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Background/Aims Rheumatology is a complex specialty covering many conditions of varying severity, from muscle pain through inflammatory arthritis such as Rheumatoid arthritis (RA) and connective tissue diseases. Most of the conditions can be managed in an outpatient/day case setting. However, acutely ill patients require safe and prompt inpatient management including specific intravenous infusions. This need to be done urgently and cannot wait to be accommodated through the Infusion unit at our hospital. Historically Medicine Acute Admission Unit has been the route to bring in these patients. However, operational bed pressures faced challenges leading to instances of delayed treatment with complications including fatality. This led to creating a direct inpatient admission pathway to the specialist ward. Methods Ward Matron designed the following robust pathway for direct patient admission to our specialist Rheumatology ward, Jevington ward. This was implemented in February 2022 after discussion and agreement with Clinical Lead consultant, pharmacist, clinical site managers and other colleagues. Rheumatology team and nurses covered the ward during working hours and by the on-call team out of hours. The overall responsibility remained with the rheumatology team. The referrals accepted only after completing appropriate paperwork. Patients carried out Lateral Flow Test (LFT) at home prior to admission. We ensured negative results and followed the Trust COVID 19 screening protocols. Subsequent screenings were done according to the updated guidelines. The planned assessment and treatments were carried out by the ward team complying with BSR/ EULAR Guidelines, infusion protocols such as standard and continuous Iloprost Infusion Protocols of the Trust. Results We assessed the delay in patient's admission, length of stay, patient outcome and experience after implementing the pathway. The significant change has been in the time to admit;from two weeks in 2018 & 19 to two days this year. This is reflected in the patient feedback. All our acutely ill patients were assessed, treated and discharged promptly on this specialist ward. Conclusion This pathway allowed safe and prompt treatment, prognosis and excellent experience for acutely ill patients with rheumatological disorders. This additionally enabled reduced length of stay supporting financial sustainability of the Trust. (Table Presented).
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Aim: To study the impact of COVID-19 admissions during 1st and 2nd surges on bacteriology of ICU respiratory isolates. Method(s): Retrospective time trend analysis of bacterial respiratory isolates from a single centre, tertiary cardiothoracic ICU (CT-ICU) from patients admitted from Jan 2018- June 2021. We compared pre-COVID-19 (January 2018- March 2020) and COVID-19 periods (April 2020- June 2021) and surge periods (surge 1: March 2020- June 2020, surge 2: January- March 2021) to similar time frames in previous years. Chi-square test used to compare proportions. Result(s): 4974 respiratory isolates (Sputum-4230, BAL-563, ET secretions-181) included. During surge 2, culture positivity and gram-negative rates tripled from baseline (20% to 75%;p<0.05). Comparing the pre- pandemic to pandemic period, rates of Klebsiella sp, Acinetobacter sp and Stenotrophomonas sp increased from 12% to 21.3%, 2.4% to 6.2% and 10.5% to 14.3% respectively, while Pseudomonas sp dropped from 30.7% to 23.1% (all p<0.05). MDR Pseudomonas increased significantly from 38.9% to 47.9% (p<0.05), with a non-significant increase in MRSA (5.2% to 9.3%;p=0.34) and MDR enterobacterales (22.6% to 23%;p=0.48). Conclusion(s): This is the first report from a UK CTICU showing a marked epidemiological shift in the bacteriology of respiratory isolates in terms of organism profile, increase in culture positivity and MDR Pseudomonas rates during the pandemic. Analyzing trends on longevity of the findings will help guide changes to infection control and antibiotic policies. This emphasizes the importance of unit specific ecology in choosing appropriate timely antimicrobial therapy and therefore improving patient outcome.
