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Introduction: The novel coronavirus has disrupted chronic pain patients’ care, on-going clinical studies, interrupted daily routines and pain management plans, as well as halted social/extracurricular activities. These disturbances may contribute to increased pain intensity, worsening disability, and deteriorating mood in a population with mental and physical health comorbidities. COVID-19 presented a unique opportunity to observe patients’ pain experience, including quality-of-life (QoL) and daily activities, as well as identify and characterize individuals who are potentially susceptible to changes during a substantial stressor. Methods: As part of on-going multi-site Boston Scientific studies prospectively observing up to 1700 chronic leg and back pain patients’ responses to spinal cord stimulation (SCS), we used smartphones to collect daily self-reported pain intensity, mood, sleep, medications, and activities. We also obtained in-clinic questionnaires and objective measures from smartwatches, sleep sensors, weekly voice recordings, and SCS usage. To evaluate changes during COVID-19, we defined two 6-week periods: “COVID” (03/6/2020—04/17/2020), “Pre-COVID” (12/20/2019- 01/30/2020). Since patients may be differentially impacted, we performed multivariate analyses integrating changes in self-reported variables between periods, which were normalized and K-means clustered to identify sub-cohorts. We also administered questions to assess patients’ emotional state during the pandemic, analyzed with natural language processing (NLP). Results: In our results (Figures 1-4), we found no differences in self-reports between pre-COVID and COVID for the entire cohort (n=70/159). However, clustering identified 3 sub-cohorts: individuals whose pain worsened (pain-susceptible), whose activities decreased (ADLsusceptible), and whose mood, sleep, medication, and activities remained the same or improved (QoL-resilient) during COVID. Partial correlations between changes in self-reports also showed differences as a function of period and sub-cohort. Sensor data indicated that NLP-identified fear related speech content during COVID was lower for the QoL-resilient group, who also had greater watch step counts during pre-COVID, supporting the idea that they had the best overall wellbeing or initial behaviors of the 3 groups. There were no differences in clinical assessments or SCS usage between sub-cohorts or periods. Conclusion: Our results indicate the existence of 3 patient sub-cohorts that diverge in their behaviors during COVID-19. We find each sub-cohort has a characteristic signature that allows us to predict the response an individual patient had to the pandemic. These findings demonstrate the importance of multi-dimensional digital monitoring with important implications for telemedicine, clinical trials and neuromodulation system management. Disclosure: Richard Rauck, MD: Boston Scientific: Contracted Research: Self, Medtronic: Contracted Research: Self, Mainstay: Contracted Research: Self, Saluda: Contracted Research: Self, Stimwave: Contracted Research: Self, SPR Therapeutics: Contracted Research: Self, Nevro: Contracted Research: Self, Neuros: Contracted Research: Self, Sara Berger, PhD: IBM: Employee:, Guillermo Cecchi, PhD: IBM: Employee:, Carla Agurto, PhD: IBM: Employee:, Elif Eyigoz, PhD: IBM: Employee:, Kristen Lechleiter, MS: Boston Scientific: Employee:, Dat Huynh, PhD: Boston Scientific: Employee:, Brad Hershey, BS: Boston Scientific: Employee:, Eric Loudermilk, MD: None, Julio Paez, MD: None, Louis Bojrab, MD: None, John Noles, MD: None, Todd Turley, MD: None, Mohab Ibrahim, MD: None, Amol Patwardhan, MD: None, James Scowcroft, MD: Nevro: Contracted Research:, Boston Scientific: Contracted Research:, Saluda: Contracted Research:, Rene Przkora, MD: Boston Scientific, Abbott, Nevro, Medtronic: Contracted Research:, Nathan Miller, MD: None, Gassan Chaiban, MD: Boston Scientific: Consulting Fee:, Matt McDonald, MS: Boston Scientific: Salary/Employee: Self, Jeffrey Rogers, PhD: IBM: Employee: [Formul presented] [Formula presented] [Formula presented]
