Prescriptions For Analgesics For The Treatment Of Osteoarthritis During The Covid-19 Pandemic: A Retrospective Analysis

Purpose: Between 2008 and 2014 approximately 32.5 million adults in the United States reported a diagnosis of osteoarthritis (OA). The 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis (OA) of the hand, hip and knee recommend treating pain due to OA with analgesic therapy as part of multi-modal treatment program. A national survey conducted by the Centers for Disease Control found that patients with OA were likely to delay care during the pandemic. Given this new barrier to healthcare, access to analgesic therapy may have become even more limited. This study aimed to evaluate changes in analgesic prescribing practices for OA as a result of the COVID-19 pandemic. Method(s): A retrospective analysis was performed to identify new prescriptions, number of doses per order and refills of 73 topical and oral analgesics from encounters for OA. OA encounters were identified using 206 ICD-10 codes for OA from July 2019 to June 2021 at UC Davis Hospital and affiliated outpatient centers. Pre-pandemic data corresponds to 2019 data and data collected after this occurred during the pandemic. Counts of new prescriptions, number of doses per order and refills by fiscal quarter were analyzed using a two-factor Poisson Regression with an interaction between quarter and year with corresponding contrasts to detect a difference between 2019 and 2020 as well as 2019 and 2021 and quarters between these years. A follow-up Sidak step-down p-value adjustment was used to correct for type I error. All statistical analyses were done with a two-sided alpha of 0.05. The Poisson Regression was performed with SAS software for Windows version 9.4 (SAS Institute Inc., Cary, NC). Result(s): A total of 31,532 encounters with a primary diagnosis of OA occurred from July 2019 to June 2021. There was an increase in the number encounters with a primary diagnosis of OA (Figure 1) but there was no statistical difference in the medications ordered from 2019 to 2020, 2019 to 2021, and the quarters between these years as well. After adjusting for Type I error, there was a significant decrease in medication refills from 2019 to 2020 (p-value 0.0031, adjusted p-value 0.0425) as well as from 2019 to 2021 (p-value <0.0001, adjusted p-value 0.003) (Figure 2), and there was a significant decrease in number of doses of analgesia from 2019 to 2020 and an increase in number of doses from 2019 to 2021 (p-value <0.0001, adjusted p-value 0.003) (Figure 3). Conclusion(s): The COVID-19 pandemic has persistent impacts on the prescribing practices of analgesics for the treatment of OA. Our data suggests that since the COVID-19 pandemic, patients with OA were overall provided with more doses of analgesics and fewer refills. It is likely that barriers imposed by COVID-19 resulted in these changes in the way analgesics are provided for the treatment of OA. [Formula presented] [Formula presented] [Formula presented]Copyright © 2023

Impact of Vaccination on Cost and Course of Hospitalization Associated with Covid-19 Infection

INTRODUCTION: The widespread impact of SARS-CoV-2 (COVID-19) has strained healthcare resources including available hospital beds and respiratory support. Patients who have been vaccinated against COVID-19 are less likely to become severely ill and require hospitalization. Current studies estimating the cost of hospitalization to the healthcare system are theoretical in nature and rely on statistical models. The risk of hospitalization, severe illness, and death remains much lower among vaccinated individuals. The primary objectives of this study were the effects of vaccination status on length of stay and cost of COVID-19 related hospitalization. Secondary objectives included rate of ICU admission and maximum level of respiratory support. METHOD(S): Setting: Single center study conducted at a large academic medical center Participants: 437 consecutively admitted patients with a diagnosis of COVID-19 infection met inclusion criteria in the study period. Of these, 79 were excluded for unknown or partial vaccination status, transfer from outside hospital, or multiple COVID-19 related admissions. Exposure: COVID-19 vaccination status Main Outcome and Measures: Hospital length of stay and cost of COVID-19 related hospitalization. RESULT(S): Overall, 279 (77.9%) unvaccinated patients compared to 79 (22.1%) vaccinated patients were hospitalized for the with a diagnosis of COVID-19. The length of stay was significantly lower in the vaccinated group (6.47 days versus 8.92 days, p = 0.03). The cost of hospitalization was not found to be statistically significant ($10,1885.0 versus $11,7936.3, p = 0.06). After conducting covariate analysis, adjusting for age, vaccinated patients had 21% lower cost compared to unvaccinated patients (p = 0.02). Vaccinated patients experienced a 70.6% lower risk of ICU admission (OR = 0.294, 95% CI 0.1219 to 0.7078, p = 0.006). Patients in the vaccinated group were also 46.2% less likely to be hospitalized beyond 7 days (OR = 0.537, 95% CI 0.306 - 0.941, p = 0.03). Unvaccinated patients required a higher degree of respiratory support (p= 0.002). CONCLUSION(S): Unvaccinated patients were found to have a longer length of stay compared to vaccinated patients when admitted for COVID-19. After adjusting for age, those who are vaccinated had a lower cost of hospitalization.