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AIM: To evaluate a digital intervention to improve physical activity in people in the UK with a musculoskeletal condition delivered during movement restrictions brought about because of the COVID-19 pandemic. METHOD: Service evaluation data collected from 26,041 participants over 5 months was assessed against national datasets to understand the reach and representativeness of the digital physical activity intervention. Measures to restrict the movement and interaction of people were in place during these 5 months. Cross-sectional data from 2752 participants across different stages of the 12-week programme assessed levels of physical activity and the components of behaviour as defined by the COM-B model (Capability, Opportunity, Motivation = Behaviour). Regression analysis investigated the relationship between programme stage and physical activity and the components of behaviour. RESULTS: In comparison to the UK population of people with a musculoskeletal condition, the intervention participants were over-represented by females, White, and inactive people. A cross-sectional analysis suggested that the number of participants regularly active increased by programme stage. Scores for the behavioural components of automatic and reflective motivation, physical and psychological capability, and physical opportunity were also improved by programme stage. CONCLUSION: The service evaluation suggests that the digital intervention, designed to improve physical activity in people with a musculoskeletal condition, could be beneficial during measures to restrict movement to slow the spread of infectious disease in those who are already motivated to become or stay active.
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This study surveys members of an Illinois state-wide consortium to chart changes to the instructional practices of academic librarians in response to the conditions brought on by the COVID-19 pandemic. The survey findings and analysis provide insights into changes made to multiple aspects of participants' teaching, such as modality, technology use, instructional design, and adjustments to students' socioemotional needs at a time of rapid change, disruption, and stress. In addition to exploring instructional adaptations of librarians, the study identifies gaps in institutional support that might be addressed at the consortial level. While librarians initially altered their teaching and instructional services in "emergency mode,” their reflections reveal that many changes could be beneficial and long-lasting, given adequate and sustained support. © 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.
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Introduction: The purpose of this descriptive study is to examine a learning health system (LHS) continuous improvement and learning approach as a case for increased quality, standardized processes, redesigned workflows, and better resource utilization. Hospital acquired pressure injuries (HAPI) commonly occur in the hospitalized patient and are costly and preventable. This study examines the effect of a LHS approach to reducing HAPI within a large academic medical center. Methods: Our learning health center implemented a 6-year series of iterative improvements that included both process and technology changes, with robust data and analytical reforms. In this descriptive, observational study, we retrospectively examined longitudinal data from April 1, 2018 to March 31, 2022, examining the variables of total number of all-stage HAPI counts and average length of stay (ALOS). We also analyzed patient characteristics observed/expected mortality ratios, as well as total patient days, and the case-mix index to determine whether these factors varied over the study period. We used the Agency for Healthcare Research and Quality cost estimates to identify the estimated financial benefit of HAPI reductions on an annualized basis. Results: HAPI per 1000 patient days for FY 20 (October 1-September 30) and FY 21, decreased from 2.30 to 1.30 and annualized event AHRQ cost estimates for HAPI decreased by $4 786 980 from FY 20 to FY 21. A strong, statistically significant, negative and seemingly counterintuitive correlation was found (r = -.524, P = .003) between HAPI and ALOS. Conclusions: The LHS efforts directed toward HAPI reduction led to sustained improvements during the study period. These results demonstrate the benefits of a holistic approach to quality improvement offered by the LHS model. The LHS model goes beyond a problem-based approach to process improvement. Rather than targeting a specific problem to solve, the LHS system creates structures that yield process improvement benefits over a continued time period.
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This study examines worker voice in the development and implementation of safety plans or protocols for COVID-19 prevention among hospital workers, long-term care workers, and education workers in the Canadian province of Ontario. Although Ontario occupational health and safety law and official public health policy appear to recognize the need for active consultation with workers and labour unions, there were limited - and in some cases no - efforts by employers to meaningfully involve workers, worker representatives (reps), or union officials in assessing COVID-19 risks and planning protection and prevention measures. The political and legal efforts of workers and unions to assert their right to participate and the outcomes of those efforts are also documented through archival evidence and interviews with worker reps and union officials. The article concludes with an assessment of weaknesses in the government promotion and protection of worker health and safety rights and calls for greater labour attention to the critical importance of worker health and safety representation.
