary obesity prevention is more important than ever.
ABSTRACT
Background and Objective(s): Congregate living settings supporting individuals with neurodevelopmental disabilities (NDD) have experienced unprecedented challenges during the COVID-19 pandemic. Infection control policies in these living settings can impact on health and well-being and occupational engagement of individuals with NDD. This study aimed to explore the development and utilization of infection control policies in congregate living settings supporting individuals living with NDD during the COVID-19 pandemic. Study Design: Qualitative research. Study Participants & Setting: This qualitative study interviewed senior administrative personnel from agencies assisting adults living with NDD residing in Developmental Services community-based congregate living settings in Ontario, Canada. Materials/Methods: A qualitative approach using Interpretive Description guided this study. Data were gathered from participants using a one-hour interview conducted online. Thematic analysis was used to analyze the data. Result(s): Semi-structured interviews were conducted with 30 individuals from 22 agencies. Participating agencies were diverse in size and geographic location. Three categories emerged through thematic analysis -Development of Infection Control Policies, Implementation of Infection Control Policies, and Impact of Infection Control Policies. Each category yielded subsequent themes. The two themes from the Development of Infection Control Policies category included New Responsibilities and Interpreting the Grey Areas, and Feeling Disconnected and Forgotten. Four themes within Implementation of Infection Control Policies included, It's Their Home (i.e., balancing public health guidance and organizational values), Finding Equipment and Resources, Information Overload (i.e., challenges with policy implementation), and Emerging Vaccination (i.e., navigating vaccination for clients and staff). The category of Impact of Infection Control Policies had one theme -Fatigue and Burnout, capturing the impact of policies on stakeholders in congregate living settings. Conclusions/Significance: Agencies experienced difficulties developing and implementing infection control policies, adversely impacting their clients, families of clients and staff. Public health guidance should be tailored to congregate settings supporting those living with NDD instead of a universal approach for all congregate settings, because many individuals living with childhood disabilities will require support from living settings of the congregate nature. Providing public health with an understanding of developmental disabilities and the supports required by individuals living in these settings can aid in the implementation of supports that better align with the human rights of individuals living with disabilities into adulthood. To address this knowledge gap, rehabilitation professionals can use a life course focus to increase knowledge and provide insights within public health institutions to enhance community capacity to support those living with NDD.
ABSTRACT
Remote learning is not a new concept. The first major correspondence program was established in the late 1800s at the University of Chicago in the United States, in which the teacher and learner were at different locations. Remote learning, sometimes referred to as “Distance Learning”, “e-Learning”, or “Virtual Learning” has evolved rapidly with the advent of the internet and accelerated with the pandemic. Historically, learning has occurred through didactic methods, delivered through textbooks and in-person lectures. With travel and group meeting restrictions due to the COVID-19 pandemic, educators have been forced to search for novel solutions to continue robust academic training programs, continuing professional development, and international exchange programs. For all the benefits of remote learning, there remain improvement opportunities. Learners and instructors alike have many logistics and resource demands, to enable meaningful engagement in remote learning. Making online content more accessible, innovative, and interactive through user-friendly tools, can future-proof education systems. An invaluable educational tool for all engaged in medical education and training, the use of remote learning will necessitate equity in access to technology and information. This article will review the benefits and limitations of remote learning, highlighting its evolution, obstacles with logistics and future directions. © World Federation of Societies of Anaesthesiologists 2022.
ABSTRACT
Introduction: Onset of the Covid-19 pandemic necessitated the abrupt interruption of Thomas Jefferson University's outpatient Pulmonary Rehabilitation (PR) program in March 2020. This study examines clinical characteristics and attitudes distinguishing those PR patients who decided to resume PR (RES) versus those who elected not to resume (DIS) when the program re-opened 16 weeks later. We hypothesized that those patients who chose not to resume would have more severe disease and/or higher Covid-19 related anxiety.Methods: The following demographic and clinical data were collected from the medical record on all subjects from the time of their initial PR entry evaluation: age, sex, pulmonary diagnosis, cardiac and psychiatric co-morbidities, pulmonary function studies (FVC, FEV1, FEV1/FVC), six-minute walk test distance, COPD Assessment Test score, use of home oxygen (yes or no), University of California San Diego Shortness of Breath Questionnaire, Public Health Questioanaire-9. A 6 question survey was administered to the RES subjects at the time of their first return visit. A 6 question survey was administered to DIS patients by mail.Results: Thirteen patients had interrupted PR;8 in the RES group, 5 in the DIS group. Mean age of the entire group was 66.6 + 11.6 years. 6/13 were male. Ten had COPD, 2 interstitial lung disease, 1 asthma. There was no statistically significant difference in any demographic or clinical parameter between the RES and DIS groups. All 5 patients in the DIS group indicated that anxiety about Covid-19 was the main reason they did not wish to resume PR;this appeared unrelated to any preexisting psychiatric/anxiety diagnosis. In the RES group, 4/8 indicated no anxiety about returning to the program, 1 mildly anxious, 1 moderately anxious, and 2 extremely anxious. All 5 patients in the DIS group indicated that wearing a face mask (which would be required for resumption of PR) during the pandemic made their breathing worse, whereas 4/7 in the RES group indicated a mask had no effect on their breathing.Conclusions: Thirty-eight percent of patients chose not to resume PR during the Covid-19 pandemic. In this small sample, no demographic or clinical parameter distinguished the RES and DIS groups. Survey results indicate anxiety related to possible Covid-19 exposure and/or the new requirement for mask wearing during exercise may have contributed to patient's decision to discontinue PR.
