ABSTRACT
Background. Patients hospitalized with severe COVID-19 infections are at risk for acute thromboembolism. There are few data on the impact of vaccines on COVID-associated acute thromboembolism (CA-ATE) in patients hospitalized with COVID-19 infection. Methods. Retrospective cohort of CA-ATE between March 2020 and March 2022 (Torrance Memorial Medical Center, pre-pandemic ATE incidence < 1%). Inclusion criteria were confirmed COVID infection, > 18 years, not admitted to ICU, and standard-dose thromboprophylaxis. Exclusion criteria were pregnancy, partial vaccination, and therapeutic dose anticoagulation. Primary outcome was CA-ATE incidence identified by routine clinical testing. We performed a multiple logistic regression for CA-ATE risk factors. Results. Of 3,218 hospitalized COVID-19 patients, 1,428 patients were included;185 were vaccinated (13%) and 1,243 unvaccinated (87%). Vaccinated status was associated with older age, diabetes, heart failure, and chronic kidney disease (p< 0.01). CA-ATE was noted in 7.0% (2.2% deep vein thrombosis (DVT), 0.5% pulmonary embolism (PE), 2.7% myocardial infarction (MI), 1.6% Ischemic stroke (IS)) in the vaccinated and 3.9% (2.7% DVT, 1.5% PE, 1.0% MI, 0.8% IS) in the unvaccinated. In our multivariate model, we found no significant difference in incident CA-ATE between vaccinated and unvaccinated (7.0% vs 3.9%, adj OR=1.35, [95% CI 0.67-2.58], p=0.38). CA-ATE was associated with older age (68 vs 61 years, OR=1.03, [95% CI 1.01-1.05], p=0.01) and heart failure (24% vs 7%, OR=2.84, [95% CI 1.35-6.00], p=0.006). No significant difference was seen in mortality (3.8% vs 4.8%, OR=0.79, [95% CI 0.35-1.69], p=0.56), CRP AUC24hr (5.7 vs 4.7, p=0.18), or D-dimer AUC24hr (596 vs 653, p=0.77) between vaccinated and unvaccinated patients. Conclusion. Adult, non-ICU, hospitalized, COVID-19 patients are at high risk for ATE. We found no association between vaccination status and ATE, but older age and congestive heart failure were predictive in this population. Decisions to anticoagulate non-ICU patients hospitalized with acute COVID-19 infections may not need to consider COVID vaccination status in as part of medical decision making, but may instead need to focus on underlying, high-risk, co-morbidities.
ABSTRACT
Background. In December 2020, B.1.1.7 lineage of SARS-CoV-2 was first detected in the United States and has since become the dominant lineage. Previous investigations involving B.1.1.7 suggested higher rates of transmission relative to non-B.1.1.7 lineages. We conducted a household transmission investigation to determine the secondary infection rates (SIR) of B.1.1.7 and non-B.1.1.7 SARS-CoV-2 lineages. Methods. From January-April 2021, we enrolled members of households in San Diego County, CA, and Denver, CO metropolitan area (Tri-County), with a confirmed SARS-CoV-2 infection in a household member with illness onset date in the previous 10 days. CDC investigators visited households at enrollment and 14 days later at closeout to obtain demographic and clinical data and nasopharyngeal (NP) samples on all consenting household members. Interim visits, with collection of NP swabs, occurred if a participant became symptomatic during follow-up. NP samples were tested for SARS-CoV-2 using TaqPath™ RT-PCR test, where failure to amplify the spike protein results in S-Gene target failure (SGTF) may indicate B.1.1.7 lineage. Demographic characteristics and SIR were compared among SGTF and non-SGTF households using two-sided p-values with chi-square tests;95% confidence intervals (CI) were calculated with Wilson score intervals. Results. 552 persons from 151 households were enrolled. 91 (60%) households were classified as SGTF, 57 (38%) non-SGTF, and 3 (2%) indeterminant. SGTF and non-SGTF households had similar sex distribution (49% female and 52% female, respectively;P=0.54) and age (median 30 years, interquartile range (IQR 14-47) and 31 years (IQR 15-45), respectively). Hispanic people accounted for 24% and 32% of enrolled members of SGTF and non-SGTF households, respectively (p=0.04). At least one secondary case occurred in 61% of SGTF and 58% of non-SGTF households (P=0.66). SIR was 52% (95%[CI] 46%-59%) for SGTF and 45% (95% CI 37%-53%) for non-SGTF households (P=0.18). Conclusion. SIRs were high in both SGTF and non-SGTF households;our findings did not support an increase in SIR for SGTF relative to non-SGTF households in this setting. Sequence confirmed SARS-CoV-2 samples will provide further information on lineage specific SIRs.