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SESSION TITLE: Management of COVID-19-Induced Complications SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Multiple pleural complications have been well described during COVID-19 infection including pneumothorax, pleural effusion and empyema. While many infections have been described as complications, here we present a case of empyema secondary to Enterococcus faecium in a patient with COVID-19 after Extra-corporeal membrane oxygenation (ECMO). CASE PRESENTATION: A 33-year-old male presented with acute respiratory distress syndrome secondary to COVID-19. He was intubated 10 days after symptom onset and subsequently placed on veno-venous ECMO, with reconfiguration to add an arterial return limb and eventually pulmonary artery return limb. During his care he was treated with remdesivir, dexamethasone and tocilizumab. His course was complicated by right heart failure requiring mechanical support, acute renal failure requiring hemodialysis, superior vena cava thrombus, multi-drug resistant Pseudomonas, Enterococcus faecalis, Klebsiella and methicillin sensitive Staphylococcus aureus infections. Eventually he was removed from ECMO on day 130. The patient remained in the ICU on positive pressure ventilation via tracheostomy. He eventually developed worsening respiratory status as well as signs concerning for an emerging infection. Broad spectrum antibiotics were initiated, and a CT chest/abdomen/pelvis was obtained that showed right pleural effusion with concern for empyema. Pleural sampling was consistent with empyema with glucose <5 mg/dL, pH <7.2, lactate dehydrogenase >200 U/L and an elevated neutrophil count. A percutaneously placed 14 french chest tube was placed and pleural irrigation with normal saline was trialed given patient need for continuous systemic anticoagulation. However, this did not sufficiently resolve the empyema and patient was started on pleural TPA/Dornase with close monitoring while on anticoagulation with clinicoradiographic improvement after a total of 6 days of therapy. Cultures eventually speciated as Enterococcus faecium and he was continued on a 6 week course of ampicillin for his empyema. DISCUSSION: Classically, Enterococcus empyema has been primarily linked with intra-abdominal infections which was not found in our patient and has not been correlated with COVID-19 infection or ECMO. Additionally, there is a significant paucity of data with regards to safety of TPA/Dornase pleural irrigation use while patients are on full dose systemic anticoagulation as was our patient. In this case he required two 3-day courses of TPA/Dornase which was tolerated well without significant complication. CONCLUSIONS: Here we describe a rare causative organism of empyema that has not been previously described in the literature as associated with COVID-19 or ECMO. Additionally, we demonstrate the safety of intra-pleural TPA/Dornase in this patient on full dose anticoagulation which is a frequent consideration when determining the method of treating empyema in complex medical patients. Reference #1: Ayad S, Gergis K, Elkattawy S, et al. Loculated empyema and SARS-COV-2 infection: A report of two cases and review of the literature. European journal of case reports in internal medicine. July 2021;8(7):002706. doi:10.12890/2021_002706. Reference #2: Bergman R, Tjan DH, Schouten MA, Haas LE, van Zanten AR. Pleural Enterococcus faecalis empyema: an unusual case. Infection. Feb 2009;37(1):56-9. doi:10.1007/s15010-007-6359-6 Reference #3: Rahman NM, Al. E, Author Affiliations From the United Kingdom Clinical Research Collaboration Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection: Nejm. New England Journal of Medicine. Nov 2011;365:518-526. doi:10.1056NEJMoa1012740. DISCLOSURES: No relevant relationships by Joshua Boster No relevant relationships by Mary Gadarowski No relevant relationships by Stephen Goertzen No relevant relationships by Amanda Hall No relevant relat onships by Erik Manninen
