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Intelligent medical management is one of several modern city and society management fields where the Internet of Things (IoT) is essential. Smart cities' current engagement between technology and the health care system is strengthened by the intelligent IoT's limitless networking capabilities for big data analysis in medicine. Allows for more practical methods for efficiently monitoring patients' health and providing medical services remotely online assessment of patients' health status by doctors, nurses, and other healthcare professionals. The of the current study aims to provide a full examination of the function of IoT in medical management systems, analyse the available concerns, and address many of the open questions. It also aims to provide an up-to-date and comprehensive review of this field. Enabling technology and hints at a variety of uses There have been suggested research plans. The following are some examples of IoT applications from previous studies: wearable technology, monitoring technology, rehabilitation technology, telehealth, behaviour modification, smart city, and smart home. This comprehensive review identifies the crucial elements that make it possible to comprehend the healthcare possibilities and obstacles providers to put IoT applications into action. Lastly, anticipated COVID-19 effects on IoT uptake this review assessed in the field of healthcare. © 2022 IEEE.
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Rationale: Asthma morbidity and mortality are disproportionately high in African Americans, especially in emerging adult (AAEA) population (age 18 to 30 years) who are between adolescence and adulthood. Few studies have been done to identify unique challenges to asthma care in African American emerging adults. Methods: We conducted virtual focus groups consisting of African American young adults (n = 16) with a physician diagnosis of asthma. Discussion questions regarding asthma triggers, management, and challenges were used. Focus group discussions were recorded and transcribed verbatim. The transcripts were then coded by three coders using a thematic saturation approach. Results: Six major domains were identified: heightened awareness and anxiety around environment and triggers;increased autonomy from parents and resultant challenges;desire for technology to aide in asthma management;impact of asthma on social group settings;asthma interference with school and/or work;and concerns during the Covid-19 pandemic. Participants reported difficulty affording asthma medications, living in unsafe environments, trouble keeping up with their young children due to asthma, regular use of technology, and utilization of nonpharmacologic remedies. While wanting to take more responsibilities as grown-ups, many felt their asthma was better controlled when they were children because of their parents' involvement in asthma management. Conclusions: African American emerging adults with asthma have unique challenges due to age and race. To achieve optimal asthma control, physicians must address these challenges through innovative means such as using technology-based tools.
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Purpose>This study aims to examine the impact of flexible work arrangements (FWAs) on employees' perceived productivity, quality of work and organisational commitment (OC) with a special focus on the United Arab Emirates. It also analyses the mediating effect of employee happiness on the relationship between FWA and employees' perceived productivity, OC and perceived work quality.Design/methodology/approach>A quantitative, non-experimental correlational study was used for this research project. The study yielded numerical data, which were analysed using a deductive approach. The analysis aimed at exploring the relationships between the constructs, which were viewed as variables;these relationships were considered correlations, mediation and moderation. The sample comprises employees currently working at different public and private sector organisations, representing all major service industries in the UAE. Nine questions were used to assess the flexibility at work and six out of the nine questions were used to measure the level of FWAs using the Likert scale.Findings>FWA has a significant and positive association with the employees' perceived productivity, quality of work and OC. It was confirmed that happiness plays a mediating role in the relationship between FWA and employee outcomes. The facility allows employees to manage their personal and professional lives with ease using their preferred work method. This ability promotes employee satisfaction. In conclusion, managers and employees around the world should view FWAs as a positive tool to enhance employee productivity and OC, particularly in an emergency like the Covid-19 pandemic.Research limitations/implications>The participants' honesty was a limitation, which could raise questions on the validity of this study. This limitation arises when the self-report method is used for data collection. Use of multiple instruments could be another limitation.Practical implications>Organisational leaders can use FWAs to improve employee outcomes. When an organisation grants flexible work options to employees, it implies that the organisation trusts its employees to complete the task. This factor motivates all employees to work with dedication, which is particularly true if the employees are creative people and wish to work on their preferred time and place.Originality/value>This study is significant because the findings will allow managers to assess the benefits of using FWAs to improve employee productivity, particularly in the service sector. It combines the aspects of perceived productivity, OC and perceived work quality, as well as employee happiness to assess the role of FWAs in organisations. The study also investigates the influence of FWAs in improving these employee outcomes. Based on the literature review, this study on FWAs is the first of its kind in the UAE, the country using a truly multinational workforce coming from more than 100 countries and cultures.