Healthcare-associated infection impact with bioaerosol treatment and COVID-19 mitigation measures.

BACKGROUND: The real-world impact of breathing zone air purification and coronavirus disease 2019 (COVID-19) mitigation measures on healthcare-associated infections is not well documented. Engineering solutions to treat airborne transmission of disease may yield results in controlled test chambers or single rooms, but have not been reported on hospital-wide applications, and the impact of COVID-19 mitigation measures on healthcare-associated infection rates is unknown. AIM: To determine the impact of hospital-wide bioaerosol treatment and COVID-19 mitigation measures on clinical outcomes. METHODS: The impact of the step-wise addition of air disinfection technology and COVID-19 mitigation measures to standard multi-modal infection control on particle counts, viral and bacterial bioburden, and healthcare-associated infection rates was investigated in a 124-bed hospital (>100,000 patient-days over 30 months). FINDINGS AND CONCLUSION: The addition of air disinfection technology and COVID-19 mitigation measures reduced airborne ultrafine particles, altered hospital bioburden, and reduced healthcare-associated infections from 11.9 to 6.6 (per 1000 patient-days) and from 6.6 to 1.0 (per 1000 patient-days), respectively (P<0.0001, R2=0.86). No single technology, tool or procedure will eliminate healthcare-associated infections, but the addition of a ubiquitous facility-wide engineering solution at limited expense and with no alteration to patient, visitor or staff traffic or workflow patterns reduced infections by 45%. A similar impact was documented with the addition of comprehensive, restrictive, and labour- and material-intensive COVID-19 mitigation measures. To the authors' knowledge, this is the first direct comparison between traditional infection control, an engineering solution and COVID-19 mitigation measures.

Wage Theft in a Recession: Unemployment, Labour Violations, and Enforcement Strategies for Difficult Times

During the Covid-19 pandemic and accompanying recession, millions of low-wage workers have become increasingly vulnerable to exploitation. Limited scholarly attention, however, has been paid to the relationship between rising unemployment, labour standards violations, and government enforcement capacities during periods of economic recession. In this article, we begin to draw out these connections. First, we turn to the case of the Great Recession of 2008-2010 in the United States to examine the relationship between rising unemployment and minimum wage violations, using Current Population Survey (CPS) data to estimate minimum wage violation rates by industry and demographic group. We find that minimum wage violations rose in tandem with rising unemployment, and were shouldered by some groups of low-wage workers more than others, and that they were unexpectedly affected certain industries more than others. We then use an analysis of internal complaint data filed with the San Francisco Office of Labour Standards Enforcement (OLSE) to illustrate that even during non-recession periods, the number of complaints received by industry are in some cases wildly disproportionate to the estimated violation rates by industry. This underscores the shortcomings of the complaint-based enforcement model, which is by far the most common mode of workplace regulation in the United States. Finally, we discuss how this empirical evidence points to the importance of developing alternatives to complaint-based models of enforcement – in particular, strategic enforcement and co-enforcement – especially during periods of high unemployment. © 2021 Kluwer Law International BV, The Netherlands