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Purpose : The effect of coronavirus disease 2019 (COVID-19) on ophthalmic surgical case numbers in Australia and globally remains poorly characterised. Increased incidence of COVID-19 in Australia between March and April 2020 led to a national lockdown and elective surgery restrictions. The aim of this population-based study was to quantify the early impact of COVID-19 on ophthalmic surgery in Australia, comparing surgical service rates in 2019 and 2020. Methods : Retrospective analysis of the number of ophthalmic surgical services in 2019 and 2020 in all Australian States and Territories, as recorded by Medicare (Australian Government-funded universal health insurance scheme subsidising healthcare costs for Australian residents). Monthly surgical service rates were calculated and Poisson regression was used to compare the change in service rates between months. Results : Between March and April 2020, surgical service rates decreased for: cataract surgery (by 71%, 95% CI: 70-72%), cataract surgery with minimally invasive glaucoma surgical device insertion (by 71%, 95% CI: 65-75%), pterygium removal (by 67%, 95% CI: 60- 72%), corneal transplantation (by 31%, 95% CI: 9-48%), and collagen crosslinking for corneal ectasias (by 35%, 95% CI: 18-48%). Comparatively, service rates for these surgeries did not differ or decreased less between March and April 2019. Interestingly, glaucoma filtration surgery rates decreased between March and April in 2020 (by 44%, 95% CI: 29- 56%) and also in 2019 (by 45%, 95% CI: 31-55%), whilst retinal detachment surgery rates were unchanged between these months in 2020 (crude decrease 9%, 95% CI: -28 to 16%) and 2019 (crude decrease 11%, 95% CI: -26 to 9%). Conclusions : Despite relatively low rates of COVID-19 community transmission in Australia in 2020, ophthalmic surgical service rates decreased during months in lockdown and with restrictions, largely for non-time-critical conditions. These data may have health planning implications as the pandemic continues, with future lockdowns and restrictions possible, especially as COVID-19 variants emerge.
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Background: Influenza and bronchiolitis are serious infections especially among vulnerable pediatric populations. Earlier studies have suggested that the transmission of influenza viruses can be reduced by face masking and social distancing measures. In response to the COVID-19 pandemic, Ohio adopted various measures including school closing, travel restrictions, social distancing, and face masking in March, 2020. These measures have created a unique opportunity to study the impact of social distancing measures on the spread of potentially serious viral infections such as influenza and respiratory syncytial viral (RSV) infections of children in our locality. Methods: This is a retrospective cohort study conducted at Akron Children's hospital in Northeast Ohio where the peak respiratory season extends from October to April. The primary outcome was to evaluate the prevalence of influenza A and B and RSV infections before and after implementation of social distancing measures. Prevalence of SARS-CoV-2 was also tracked for comparison. Viral assay data were collected between October 1, 2020 through April 30th, 2021 (during the pandemic and social distancing implementation) and compared with two pre-COVID19 respiratory seasons: 2018-19 and 2019-20. Results from all patients who received viral testing as a part of their medical care were included. Viral tests included rapid antigen tests for Influenza A/B and RSV (Quidel SoFIA), Respiratory Film Array (BioFire, includes flu, RSV, and SARS-CoV-2 targets), and single target tests for SARS-CoV-2 from multiple vendors (see Table 1). Results: There was a dramatic increase in viral testing in the 2020-2021 respiratory season. With most of the new test targeting SARS-CoV-2, Flu and RSV antigen tests decreased significantly but were replaced in part by Respiratory FilmArray use (Table 1). Pre-COVID-19, the peak incidence of RSV occurred in December for the 2018-19 (28.9%, average of 8.8%) and 2019- 20 (24.7%, average of 8.8%) seasons. After social distancing measures, the incidence and positivity rate for RSV was 0% until March 14, 2021 when the first RSV case was detected in our locality, concurrent with relaxation of social distancing measures. Pre-COVID 19, the peak incidence of Influenza A virus occurred during February in the seasons 2018-19 (40.9%;average of 13.6%) and 2019-20 (24.1%, average of 6.1%). Influenza B had a low incidence throughout 2018-2019 (average of 0.3%) with a peak during January in the 2019-2020 season (24.0%, average of 6.8%). During the 2020-2021 season, we detected only two isolated cases of Influenza B virus and no cases of Influenza A virus through April 30, 2021 (Figure-1). Conclusion: Social distancing and mask mandates can be effective tools to decrease the rates of potentially serious infections such as Influenza and RSV in the pediatric population. Travel restrictions and school closures likely had an affect but were not evaluated during this study.