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Introduction: COVID-19 is a well-known cause of severe ARDS (acute respiratory distress syndrome), however recent data suggests that COVID-19 could represent a unique form of lung injury that places patients at increased risk of various uncommon complications such as pneumothorax, pneumomediastinum and subcutaneous emphysema. Studies so far have reported an increased incidence of barotrauma in intubated COVID-19 patients with unclear predictors. Our study aims to identify the different variables associated with development of pneumothorax, pneumomediastinum and subcutaneous emphysema in critically ill COVID-19 patients. Methods: We examined patients admitted to the intensive care unit from March 2020 to Feb 2021 at a large tertiary care center in Detroit, Michigan. We identified a total of 25 patients with COVID-19 ARDS requiring mechanical ventilation who developed pneumothorax, 12 who developed pneumomediastinum and 7 with subcutaneous emphysema. We compared those to 66 patients admitted with COVID-19 ARDS also requiring mechanical ventilation who did not develop any of these complications. The mean age of patients in our subject group was 61.81 years compared to a mean of 69.05 years in the control group. Male patients accounted for 58.33% of the subject group and 60.61% in the control group. Results: we detected a statistically significant difference in the modified Sequential Organ Failure Assessment Score (mSOFA) between the patients who developed these complications compared to those who did not (p<0.0001), with score being surprisingly lower in the group who developed the complication as opposed to those who did not (median mSOFA in subjects 3.5, n=32 vs median mSOFA in controls 11, n=66). Analysis of the subgroups of the mSOFA score revealed no statistically significant difference in the PF ratio (p=0.1995), platelet counts (p=0.065) and total bilirubin (p=0.4403). However, MAP was noted to be significantly lower in the control group than in the subject group accounting for a higher mSOFA score (p=0.0031). Similarly, creatinine was noted to be higher in the control group (p<0.0001) compared to the subject group. Discussion: In viewing our baseline patient characteristics we found a statistically significant difference (p<0.0001) in the rate of baseline chronic kidney disease between our subjects and control patients, with control patients having 100% baseline CKD and subjects having 19.4% baseline CKD. This could account for the higher mSOFA scores in controls. Conclusion: mSOFA did not predict the development of pneumothorax, pneumomediastinum or subcutaneous emphysema in patients admitted with COVID-19 ARDS requiring mechanical ventilation.
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Background: The coronavirus disease 2019 (COVID-19) has quickly spread to become a pandemic. Most studies demonstrate that increased liver enzymes in COVID-19 have little clinical relevance. In severe COVID-19, lower albumin levels are seen. Aim: To see how hypoalbuminemia levels affect the COVID-19 patients. Study design: Retrospective cohort study. Place and duration of study: Services Institute of Medical Sciences Lahore and Bahria International Hospital, Lahore from 10th January 2021 to 17th September 2021. Methodology: Sixty-seven confirmed cases of COVID-19 on RT-PCR were recruited. They were further divided into two groups. Group N (normal albumin levels) had thirty-six participants whereas group HA (hypoalbuminemia) contained thirty-one participants. Both males and females of all age groups, having complete medical records were included. Biochemical variables were noted from the medical record within 48 to 72 hours after admission. Twenty eight days follow up was done to note the mortality. Patients having incomplete medical records who expired within 2 days after admission were excluded. Results: A significantly higher number of deaths, lymphopenia, hypertensive, diabetics, and asthmatic participants were found in Group HA as compared to Group N. Hypoalbuminemia is mostly seen in older age and biochemical variables such as total leukocyte count and, neutrophils were elevated, whereas lower levels of lymphocytes were found in group HA. Lower lymphocytes and higher creatinine levels are the most prevalent predictors of mortality. The Pearson’s correlation of albumin with lymphocytes showed a positive correlation and inverse correlation with TLC, Neutrophil counts, CRP levels Conclusion: The group HA is associated with higher mortality and increased levels of prognostic factors of mortality.
