ABSTRACT
Background: COVID-19 is associated with increased morbidity and mortality in patients with ESKD on chronic dialysis. Vaccination against other viruses is known to be less effective in these patients compared to the general population. Data on the titers of antibody following SARS-CoV-2 vaccination in these patients is inconsistent. The efficacy of SARS-CoV-2 vaccination to prevent severe disease in ESKD patients with COVID-19 remain unknown. We compared the incidence of hospitalization and COVID-19 related death after COVID-19 disease in dialysis patients based on SARSCoV- 2 vaccine status. Method(s): Single-center, retrospective cohort study. We included all adults on dialysis (in-center and home) within the Mayo Clinic Health System in the Midwest (USA) with laboratory proven SARS-CoV-2 infection between 1/1/2020 and 3/30/2022 (n=225). Patients' demographics, clinical characteristics, laboratory data including SARS-CoV2 infection test results, and SARS-CoV-2 vaccination information were collected. The primary outcome was the incidence of hospitalization and COVID-19 related death after COVID-19 disease. Result(s): 244 infections occurred in 225 patients, 119 (49%) were vaccinated and 8.4% (n=19) died. Among those who died, 73.7% (n=14) were not vaccinated compared to 49.3% of those who were alive (p=0.041). A total of 78 patients had 83 hospitalizations;71.1% were not vaccinated compared to 41% not hospitalized (p<0.001) (Table). Conclusion(s): The incidence of hospitalization and COVID-19 related death after COVID-19 disease was significantly higher in non-vaccinated compared to vaccinated dialysis patients. This data suggests that SARS-CoV-2 vaccination improves outcomes in dialysis patients who develop COVID-19 disease. Table - Death and hospitalization in vaccinated and non-vaccinated dialysis patients a Total 244 infections. 18 patients had reinfection (1 with 2 reinfections and 17 with one reinfection). Among the 18 patients with reinfection, 2 died, 8 were not hospitalized, 4 were hospitalized after 1st COVID, and 5 were hospitalized after 2nd COVID. b Total 225 infections. c Among 78 patients.
ABSTRACT
This chapter introduces the book to the reader, explaining that it is part of the European Science Education Research Association (ESERA) Science Education Research Series. The volume represents one output from ESERA’s ‘Science Education in Out-of-School contexts’ special interest group. The manner in which the book progressed from an original idea to the finished work is presented. A brief history of the rise of public interest in the environment ends by noting that a number of complex problems face society, including poverty, climate change, biodiversity loss, water security and pandemics. The idea of ‘wicked problems’ is introduced in the context of the COVID-19 pandemic and the growth in public interest in science, medicine and health research. It is noted how wicked problems can be addressed in school science lessons but that museums, science centres, zoos, aquaria, botanic gardens and science cafés, all depend on being topical and relevant and can provide huge opportunities for public engagement. It is also noted that the authors of the book focus on how out-of-school settings can prompt important disciplinary and cross-disciplinary engagement among learners. The editors hope that the book will open up a new dimension in the field, bringing together the concerns of practitioners and the outcomes of research, synthesising educational priorities with sustainability goals. © 2021, Springer Nature Switzerland AG.
ABSTRACT
Background: The University of Colorado (UCH) Consultation-Liaison Psychiatry (CLP) service and Psychiatric Consultation for the Medically Complex clinic (PCMC) are developing a brain health outreach program for those hospitalized with COVID. Patients with COVID have increased risk of cognitive and psychiatric sequelae due to intrinsic viral properties, hyperinflammatory state, and increased disposition to ICU level care (Inoue, 2019;Cothran, 2020). Development of a post COVID brain health program has become paramount and UCH is not alone in creation of new clinic protocols to meet the needs of this population (Rovere Querini, 2020;O'Brien, 2020). Hospitals around the globe are developing new screeners to identify patients at higher risk of neuropsychiatric sequelae and refer them to appropriate resources. Methods: The program makes use of two arms: The first assesses those discharged from the hospital using a screener developed by the UCH post-COVID hospitalization program. The second screens patients currently admitted to the hospital with COVID using psychiatric and neurocognitive screeners. Both allow patients to be referred to PCMC for evaluation and treatment. Evaluation includes psychiatric interview and additional screeners including: Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment (MoCA) and PTSD Checklist for DSM-5 (PCL-5). Additional neuropsychiatric evaluation via Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and cognitive rehabilitation referral, are available. Clinic treatment includes pharmaceuticals, individual therapy referral, or referral to the PCMC COVID Survivorship Support Group. Results: To date, 100 patients have been screened in arm 1 (outpatient outreach) and arm 2 (inpatient outreach). In arm 2, about 54% of the population identifies as female, 46% as male, 61% identified as white, and 86% spoke English. Of those in arm 2 that agreed to full participation, 26% agreed to future check-ins and 6% were seen in the clinic. There was a difference in those who did and didn't fully participate based on ethnicity, language, and insurance status;though not of statistical significance. HADs scores demonstrated different trends based on these same demographic factors, though also not statistically significant. Discussion: By using this two-armed approach, the service has been able to more effectively outreach patients and refer them to appropriate care. Though data is not complete, referral needs seem to differ based on demographic data. Conclusions: As data continues to be collected, the clinic model is expanding to outreach high risk patients for neuropsychiatric sequelae. This will strengthen our existing system, with risk of reoccurrence of similar events, and inform a new standard of care for COVID survivors. 1. Cothran, T. P., Tam, J. W.;et.al. (2020). A brewing storm: The neuropsychological sequelae of hyperinflammation due to COVID-19. Brain Behav Immun, 88, 957-958. 2. Inoue, S., Nishida, O, et.al. (2019). Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg, 6(3), 233-246. 3. O'Brien, H., Hurley, K., et.al. (2020). An integrated multidisciplinary model of COVID-19 recovery care. Ir J Med Sci, 1-8. 4. Rovere Querini, P., Ciceri, F., et.al. (2020). Post-COVID-19 follow-up clinic: depicting chronicity of a new disease. Acta Biomed, 91(9-s), 22-28.