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Background: Successful vaccination against SARS-CoV2 is highly effective in preventing serious COVID-19 illness and is particularly recommended for at risk populations including patients with multiple myeloma (MM). However, there is uncertainty to which extent modern intensified therapies targeting plasma cell features might attenuate vaccination responses;some early vaccination recommendations for MM have proposed extended treatment breaks of several weeks to maximise vaccination success. Such an approach can be challenging in UHiR MM and pPCL, where maintaining treatment intensity is hallmark for preventing rapid relapse of the aggressive tumor. To address this uncertainty, we measured post-vaccination serological responses in patients treated uniformly with intensified Dara-VR consolidation and Dara-R maintenance post-ASCT for UHiR NDMM or pPCL in the UK OPTIMUM/MUKnine trial (NCT03188172). Methods: Between Sep 2017 and Jul 2019, 107 patients with UHiR NDMM or pPCL were recruited to OPTIMUM and received intensified post-ASCT consolidation with Dara-VR(d) for 18 cycles followed by maintenance with Dara-R until progression. In an exploratory analysis, centrally stored serum samples available for patients with a completed and documented vaccination history of two doses of an anti-SARS-CoV2 vaccine were analyzed for serological vaccine responses Total IgG/IgA/IgM Anti-SARS-CoV-2 spike glycoprotein was measured by ELISA (MK654;The Binding Site). As per UK national guidance and local availability, patients received two vaccine doses 12 weeks apart of either tozinameran (Pfizer/Biontech) or vaxzevria (AstraZeneca);serum taken at least 3 weeks after patients received their second dose was analyzed. Results were correlated with baseline characteristics and annotated with treatment and response data. Patient with available matched serological and vaccination status data at time of data cut-off (09 JUL 2021) were included. Collection of vaccination status data is ongoing and updated results comprising additional patients enrolled in OPTIMUM, as well as antigen levels, will be presented. Data will also comprise longitudinal antibody level measurements for patient with available sequential material. Results: Serological vaccine response data was available for 40 OPTIMUM patients with documented completed double vaccination status. Median patient age was 58.5 years (range 39-70) and clinical and molecular tumor features were similar to the overall trial safety population. All patients had received their second dose before June 2021. Of the 40 patients, 42.5% had received tozinameran and 57.5% vaxzevria. Baseline characteristics of the two groups were comparable. At time of second vaccine dose, 55% of patients were receiving Dara-VR consolidation treatment and 45% Dara-R maintenance. There was no recommendation to pause trial treatment for purposes of vaccination and no extended times off treatment for this reason were reported. Overall, 72.5% of patients had a positive vaccine antibody level as per manufacturer cut-point for high specificity evidence of antigen exposure (infection or vaccine). The response rate was nominally higher for vaxzevria (91.3%) than for tozinameran (47.1%), a dysbalance that will be further investigated with ongoing extension of the cohort. Of note, 90% of patients analyzed had reached a complete response (CR) of their MM prior to being vaccinated, and the majority of patients not in CR had a positive vaccine response. Response rates were nominally slightly higher in patients in receipt of Dara-R maintenance at time of second dose with 77.8% compared to Dara-VR consolidation with 68.2%. Conclusions: These results show a high serological response rate to COVID-19 vaccination in UHiR MM patients receiving intensified post-ASCT consolidation and maintenance therapy in remission. Findings suggest that continuation of intensified post-ASCT therapy for patients with aggressive tumors and a high risk of relapse are compatible with serological responses to commonly used COVID-19 vaccines. Disclosures: Jen er: Janssen: Consultancy, Honoraria, Speakers