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Purpose: This study aims to examine the impact of flexible work arrangements (FWAs) on employees’ perceived productivity, quality of work and organisational commitment (OC) with a special focus on the United Arab Emirates. It also analyses the mediating effect of employee happiness on the relationship between FWA and employees’ perceived productivity, OC and perceived work quality. Design/methodology/approach: A quantitative, non-experimental correlational study was used for this research project. The study yielded numerical data, which were analysed using a deductive approach. The analysis aimed at exploring the relationships between the constructs, which were viewed as variables;these relationships were considered correlations, mediation and moderation. The sample comprises employees currently working at different public and private sector organisations, representing all major service industries in the UAE. Nine questions were used to assess the flexibility at work and six out of the nine questions were used to measure the level of FWAs using the Likert scale. Findings: FWA has a significant and positive association with the employees’ perceived productivity, quality of work and OC. It was confirmed that happiness plays a mediating role in the relationship between FWA and employee outcomes. The facility allows employees to manage their personal and professional lives with ease using their preferred work method. This ability promotes employee satisfaction. In conclusion, managers and employees around the world should view FWAs as a positive tool to enhance employee productivity and OC, particularly in an emergency like the Covid-19 pandemic. Research limitations/implications: The participants’ honesty was a limitation, which could raise questions on the validity of this study. This limitation arises when the self-report method is used for data collection. Use of multiple instruments could be another limitation. Practical implications: Organisational leaders can use FWAs to improve employee outcomes. When an organisation grants flexible work options to employees, it implies that the organisation trusts its employees to complete the task. This factor motivates all employees to work with dedication, which is particularly true if the employees are creative people and wish to work on their preferred time and place. Originality/value: This study is significant because the findings will allow managers to assess the benefits of using FWAs to improve employee productivity, particularly in the service sector. It combines the aspects of perceived productivity, OC and perceived work quality, as well as employee happiness to assess the role of FWAs in organisations. The study also investigates the influence of FWAs in improving these employee outcomes. Based on the literature review, this study on FWAs is the first of its kind in the UAE, the country using a truly multinational workforce coming from more than 100 countries and cultures. © 2021, Emerald Publishing Limited.
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Background: Spontaneous pneumothorax is a rare complication seen in patients of COVID-19 pneumonia. The risk factors associated with this complication and its incidence remain unknown largely. We herein, review and present the incidence, clinical characteristics and outcomes of spontaneous pneumothorax in 1767 patients admitted in three COVID treatment tertiary care centers in Lahore. Study Design: Retrospective study Place and Duration of Study: Services Institute of Medical Sciences Lahore and Bahria International Hospital Lahore from 15th April 2020 to 15th May 2021. Methodology: One thousandseven hundred and sixty-seven patients who were diagnosed with a spontaneous pneumothorax were enrolled. Clinical characteristics of these cases were also reviewed and recorded. Results: One thousand and five hundred patients had positive RT PCR from nasopharyngeal swab. Eleven (.62%) cases of COVID-19 patients who developed spontaneous pneumothorax were identified. The initial HRCT imaging showed typical and diffuse bilateral ground-glass opacities and consolidations, mainly in their peripheral, posterior and basal lung regions. Three patients had pneumothorax late in the course of disease after they were discharged home. We had only one mortality among those (11) cases and that was also not related to the pneumothorax directly but to development of sepsis and multi-organ failure. Conclusion: Spontaneous pneumothorax is a rare complication seen in COVID-19 pneumonia.
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The whole world is suffering from COVID-19 pandemic. This disease has halted life and has a negative impact on physical and mental health of all individuals. Objectives: To identify impact of BMI on Covid-19 clinical features and its management in terms of relationship among patients at government hospitals, Pakistan. Study Design: Cross-sectional study. Methodology: This study enrolled 206 patients having both genders and was carried at Life Diabetes Centre, Gujrat and CMH Kharian Medical College (CKMC), over a period of 3 months, Kharian-Pakistan following ethical review committee's (ERC) approval. Statistical analysis: Data was analyzed by SPSS software, version 17. Parameters like age, gender and treatment taken were presented as frequency. Chi square was applied to see the correlation with p-value <0.05 as significant. Results: Total 206 patients were randomly selected, 89 male and 117 females. Among 206, patients (n=133) showed symptoms while rest of the patients (73) remained asymptomatic. There was no association of BMI with COVID-19 symptoms having P-value greater than 0.05. There was an association of BMI with gender as P-value (0.000*). There was an association of BMI with age having P-value (0.000*). Conclusion: From present study, we concluded that there was a correlation between BMI and individuals with higher BMI as they developed more serious symptoms and required active management strategies in comparison to individuals who were either underweight or normal weight.