The Use of the Alveolar Gas Meter for Assessment of Gas Exchange Abnormalities in COVID-19

Introduction: COVID-19 pneumonia varies in clinical expression from asymptomatic to severe ARDS. In early COVID-19, some patients have subtle abnormalities and their clinical trajectory is often unclear. We used an alveolar gas meter (AGM), which is designed to measure gas exchange parameters non-invasively while obviating the need for arterial blood gas measurement. The AGM has previously been compared to arterial blood gas analysis with the suggestion that the oxygen deficit by the AGM provides a useful surrogate to the alveolar to arterial oxygen difference (AaDO2) and it is sensitive to minor changes in pulmonary gas exchange. We sought to test the hypothesis that the AGM could be a useful instrument to identify COVID-19 patients at risk of deterioration before obvious respiratory failure had ensued. Methods: We identified 13 patients in the emergency department or non-ICU medical ward who were COVID-19 positive or strongly suspected to be COVID-19 positive. We enrolled patients with informed consent who did not require high dose oxygen. In patients with low dose oxygen, we removed supplemental oxygen with IRB consent to study room air gas exchange. Data were analyzed using Microsoft Excel and an unpaired, two-tailed student's t-test with equal variance was performed to assess for statistical significance between means. Results: Among the 13 patients enrolled, 12 were COVID positive, 5 were discharged home, and 8 were admitted. The AGM readings revealed an oxygen deficit of 55.4 ± 19.9 (mean ± SD) in the hospitalized patients vs. 31.6 ± 14.0 in those sent home (P=0.041). Among the 13 patients, 6 required supplemental oxygen whereas 7 did not. The AGM readings revealed an oxygen deficit of 65.0 ± 9.12 in those requiring supplemental oxygen vs. 30.1 ± 12.7 in those who remained on room air (P=0.00016). There was no statistically significant difference in the end-tidal CO2 between those who were admitted and discharged home or between those who required supplemental oxygen and those who did not. None of our participants required intubation, mechanical ventilation, high flow nasal cannula oxygen, or non-invasive ventilation. Conclusion: The AGM provides an early marker of gas exchange impairment in COVID-19. The data suggest that patients at risk of respiratory failure may be identified early, prior to obvious clinical deterioration in a rapid, non-invasive fashion. Such strategies may be helpful in the triage of patients or for enrolling high risk patients into interventional clinical trials.

Exploring the Relationships Between Resilience and News Monitoring with COVID Distress in Health Profession Students

OBJECTIVE: Alarming rates of anxiety and burnout in pre-clinical health profession trainees are now challenged by additional COVID-19 stressors. This study explored COVID-related stressors among first-year medical, physician assistant, nurse practitioner, and veterinary medical students. The authors examined associations between resilience, news monitoring, and COVID stress. METHODS: Students completed an online questionnaire that included the Brief Resilience Scale at their matriculation in August 2019. Survey results were linked to demographic information collected by all schools. A follow-up survey in May 2020 included original questions on COVID-19 stressors and news monitoring. Statistical analyses included descriptive statistics and multivariable linear regression models. RESULTS: Across schools, 74% (266/360) provided consent for the 2019 survey, and 76% (201/264) responded to COVID-19 questions in the follow-up 2020 survey. Students were "extremely" or "very" concerned about family members getting infected (n = 71, 76% School of Medicine (SOM);n = 31, 76% School of Nursing (SON);n = 50, 75% School of Veterinary Medicine (SVM)) and curriculum schedule changes (n = 72, 78%, SOM;n = 28, 68% SON;n = 52, 79% SVM). Greater frequency of COVID news monitoring was associated with greater COVID-related stress (p = 0.02). Higher resilience at matriculation was associated with lower COVID-related stress ten months later (p < 0.001). CONCLUSIONS: Amid COVID-19 uncertainty, health science schools should address the immense student stress regarding curriculum disruptions. The results of this study underscore the powerful role of resilience in protecting against stress not only during the known academic rigor of health professions training but also during unprecedented crises.