ABSTRACT
Background Low- and middle-income countries (LMICs) shoulder a disproportionately high burden of critical illness with limited healthcare infrastructure. However, despite increased attention on critical care capacity due to Covid-19, LMIC intensive care unit (ICU) capacity remains largely undescribed-especially in East Africa. We sought to characterize barriers to critical care capacity and delivery in Rwanda, hypothesizing that gaps in specialized personnel, training, and supervision ('human resources') would be perceived as more important limitations to high-quality ICU care compared to gaps in beds, medications, and diagnostics ('facilities, materials, equipment'). Methods We performed a cross-sectional survey of all hospitals with dedicated ICUs in Rwanda using a mixed-methods approach, adapting conceptual frameworks for health services evaluation in global disaster response and emergency medicine. Using World Health Organization (WHO)-developed benchmarks for facility-level surgery and trauma evaluations, we created a set of tools for ICU assessment. Questionnaires for physicians, nurses, trainee physicians, and hospital leadership were developed and pilot tested using REDCap software. Inventories of ICU and hospital capacity using an adapted WHO tool were undertaken at each site. Descriptive statistics including percentages, means, and standard deviations were performed. IRB approval was obtained though Columbia University Medical Center and the University of Rwanda. Results Four hospitals in Rwanda were identified with dedicated ICUs. Total ICU beds were 27 (5- 8), total annual ICU admissions were 1128. The majority (96%) of invited ICU medical staff completed the survey, including nurses (N=60), trainee physicians (N=29), and attending physicians (N=10). Complete inventories were obtained from all 4 hospitals. Respondents identified insufficient staffing (63%), equipment/bed shortages (40%), lack of training opportunities (36%), and inadequate supervision (23%) as key obstacles to providing high quality critical care. Both human resources (39%) and material resources (28%) were identified as key gaps. Inability to treat common critical illnesses was frequently reported. Inventories at the hospital level clearly identified resource constraints. Conclusions In this study, gaps in both material and human resources were perceived as limiting ICU care, in line with provider perceptions of inadequate care quality. Obstacles to change include material gaps, lack of training, and institutional barriers. Notably, health system leadership in Rwanda on multiple levels is aware of these gaps and challenges with specific plans to improve training, support, and availability of equipment and supplies. This study emphasizes the complex nature of LMIC critical care limitations, providing insight into addressing them institutionally.
ABSTRACT
The COVID-19 pandemic has had a significant impact on the mental health of the people of Canada. Most have found it challenging to cope with social distancing, isolation, anxiety about infection, financial security and the future, and balancing demands of work and home life. For some, especially those who have had to face pre-existing challenges such as structural racism, poverty, and discrimination and those with prior mental health problems, the pandemic has been a major impact. The Policy Briefing Report focuses on the current situation, how the COVID-19 pandemic has exacerbated significant long-standing weaknesses in the mental health system and makes specific recommendations to meet these challenges to improve the well-being of the people of Canada. The COVID-19 pandemic has had a detrimental effect on mental health of people in Canada but the impact has been variable, impacting those facing pre-existing structural inequities hardest. Those living in poverty, and in some socially stratified groups facing greater economic and social disadvantage, such as some racialized and some Indigenous groups and those with preexisting mental health problems, have suffered the most. Some occupational groups have been more exposed to the virus and to psychological stress with the pandemic. The mental health care system was already overextended and under resourced. The pandemic has exacerbated the problems. The care system responded by a massive move to virtual care. The future challenge is for Canada to strengthen our knowledge base in mental health, to learn from the pandemic, and to provide all in Canada the support they need to fully participate in and contribute to Canada’s recovery from the pandemic. © 2020 Asmundson et al.