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The impact of Coronavirus (COVID-19) disease has been reported for different countries. Males are at high risk of death due to COVID-19 as compared to females. There is no data available for Pakistan, the South Asian region. We are therefore undertaking this analysis to determine the gender effect on the outcomes of COVID-19 in the South Asian nation of Pakistan. An online survey was performed across Pakistan (Punjab, Sindh, Khyber Pakhtunkhwa, Balochistan) and national figures from the Pakistani government. In total, N = 113 individuals were included (92 males and 21 females). The descriptive statistics, association tests, and Pie chart indicate that males are more impacted by COVID-19 as compared to females. The doctor’s response indicates that 81.4% of males and 18.6% females are COVID-19 effective in Pakistan. Information from Pakistani national government statistics indicates that the number of male cases are 78%. Therefore, from the entire studies, we can infer that COVID-19 attacks more on males rather than females in the South Asian nation Pakistan. However, more quantitative studies are recommended to measure the extent to which sex would result in COVID-19 outcomes among Pakistan’s South Asian countries. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Background: The lockdown due to Covid-19 has impacted certain aspects of cognition among medical students. Aim: To explore the impact of the Covid-19 lockdown on metamemory among medical students studying in a private medical college in Pakistan. Study design: Experimental study. Methodology: This study with enrolled students (n=233) was carried out after ethical review committee's (ERC) approval at CMH Kharian Medical College (CKMC), Physiology Department, Kharian-Pakistan. Both male and female medical students were enrolled. In phase 1, the students reported to the Physiology laboratory where age and gender were recorded. Metamemory was measured using the Multi-factorial Memory Questionnaire (MMQ)Satisfaction scale using the Baycrest Centre protocols for its administration and scoring. Data was analyzed by SPSS software, version 21. MMQ-Satisfaction score was presented as mean +/- SD. Statistical significance was taken at p value <0.05. Results: Among males mean +/- SD for Pre Covid-19 MMQ was 43.24 +/- 9.58 while mean +/- SD for Post Covid-19 MMQ males was 55.32 +/- 6.01. Significant difference was seen between Pre & Post Covid-19 MMQ scores with p-value of <0.000. Conclusion: We concluded that significant difference was seen between Pre & Post Covid-19 MMQ scores with p-value of <0.000. However, means among all age groups were significantly equal with the others in Pre & Post COVID-19 MMQ. Similarly, means were significantly equal among both genders for Pre & Post COVID19 MMQ.
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Background: The whole world is facing one of the biggest health related disaster (COVID-19) of the century. Aim: To identify age and gender-based differences in Covid-19 clinical features and its management among patients at government hospitals, Pakistan. Study design: Cross-sectional study. Methodology: This study with enrolled subjects (n=206) was carried out after ethical review committee's (ERC) approval at Life Diabetes Centre, Gujrat and CMH Kharian Medical College (CKMC), over a period of 3 months, Kharian-Pakistan. Both male and female medical subjects were enrolled. Statistical analysis: Data was analyzed by SPSS software, version 17. Parameters like age, gender and treatment taken were presented as frequency. Chi square was applied to see the correlation with p-value <0.05 as significant. Results: Total 206 patients were randomly selected, 89 male and 117 females. Among 206, patients (n=133) showed symptoms while rest of the patients (73) remained asymptomatic. There was no association of age and gender with COVID-19 symptoms having P-value greater than 0.05. There was a significant association between treatments given was significantly related with age having P-value (0.006*). Conclusion: We concluded that there was no strong association between age and gender-based differences in Covid-19 clinical features;this could be due to small sample size.