Bureau;BMS/Celgene: Consultancy, Honoraria, Speakers Bureau;Takeda: Consultancy;Pfizer: Consultancy. Hall: BMS/Celgene: Research Funding;Janssen: Research Funding. Garg: University Hospital Leicester: Current Employment;Takeda Janssen Novartis Sanofi: Other: Travel Accommodations, Expenses;Amgen Janssen Novartis Sanofi Takeda: Honoraria. Jackson: J and J: Consultancy, Honoraria, Speakers Bureau;GSK: Consultancy, Honoraria, Speakers Bureau;takeda: Consultancy, Honoraria, Research Funding, Speakers Bureau;amgen: Consultancy, Honoraria, Speakers Bureau;celgene BMS: Consultancy, Honoraria, Research Funding, Speakers Bureau;oncopeptides: Consultancy;Sanofi: Honoraria, Speakers Bureau. Pratt: Binding Site: Consultancy;BMS/Celgene: Consultancy;Gilead: Consultancy;Janssen: Consultancy;Takeda: Consultancy;Amgen: Consultancy. Cook: Karyopharm: Consultancy;Sanofi: Consultancy;Takeda: Consultancy, Research Funding;Janssen: Consultancy, Research Funding;BMS/Celgene: Consultancy, Research Funding;Amgen: Consultancy. Drayson: Abingdon Health: Current holder of individual stocks in a privately-held company. Kaiser: BMS/Celgene: Consultancy, Other: Travel support, Research Funding;Janssen: Consultancy, Other: Educational support, Research Funding;GSK: Consultancy;Karyopharm: Consultancy, Research Funding;Pfizer: Consultancy;Amgen: Honoraria;Seattle Genetics: Consultancy;Takeda: Consultancy, Other: Educational support;AbbVie: Consultancy.
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Background/Case Studies: Convalescent plasma mediates passive immunity through the transfer of protective antibodies. It is an inexpensive and readily accessible therapy whose efficacy is unknown in the current COVID-19 pandemic. COVID-19 convalescent plasma (CCP) with high neutralizing antibody titers may have a greater likelihood of efficacy than low titer CCP. Study Design/Methods: The Passive Immunity Trial for Our Nation (PassITON) is a multicenter, blinded, placebo-controlled, randomized clinical trial. The studyâ ™s purpose is to evaluate efficacy of convalescent plasma containing neutralizing antibodies to COVID-19 in moderate-to-severe hospitalized adults with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV- 2). Unlike other published CCP studies, this study quantified SARS-CoV-2 antibody titers and screened CCP units for neutralizing SARS-CoV-2 antibodies with binding assays. Serum samples obtained from CCP donors were first screened by the Abbott TM ARCHITECT TM IgG qualitative platform for the presence of detectable antibody against SARS-CoV-2. Positive samples in the Abbott assay were quantified for IgG binding against the RBD of SARS-CoV-2 using a liquid bead-array (RBD Luminex). Units with a mean fluorescence intensity (MFI) of 8000 U/mL or greater were then assessed for neutralization using a VSV-SARS-CoV-2 chimeric virus neutralization assay. Units were deemed eligible for transfusion if they met a threshold of neutralization (50% neutralization titer (NT50) > 1:50). Both cutoffs were determined by screening a subset of samples for neutralization using a traditional live-virus plaque-reduction neutralization titer (PRNT) assay. Results/Findings: A total of 429 donors donated over 1200 CCP units for screening between April 22, 2020 and January 29, 2021. Initial studies of approximately 60 donors samples were used to create a cut off for the RBD binding assay;the vast majority of samples with RBD < 8000 IU/mL did not demonstrate neutralization activity of NT50>50. Ten samples were used to demonstrate a tight linear relationship between the NT50 and PRNT50. Using these cut-offs approximately 25% of the plasma donations in this program met or exceeded the minimum thresholds during antibody screening and were selected for use in the trial. Twenty-seven institutions participated in the study, representing all census regions in the United States (Figure 1). Presently, 837 patients have been randomized for the study. Conclusions: While the efficacy of CCP is unknown given the variable results that have been published to date, the PASSITON study design optimizes the efficient procurement of CCP with high levels of neutralizing antibodies.