ABSTRACT
BACKGROUND: There is a lack of evidence on how the multimodal dynamic process of resilience has impacted personal adaptation of frontline healthcare professionals, working under extreme pressure during the COVID-19 global pandemic. OBJECTIVES: To explore resilience, burnout and wellbeing for UK pharmacists in patient-facing roles, including individual and organisational factors that align to the ABC-X theoretical model of the dynamic process of resilience. METHODS: A non-experimental pragmatist research design was adopted, with a cross-sectional online survey distributed via social media and professional networks between June and July 2020. Quantitative data aligned to a positivist research paradigm was collected using validated scores, to statistically analyse wellbeing, burnout and resilience. Qualitative textual data, consistent with an interpretivist research paradigm, were analysed following an inductive thematic approach. RESULTS: A total of 199 surveys from pharmacists working within community, hospital and GP sectors were analysed. Wellbeing scores were strongly correlated to resilience scores. Wellbeing and resilience scores were both inversely correlated with burnout scores. Two-thirds of participants were classified as high-risk within the burnout scales.Key stressors were highlighted by participants, who described how individual resources and perceptions shaped their experience, which overall contributed to their burnout. Organisations that supported pharmacists embraced change and quickly adopted new ways of working, such as teleconsultations, flexible and remote working, redesign of workflow, alongside clear guidance. However, there was also reported frustration at lack of, slow or conflicting guidance from employers. CONCLUSIONS: This study adds to the growing evidence base for how individuals are affected by adverse events in a dynamic environment, alongside the role that employers can play in supporting individual and organisational resilience. It provides an opportunity to learn from pharmacists' responses to the COVID-19 pandemic, and a call to action for healthcare organisations to rebuild and invest resources into sustained support for staff wellbeing.
ABSTRACT
Evidenced annual impact of a specialist commissioned regional tracheostomy team aiming to reduce the risk of community tracheostomies.There are an increasing number of tracheostomies being inserted nationally with no national framework for ongoing review following discharge to the community setting. This has the potential to result in poor clinical outcomes and ongoing dependence on acute care services and high cost packages of care. Prior to this service innovation, community tracheostomy patients were managed primarily by GP’s with very few patients receiving specialist input. We found that this was resulting in repeated hospital admissions, lack of specialist review to assess for weaning potential and due to the lack of tracheostomy competent placements, was causing individuals to be relocated away from their families. £301,000 investment from regional Clinical Commissioning Groups (CCG’s) was secured in April 2020 to create a specialist Nurse/Allied Health Professional led team consisting of 2.5 team members: Nurse (Clinical Lead), Physiotherapist and Speech and Language Therapist. Quantitative and qualitative data was collected during the first year of substantive funding to evidence service impact including: number of community decannulations with associated continuing healthcare cost saving, reduced dependence on secondary care, improved access to community placements, hospital admission avoidances and lived patient experiences. A total cost saving of £405,050.68 with an additional cost avoidance of £2,700,000 from acute in-reach decannulations during the first 6-month COVID-19 wave was achieved over this 12-month period. We have demonstrated the positive impact specialist tracheostomy services can have across primary and secondary care with the aim of this service model being used for national service provision pathway developments. Specialist tracheostomy services can achieve huge impact within the community setting both to improve clinical outcomes for this vulnerable patient group and to achieve substantial annual cost saving to the NHS.
ABSTRACT
Introduction: COVID-19 has acted as a catalyst for radical changes in the working practices of pharmacists. Whilethere is emerging evidence of adaptability mitigating burnoutamongst pharmacists in other countries (1), what has yet tobe established is the extent to which the well-being and resilience of pharmacists in the UK may be supported throughchanges in intra and inter-professional working practices.Aim: As part of a wider project aiming to explore the impact of COVID-19 on pharmacists' wellbeing and resilience,in this abstract we present findings exploring the impact onworking relationships within pharmacy and multidisciplinary teams.Methods: An online questionnaire containing validatedmeasures of wellbeing and resilience and free-text openquestions exploring the impact of COVID-19 on workingpractices was piloted on five practising pharmacists. Thisquestionnaire was subsequently distributed via social mediaand professional networks in June 2020. Convenience sampling was used whereby any UK-registered pharmacist in apatient-facing role was eligible to take part. Inductive thematic analysis of the free text responses was conducted. Thisabstract presents one key theme;intra and inter-professionalrelationships.Results: A total of 202 questionnaires were completed(Table 1), with 192 participants entering free-text responses. Participants reported pharmacy teams becoming closer,supporting one another and working more cohesively. Workredesign and staff upskilling were given as positive examplesof practice change in response to the pandemic. Reportedchallenges included managing conflict within a team due toheightened stress, sustaining staff morale, exhaustion, andprioritising others to the detriment of their own wellbeing:"I have no time for myself as I'm too busy keeping the dayto day working and supporting my team emotionally. I'memotionally exhausted and at home I withdraw and ignorethe outside world as I'm at breaking point but don't want mycolleagues to see this."Inter-professional relationships sometimes improved as aresult of more effective communication, extended networkingand pharmacists feeling valued and recognised as integralto multidisciplinary working. Supportive inter-professionalworking was described as a "Great sense of comradery-we're in this together". Yet for others, inter-professionalworking proved challenging, with non-engagement of clinicians, frequently changing guidance from senior management, and restricted staff interaction due to remote or shiftworking. Conclusions: Whilst for some the pandemic facilitated improved inter-and intra-professional interactions, for othersthis was viewed as challenges of daily practice. Due to recruiting via social media, this study is limited by the responsenumbers and is therefore not representative of all UK registered pharmacists. However, a key strength is that pharmacists from all sectors of practice responded, in comparisonto other studies which have focused solely on communitypharmacists. Results from this study can be used to supportsustainable change in fostering collaborative working withinpharmacy and multi-professional healthcare teams.