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WATERLIT Abstract: Management of patients with severe or critical COVID-19 is mainly modeled after care for patients with severe pneumonia or acute respiratory distress syndrome (ARDS) from other causes, and these recommendations are based on evidence that often originates from investigations in resource-rich intensive care units located in high-income countries. Often, it is impractical to apply these recommendations to resource-restricted settings, particularly in low- and middle-income countries (LMICs). We report on a set of pragmatic recommendations for acute respiratory failure and mechanical ventilation management in patients with severe/critical COVID-19 in LMICs. We suggest starting supplementary oxygen when SpO2 is persistently lower than 94%. We recommend supplemental oxygen to keep SpO2at 88–95% and suggest higher targets in settings where continuous pulse oximetry is not available but intermittent pulse oximetry is. We suggest a trial of awake prone positioning in patients who remain hypoxemic;however, this requires close monitoring, and clear failure and escalation criteria. In places with an adequate number and trained staff, the strategy seems safe. We recommend to intubate based on signs of respiratory distress more than on refractory hypoxemia alone, and we recommend close monitoring for respiratory worsening and early intubation if worsening occurs. We recommend low–tidal volume ventilation combined with FiO2 and positive end-expiratory pressure (PEEP) management based on a high FiO2/low PEEP table. We recommend against using routine recruitment maneuvers, unless as a rescue therapy in refractory hypoxemia, and we recommend using prone positioning for 12–16 hours in case of refractory hypoxemia (PaO2/FiO2 < 150 mmHg, FiO2 ≥ 0.6 and PEEP ≥ 10 cmH2O) in intubated patients as standard in ARDS patients. We also recommend against sharing one ventilator for multiple patients. We recommend daily assessments for readiness for weaning by a low-level pressure support and recommend against using a T-piece trial because of aerosolization risk
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The whole world is facing one of the biggest health related disasters of the century. As a novel disease, Covid-19 has so many parameters yet to explore. Objectives: To explore any correlation between atopy and Covid-19 among residents of Gujrat and Kharian, Punjab, Pakistan. Study Design: Cross-sectional study. Methodology: This study with enrolled subjects (n=206) was carried out after ethical review committee’s (ERC) approval at Life Diabetes Centre, Gujrat and CMH Kharian Medical College (CKMC), over a period of 3 months, Kharian-Pakistan. Both male and female medical subjects were enrolled. Statistical analysis: Data was analyzed by SPSS software, version 17. Parameters like gender, allergy and treatment taken were presented as frequency and percentage. Chi square was applied to see the correlation with p-value <0.05 as significant. Results: Total 206 patients were randomly selected, 89 male and 117 females. Among 206, only 13 patients had allergy from different allergens. Only 2 patients required hospitalization and injectable treatment. Conclusion: We concluded that there is strong affiliation between atopy and Covid-19 presentations.
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Contactless authentication has become a trending topic these days, especially in this Corona pandemic situation, where contactless access systems are precautionary steps. The two most important contactless authentication systems right now are facial recognition and gait recognition. With having a possibility of spook attacks on facial recognition, gait patterns have gained popularity especially in the high-secured zones. Gait biometrics is considered as the next generation of biometrics which can enable identification of subjects even through a certain distance, avoiding any surface-contact. However, complex challenges gait patterns are mainly the view angles and distances for environmental setup and crucial gait features for algorithm setup. Hence, the authors are extending their previous work which is identifying 'specific targets' based on their gait patterns in Defence applications. We combined facial recognition designed with our anti-spoofing algorithm and gait patterns which gave on an average 92% accuracy irrespective of their background, motion, and angle. © 2020 IEEE.