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Previous case reports describe the inadvertent administration of methylergonovine to newborns resulting in rare, life-threatening events including neonatal death. To our knowledge, no case reports exist detailing inadvertent methylergonovine administration in the emergency medicine literature. A newborn infant presented to the emergency department (ED) at hour five of life following methylergonovine administration with periods of apnea and cyanosis. The infant required intubation, mechanical ventilation, and a seven day neonatal intensive care stay. This rare case describes the potential for this error to occur in the community and heightens the vigilance of emergency medicine providers when caring for newborns in their first hours of life.
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Emergency Service, Hospital , Medication Errors , Methylergonovine/poisoning , Poisoning/diagnosis , Poisoning/therapy , Female , Humans , Infant, Newborn , Intensive Care Units, NeonatalABSTRACT
Aims The primary aim was to assess the rate of postoperative COVID-19 following hip and knee arthroplasty performed in March 2020 in the UK. The secondary aims were to assess whether there were clinical factors associated with COVID-19 status, the mortality rate of patients with COVID-19, and the rate of potential COVID-19 in patients not presenting to healthcare services. Methods A multicentre retrospective study was conducted of patients undergoing hip or knee arthroplasty during the first wave of the COVID-19 pandemic (1 March 2020 to 31 March 2020) with a minimum of 60 days follow-up. Patient demographics, American Society of Anesthesiologists grade, procedure type, primary or revision, length of stay (LOS), COVID-19 test status, and postoperative mortality were recorded. A subgroup of patients (n = 211) who had not presented to healthcare services after discharge were contacted and questioned as to whether they had symptoms of COVID-19. Results Five (0.5%) of 1,073 patients who underwent hip or knee arthroplasty tested positive for SARS-CoV-2 postoperatively. When adjusting for confounding factors, increasing LOS (p = 0.022) was the only significant factor associated with developing COVID-19 following surgery and a stay greater than three days was a reliable predictor with an area under the curve of 81% (p = 0.018). There were three (0.3%) deaths in the study cohort and the overall mortality rate attributable to COVID-19 was 0.09% (n = 1/1,073), with one (20%) of the five patients with COVID-19 dying postoperatively. Of the 211 patients contacted, two had symptoms within two to 14 days postoperatively with a positive predictive value of 31% and it was therefore estimated that one patient may have had undiagnosed COVID-19. Conclusion The rate of postoperative COVID-19 was 0.5% and may have been as high as 1% when accounting for those patients not presenting to healthcare services, which was similar to the estimated population prevalence during the study period. The overall mortality rate secondary to COVID-19 was low (0.09%), however the mortality rate for those patients developing COVID-19 was 20%.
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INTRODUCTION: Adverse Social Determinants of Health (SDoH) negatively impact child health outcomes. Outpatient SDoH screening is recommended by the American Academy of Pediatrics, but inpatient screening is not routine. This study sought to identify the prevalence of adverse SDoH in families of children admitted to a tertiary care pediatric intensive care unit (PICU) and to identify patient characteristics associated with positive screens. METHODS: An existing SDoH measure modified to include domains for which we were equipped to provide support was administered by a social worker to a primary caregiver of PICU patients from 2/18/20 - 6/4/20. Screens were positive if caregivers reported lack of access or worry about lack of access to services within the past year. Domains included housing, utilities (electricity, gas, water), childcare, mental health care and transportation. Patient demographics, diagnoses, lengths of stay, survival, and Pediatric Logistic Organ Dysfunction (PELOD) scores were collected from electronic medical records. Due to SARS-CoV-2, our study was paused from 3/9/20 - 4/21/20, allowing secondary analysis of SDoH before and after onset of the pandemic. All families received a resource guide in support of SDoH;families with positive screens were provided personalized support by social workers. RESULTS: Of the 84 families screened in the PICU, 26 (31%) screened positive for at least one adverse SDoH. Transportation (17%) and housing (13%) were the most commonly reported adverse SDoH. Thirteen (15%) families reported needs in multiple SDoH domains. There were no differences between patient characteristics, primary diagnosis, PELOD score, survival, or length of stay between families with positive or negative SDoH screening. In the post-SARSCoV- 2 epoch, children were older (9 vs. 4 years), had shorter PICU lengths of stay (3 vs. 7 days), and presented with less sepsis (19% vs. 67%) and more neurologic and respiratory diagnoses (30% vs. 3% and 20% vs. 13%). Adverse SDoH were similar between epochs. CONCLUSIONS: Almost a third of families with children admitted to the PICU had adverse SDoH. The optimal approach to routine screening and support of SDoH in families with critically ill children should be studied.