ABSTRACT
Purpose/Aims Healthcare workers internationally continue to look for innovative ways to improve patient outcomes and optimize resource utilization during the coronavirus disease 2019 (COVID-19) pandemic. Proning awake, nonintubated patients has been suggested as a potential intervention in critical care. The aim of this study is to provide a multidisciplinary approach to safely perform awake self-prone positioning in the acute care setting. Design This is a prospective, descriptive study. Method Patients with COVID-19 were screened and enrolled within 48 hours of a positive test. After approval from the primary team, patients were provided education materials by a multidisciplinary team on the self-prone intervention. Visual cues were placed in the room. Patients were requested to maintain a diary of hours of prone positioning. Patients' baseline characteristics, admission vitals, daily oxygen requirements, and level of care were collected. Results Of 203 patients screened, 31 were enrolled. No pressure-related injury or catheter (intravenous or urinary) displacement was identified. Eighty-one percent of patients spent less than 8 hours a day in prone positioning. Among patients enrolled, none required invasive ventilation or died. Conclusions Awake self-proning can be performed safely in patients given a diagnosis of COVID-19 in the acute care setting with a multidisciplinary team.
ABSTRACT
Background: COVID-19 lockdown began in Scotland on 23rd March 2020. This was followed by a significant reduction in unselected medical admissions to Scottish hospitals with increased illness severity and in-patient mortality This study aimed to investigate the specific effect of lockdown on admissions with liver disease in Scotland Methods: Patients admitted to 7 major Scottish hospitals with chronic liver disease in April 2020 were identified and compared with admissions in April 2017, 2018 and 2019 (n=459) Data was collected on patient demographics and disease characteristics Socioeconomic deprivation was derived from the Scottish Index of Multiple Deprivation (SIMD) in quintiles for analysis (1=most deprived;5=least deprived) Statistical analysis was done using SPSS version 22 Results: The median age of the whole cohort was 58 years (IQR: 49-66) They were predominantly male (n=267;58 2%) 204 (44 4%) were from the most deprived quintile of the population The median MELD was 16 (IQR: 12-21) 354 (77 1%) had alcoholic liver disease (ALD) as either the primary or a contributory factor to their disease Median length of stay was 7 days (IQR: 4-14) 46 patients died in hospital giving an inpatient mortality of 9 8% Table 1 outlines the comparisons between patients admitted in April 2020 (n=111) and the previous 3 years (n=348) No difference was seen in age (59 years vs 58;p=0 88) or gender (59 men (53 2%) vs 208 men (59 8%);p=0 22) Severity of liver disease on admission was similar (MELD 15 vs 16;p=0 68) Although serum sodium was reduced in the pre-COVID era group (135 (130-138), n=348) compared with the COVID-lockdown cohort (137 (132-140), n=111) (p=0.01) no significant differences were seen in other blood parameters Length of stay (7 days vs 8 days;p=0 093), inpatient mortality (8 3% vs 10 4%;p=0 51) and socioeconomic deprivation by SIMD (p=0 41) were not significantly different between the two cohorts. There was not a significant difference between the number of patients admitted in each year (poisson regression analysis p=0 37) Conclusion: The lockdown introduced to control the COVID pandemic in Scotland did not have a significant impact on the number, severity of liver disease at presentation or outcomes in patients admitted with chronic liver disease, in contrast with unselected medical admissions in the immediate post lockdown period(Table Presented).