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Objective: To compare the performance of medical undergraduate students in online and traditional exams and to gauge student satisfaction regarding online exams. Study Design: Cross Sectional study Place and Duration of Study: This study was conducted at the Liaquat National Hospital and Medical College during the period of June-July 2020. Materials and Methods: The target population was second year MBBS students who had given a paper based traditional exam in their first year of medical college and an online exam in second year. Scores of both the exams were compared. Students 'opinions about the online exam were collected through an online survey. Data was analyzed using SPSS version-17. Results: There were 88 students who had attempted both year 1 and 2 examinations. There were statistically significant differences amongst median scores of both exams [p=0.016]. Out of 78 responses received majority of the students were satisfied with the instructions and felt that the amount of proctoring was sufficient for a fair exam. Students were equally divided in term of technical or connectivity issues and background noise. Regarding the entire online examination most students reported similar concerns i.e. not fully prepared for the exam due to Covid-19 patients at home and lack of resources. As compared to traditional exam students found online exam difficult to attempt due to technical issues such as power outages, internet issues and software glitches. Conclusion: With better performance in an online exam, students still prefer the traditional exam format better than online exams due to several reasons. This highlights the importance of investing in e-learning and e-assessment infrastructure.
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This manuscript contributes a progressive mathematical model for the analysis of novel coronavirus (COVID-19) and improvement of the victim from COVID-19 with some suitable circumstances. We investigate the innovative approach of the m-polar neutrosophic set (MPNS) to deal with the hesitations and obscurities of objects and rational thinking in decision-making obstacles. In this article, we propose the generalized weighted aggregation and generalized Einstein weighted aggregation operators in the context of m-polar neutrosophic numbers (MPNNs). The motivational aim of this paper is that we present a case study based on data amalgamation for the diagnosis of COVID-19 and examine with the help of MPN-data. By using the proposed technique on generalized operators, we discuss the recovery of the victim with the time factor, proper medication, and some suitable circumstances. Ultimately, we present the advantages and productiveness of the proposed algorithm under the influence of parameter partial derivative to the recovery results. The versatility and superiority of the proposed methodology with some existing approaches can be observed by the comparative analysis.
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Objective: To evaluate the stress level among doctors and nurses during COVID-19 crises. Study design: Descriptive correlational study Place and duration of study: Department of Medicine &Critical Care, Services Hospital Lahore and Bahria International Hospital, Lahore from 1st May 2020 to 31st July 2020 Methodology: Descriptive correlational study design to evaluate the stress level among doctors and nurses. A couple of other factors were also identified like lack of personal protective equipment's (PPEs) and family pressure to quite job along with COVID-19 stress. Two groups were substituted one with exposure of COVID-19 and other without its exposure. The internal review board and ethical committee of Bahria International Hospital, Lahore, approved the study. Questionnaire was collected after proper informed consent from health professionals working at COVID management units at Services Hospital Lahore and Bahria International Hospital Lahore. Chi-Square test and Odd ratios were calculated among the stated groups of doctors and nurses. Results: Statistical analysis among the groups of doctors and nurses exposed and not exposed shows significant higher levels of anxiety in doctors and nurses who were involved in management of COVID-19 patients directly as compared to those who were not. Similarly, the level of risks increased almost double in the exposed healthcare workers. Availability of personal protective equipment and pressure from the families to quit the job also plays significant role in elevating of anxiety levels. Conclusion: Study concludes that anxiety increases in the health care professionals due to lack of robust systems to cope up with the COVID-19 pandemic. Factors like stress from family, lack of proper protective equipment leads to fear of being infected and taking the infection to their loved ones. It is responsibility of management of health care set ups to ensure the availability of PPEs and making a robust system of infection control to help combat the pandemic. © 2020 Lahore Medical And Dental College. All rights reserved.