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INTRODUCTION: Clinical phenotypes of acute hypoxic respiratory failure (AHRF) in COVID-19 have been proposed- Gattinoni type ?L? with less interstitial edema/ lung weight and greater compliance vs type ?H? with a more classic acute respiratory distress syndrome (ARDS) pattern of interstitial edema, higher lung weight and lower compliance. Lung ultrasound (LUS) is a sensitive tool for the detection of interstitial pulmonary edema. Our objective was to describe lung US profiles in COVID-19 induced AHRF, in association with markers of severity and outcomes. METHODS: Retrospective observational study. Consecutive critically-ill adult COVID-19 patients with AHRF and P/F ratio <300mmHg who underwent LUS performed by a single provider in March-April 2020 were included. Patients with an established alternate etiology of AHRF, or chronic lung parenchymal pathology, were excluded. LUS was performed in the anterior and lateral zones. LUS phenotypes were: A (<3 B-lines per intercostal space (ICS) permitted), B (at least 3 B-lines in any ICS) and C (consolidation >1cm thickness). B and C profiles could overlap. The A-profile was compared to all others in the analyses of statistical significance. Outcomes included the need for and duration of mechanical ventilation, need for tracheostomy and mortality. RESULTS: Ten patients met eligibility criteria. 3 demonstrated A-profile, 6 B-profile and 1 C-profile. Median days (interquartile range) from symptom onset to LUS was: A- 6 (6-14, p=0.20), B- 18 (8-30), C- 6. Median P/F ratio at the time of LUS was: A- 152 (103-269, p=0.31), B- 131 (112- 146), C-98. Median C-reactive protein (mg/dL): A- 8 (5-10, p=0.3), B- 18 (6-31), C- 12. Median Lactate Dehydrogenase (IU/L) was: A- 528 (287-594, p=0.36), B- 622 (528-787), C- 258. Median D-Dimer (mg/L FEU) was: A- 0.88 (0.64- 3.12, p=0.57), B- 2.50 (1.74-35.00), C- 0.35. Mechanical ventilation was required in: A- 1 (33%, p=0.067), 6 (100%), C- 1 (100%). Median days of mechanical ventilation was: A- 0 (0-20, p=0.03), B- 36 (32-52), C- 88. Median static compliance (mL/cmH2O) was: A- 18, B- 27 (25-28), C- 37. Tracheostomy was performed in: A- 0 (0%, p=0.008), B- 6 (100%), C- 1 (100%). Mortality was: A- 0, B- 1 (17%), C- 0. CONCLUSIONS: An A-profile on LUS appeared to be associated with less severe respiratory illness in COVID-19 AHRF with P/F< 300mmHg.
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BACKGROUND: As a response to the acute strain placed on the National Health Service during the first wave of coronavirus disease 2019 in the UK, a number of junior doctors including ENT trainees were redeployed to other clinical specialties. This presented these trainees with novel challenges and opportunities. METHODS: A qualitative study was performed to explore these experiences, undertaking semi-structured interviews with ENT trainees between 17th and 30th July. Participants were recruited through purposeful sampling. Interview transcripts underwent thematic analysis using Dedoose software. RESULTS: Seven ENT trainees were interviewed, ranging from specialty trainee years four to eight ('ST4' to 'ST8') in grade. Six core themes were identified: organisation of redeployment, utilisation of skill set, emotional impact of redeployment, redeployed team dynamics, concerns about safety and impact on training. CONCLUSION: The ENT trainees' experiences of redeployment described highlight some important lessons and considerations for future redeployments.