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PURPOSE: Conclusive data on safety of remdesivir in renal impaired as well as the incidence of liver injury are lacking. The primary objective of this study is to assess the incidence of acute kidney injury (AKI) and to trend the liver function tests (LFTs) during remdesivir treatment and change in eGFR from baseline to end of remdesivir treatment as well as 48 hours after completion of therapy. METHODS: This is a retrospective chart review study including adult Covid19 patients receiving remdesivir with a baseline eGFR< 30 ml/min per 1.73 m∧2 from December 2020 to May 2021. The primary outcome of the study is the incidence of AKI and hepatic injury. The secondary outcome is to assess the efficacy of remdesivir defined by oxygen requirement during therapy. RESULTS: Seventy-one patients were included in the study. Average eGFR improved by 30.3% at the immediate end of remdesivir treatment and by 30.6% at 48 hours after the end of the treatment (both P< 0.0001). Comparing to baseline, creatinine at the end of remdesivir treatment decreased by 20.9% (P< 0.0001), creatinine of 48 hour after remdesivir treatment decreased by 20.5% (P< 0.0001). Creatinine clearance increased by 26.6% (P< 0.0001) at end of treatment and increased by 26.2% (P< 0.0001) by 48 hours after end of treatment. AST average increased by 2.5% at the end of remdesivir treatment (P=0.727). At 48 hours after remdesivir completion, average AST dropped by 15.8% (P=0.021). ALT average increased by 25% (P=0.004) at the end of remdesivir treatment and increased by 12.0% (P=0.137) at 48 hours after remdesivir completion. Both direct and total bilirubin at end of remdesivir treatment as well as 48 hours later remained stable and did not have significant changes from baseline (P >0.05). Overall, 38% (27 out of 71 patients) experienced oxygenation improvement shown by down-titration of oxygen therapy. Fifty-seven percent of patients received other nephrotoxic medications. The mortality rate is 33.8%. Fifteen of the 71 patients were admitted into ICU. Sixty-five percent (46/71) patients were discharged alive from hospital. CONCLUSIONS: This study showed that remdesivir use in renally impaired Covid 19 patients with eGFR< 30 ml/min is safe and effective. However, large and prospective studies are needed to validate our findings.
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INTRODUCTION: The COVID-19 pandemic is this century's largest public health emergency and its successful management relies on the effective dissemination of factual information. As a social media platform with billions of daily views, YouTube has tremendous potential to both support and hinder public health efforts. However, the usefulness and accuracy of most viewed YouTube videos on COVID-19 have not been investigated. METHODS: A YouTube search was performed on 21 March 2020 using keywords 'coronavirus' and 'COVID-19', and the top 75 viewed videos from each search were analysed. Videos that were duplicates, non-English, non-audio and non-visual, exceeding 1 hour in duration, live and unrelated to COVID-19 were excluded. Two reviewers coded the source, content and characteristics of included videos. The primary outcome was usability and reliability of videos, analysed using the novel COVID-19 Specific Score (CSS), modified DISCERN (mDISCERN) and modified JAMA (mJAMA) scores. RESULTS: Of 150 videos screened, 69 (46%) were included, totalling 257 804 146 views. Nineteen (27.5%) videos contained non-factual information, totalling 62 042 609 views. Government and professional videos contained only factual information and had higher CSS than consumer videos (mean difference (MD) 2.21, 95% CI 0.10 to 4.32, p=0.037);mDISCERN scores than consumer videos (MD 2.46, 95% CI 0.50 to 4.42, p=0.008), internet news videos (MD 2.20, 95% CI 0.19 to 4.21, p=0.027) and entertainment news videos (MD 2.57, 95% CI 0.66 to 4.49, p=0.004);and mJAMA scores than entertainment news videos (MD 1.21, 95% CI 0.07 to 2.36, p=0.033) and consumer videos (MD 1.27, 95% CI 0.10 to 2.44, p=0.028). However, they only accounted for 11% of videos and 10% of views. CONCLUSION: Over one-quarter of the most viewed YouTube videos on COVID-19 contained misleading information, reaching millions of viewers worldwide. As the current COVID-19 pandemic worsens, public health agencies must better use YouTube to deliver timely and accurate information and to minimise the spread of misinformation. This may play a significant role in successfully managing the COVID-19 pandemic.