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SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To determine whether race/ethnicity is a risk factor for severe disease or death in COVID-19. METHODS: Retrospective analysis of adult patients >18 years-of-age with laboratory-confirmed COVID-19, hospitalized between March 1 to June 30, 2020 to nine acute-care hospitals within a metropolitan healthcare organization. Information on demographics, co-morbid conditions and outcomes were obtained from a system-wide database. Multiple regression analysis was performed to determine independent predictors of invasive-mechanical ventilation (MV), hospital length-of-stay (LOS), discharge disposition and mortality related to race/ethnicity controlling for age, gender and comorbidity. RESULTS: The cohort consisted of 3727 subjects (mean age 60.5±17.1 years, 55.8% male);2278 (61.1%) were black and 640 (17.1%) were white. Seven-hundred fifty (20.1%) patients received invasive-MV, 520 (13.9%) died, and median hospital LOS was 6.2 (IQR: 3.2-12) days. There were 2970 (80.4%) patients who were black or hispanic (Black/Hispanic). Black/Hispanic patients were younger compared to others (59.7 [16.6] vs 63.7 [18.4] P <0.0001), but equally distributed by sex (47.4% vs 48.5%;P=0.61). In the unadjusted analysis, black/Hispanic patients required more invasive-MV (20.6% v 15.3%;P=0.001) and had longer hospital LOS (6.6 [3.4-12.8] vs 5.2 [2.8-10.2]). In the adjusted analysis, being black/Hispanic was independently associated with invasive-MV (OR 1.54, CI 1.18-2.03;P=0.002) and longer hospital LOS (P<0.001) after controlling for age, gender, and comorbidity. However, there were no differences in mortality between black/Hispanic patients and other races (P=0.52). When comparing black patients as a distinct group with non-black patients, the black patients were more likely to receive invasive-MV (OR 1.38, CI 1.1-1.7;P=0.003) and less likely to be discharged home (OR.72, CI.6-.86;P<0.001) after adjustments for confounding factors. Hospital LOS was 21% longer in black patients (P<0.001) compared to other races, but there was no between-group difference in mortality (P=0.39). CONCLUSIONS: Race/ethnicity was independently associated with important clinical outcomes after adjustments for major confounding variables. Patients who were black or black/Hispanic were more likely to receive invasive-MV and had longer hospital LOS. However, there were no differences in mortality between minority patients and other races. CLINICAL IMPLICATIONS: Clinical outcomes in COVID-19 patients may be related to racial health-disparities. DISCLOSURES: No relevant relationships by Muhtadi Alnababteh, source=Web Response No relevant relationships by Mansi Chaturvedi, source=Web Response Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: $5001 - $20000 Added 07/01/2020 by Gail Drescher, source=Web Response, value=Consulting fee Technical Editor Resp Care Journal relationship with American Association for Respiratory Care Please note: $1001 - $5000 Added 07/01/2020 by Gail Drescher, source=Web Response, value=Salary No relevant relationships by Muhammad Hashmi, source=Web Response No relevant relationships by Fatima Hayat, source=Web Response No relevant relationships by Lakshmi Jayaram, source=Web Response No relevant relationships by Akshay Kohli, source=Web Response No relevant relationships by Emil Oweis, source=Web Response No relevant relationships by Akram Zaaqoq, source=Web Response
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SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To examine COVID-19 patients requiring invasive mechanical ventilation (MV) and/or Extracorporeal Membrane Oxygenation (ECMO) to better understand patient selection for ECMO, clinical management, and short-term outcomes. METHODS: Retrospective study of patients >18-years-old admitted to the hospital with COVID-19 requiring MV. Lung-protective ventilation was used in all patients with initial set PEEP of 8-10 cm H20 for plateau pressure <30 cm H20. ECMO was considered per pre-specified institutional criteria for refractory hypoxemia despite maximum-medical therapy, in qualifying patients. Exclusion criteria for ECMO included age >65 years, multi-system organ failure, and MV >10 d. Data captured included baseline patient characteristics, co-morbidities, pre-ECMO respiratory support, ECMO settings, laboratory results, and COVID-19 therapeutic interventions. RESULTS: We analyzed 59 patients who required invasive MV, including 13 who met criteria for ECMO. There were no between-group differences in gender, BMI, or co-morbidities. More ECMO patients received Tocilizumab (p=.003), but steroid use was similar (p=.44). Nine ECMO (69.2%) patients were decannulated. Crude ICU mortality was comparable between the ECMO and MV groups (6/13 [46.15%] vs. 22/46 patients [47.82%];p=0.92). Higher pre-ECMO D-dimer (9.740 [4.84-20.00] mcg/mL vs. 3.800 [2.19-9.11] mcg/mL;p=0.05), LDH (1158 ±344.5 units/L vs. 575.9 ±124.0 units/L;p=0.001), and troponin (0.4315 ±0.465 ng/mL vs. 0.034 ±0.043 ng/mL;p=0.04) were associated with mortality. Time on MV was significantly longer in the ECMO group (563.3 [422.1-613.9] h vs. 247.9 [101.8-479] h in MV;p<.001) as well as ICU length of stay (LOS) (576.2 [457.5-652.8] h in ECMO vs. 322.2 [120.6-569.3] h in MV;p=0.01). CONCLUSIONS: ECMO was associated with prolonged MV and extended ICU LOS. Markers of coagulation, inflammation and cardiac injury were elevated in ECMO patients who did not survive. CLINICAL IMPLICATIONS: ECMO is a potentially effective rescue therapy for COVID-19 associated pneumonia. DISCLOSURES: No relevant relationships by Muhtadi Alnababteh, source=Web Response No relevant relationships by Rajus Chopra, source=Web Response Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: $5001 - $20000 Added 07/01/2020 by Gail Drescher, source=Web Response, value=Consulting fee Technical Editor Resp Care Journal relationship with American Association for Respiratory Care Please note: $1001 - $5000 Added 07/01/2020 by Gail Drescher, source=Web Response, value=Salary No relevant relationships by Muhammad Hashmi, source=Web Response No relevant relationships by Fatima Hayat, source=Web Response No relevant relationships by Akshay Kohli, source=Web Response No relevant relationships by Emil Oweis, source=Web Response No relevant relationships by Karthik Vedantam, source=Web Response No relevant relationships by Akram Zaaqoq, source=Web Response
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SESSION TITLE: Late-breaking Abstracts SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: To generate a preliminary version of a novel risk score to predict the need for invasive mechanical ventilation (MV) in patients with COVID-19. METHODS: Retrospective analysis of patients >18 years-of-age with laboratory-confirmed COVID-19 admitted between March 15-April 15, 2020 to a tertiary-care center. Demographic, laboratory, clinical, and outcome information were recorded, using a standard data-collection format. RESULTS: The cohort included 265 subjects (mean age 59.3 ±16.4 years, 55.1% male) and 54 (20.4%) required invasive MV. Significant between-group univariate results, based on the need for invasive MV, were used in multiple-regression analysis. Admission heart rate (HR) (OR 1.032 [CI 1.013-1.015];p<0.001), SpO2/FIO2 (S/F) ratio (OR.619 [CI.463-.829];p=0.001), and any positive initial troponin (TnI) (OR 4.18 [CI 1.93-9.036];p<0.001] independently predicted the need for invasive MV. The best cutoff points for the variables HR and S/F ratio were also determined: HR >101.5 BPM (AUC 0.686, 68.5% sensitivity & 66.4% specificity) and S/F ratio <4.4 (AUC 0.714, 72.2% sensitivity & 61.6% specificity). The overall model showed good calibration (Hosmer-Lemeshow = 6.3;p=0.39) and predictive ability (AUC =.80). Patients with a single, positive variable had an invasive MV risk = 15.4%, but this increased to 29% with 2 variables and 60.5% (p<0.001) with the presence of all 3. CONCLUSIONS: This pilot study provides insight into early factors related to patient acuity and the use of medical resources. Thresholds for 3 common clinical variables – HR, S/F ratio and TnI – predicted the need for invasive MV with good accuracy and provide an easily-applied scoring system to determine risk. CLINICAL IMPLICATIONS: We developed a simple, novel risk score to quantify the need for invasive MV in COVID-19 patients, with preliminary testing showing the 3 components had good predictive ability. DISCLOSURES: No relevant relationships by Muhtadi Alnababteh, source=Web Response No relevant relationships by Neerja Desai, source=Web Response Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: $5001 - $20000 Added 07/01/2020 by Gail Drescher, source=Web Response, value=Consulting fee Technical Editor Resp Care Journal relationship with American Association for Respiratory Care Please note: $1001 - $5000 Added 07/01/2020 by Gail Drescher, source=Web Response, value=Salary No relevant relationships by Muhammad Hashmi, source=Web Response No relevant relationships by Emil Oweis, source=Web Response No relevant relationships by Mishaal Talish, source=Web Response No relevant relationships by Karthik Vedantam, source=Web Response