Association of Body Mass Index with the Severity of SARS-COVID-19 Pneumonia in Hospitalized Patients

Objective: To determine the association of body mass index with the severity of COVID-19 pneumonia in hospitalized patients. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, form May to Jun 2021. Methodology: Patients diagnosed with COVID-19 pneumonia on PCR and chest imaging and admitted to our hospital were included in the study. Body mass index was calculated on the first day of hospital admission, and they were followed up for two weeks during the disease. Increased oxygen demand, duration of admission, CT severity score and use of non-invasive ventilation were compared in patients with normal and increased body mass index. Results: A total of 800 COVID-19 patients admitted to the hospital were included in the final analysis. The mean age of the study participants was 41.36±4.55 years. Out of 800 patients, 337(42.1%) had normal BMI, 420(52.5%) were classed in the category of overweight and 43(5.4%) were obese. Furthermore, it was seen that increased demand for oxygen, high CT severity score and longer duration of hospital admission had a statistically significant relationship (p-value<0.05) with high body mass index. Conclusion: More than half of the patients admitted after diagnosis of COVID-19 had higher than normal body mass index. A significant association was found between increased demand for oxygen, high CT severity score, longer hospital admission duration, and high body mass index. © 2022, Army Medical College. All rights reserved.

Expanding interventional oncology services with the use of remote proctorship

Learning Objectives: Demonstrate the use of tele-medicine in remote proctorship when performing procedures during the COVID-19 pandemic. Background(s): Tumour ablation is a growing field within Interventional Radiology, providing a minimally invasive option in the treatment of renal, hepatic, lung and bone lesions. While the practice of tumour ablation is rapidly gaining acceptance, the expertise is still largely concentrated within specialist centres. Until recently, the few experienced practitioners could travel to support other clinicians in performing these procedures but the recent pandemic has halted this practice. We present our experience of remote proctorship in the expansion of our oncology services, offering our patients minimally invasive therapeutic options as part of their oncology care. Procedure Details: Seven ablation cases were performed over four days with virtual assistance via the Proximie platform. Cameras were used to relay the live operating field to the proctor. The intra-procedural CT images displayed in theatre were also directly linked and the addition of a tablet with an encrypted video link allowed the proctor to be seen by the operators. The proctor used integrated augmented reality tools to point, annotate and demonstrate on the screen in theatre in real time and a closed 2- way communication system was used between the operators and proctor to facilitate a dialogue throughout the procedure. Conclusion(s): The use of novel remote proctorship technology enables physicians to continue to be to able offer patients cutting edge technological advancements safely, at a time when on site presence is limited by the COVID-19 pandemic.

Streamlining day case procedures: tackling the backlog in post-COVID healthcare

Purpose: Hospitals worldwide face huge patient backlogs following the delays caused by the recent COVID-19 pandemic. Interventional Radiology (IR) is required to increase productivity to 120% in order to address the backlog and keep up with ongoing service demands. After a period of observation within the department, lack of recovery space was noted as a rate limiting step in patient and theatre turnover. Material(s) and Method(s): Data regarding a selection of day case procedures was obtained from patient tracking software. A total of 214 cases were reviewed. A literature review was also performed to determine the recommended recovery time for each procedure to develop new departmental guidelines. Result(s): The average recovery time for some procedures exceeded the recommendations in the literature. Results are listed as procedure: average recovery time;recommended time (hours:mins). The availability of a doctor to review and discharge patients was noted to be the cause of delay in some cases. A nurse-led discharge pathway, in another surgical speciality, has been reported in the literature to improve efficiency while maintaining safety. Conclusion(s): The recovery times for day case procedures far exceeds the reported recommendations, limiting our productivity. At present, a nurse-led discharge pathway does not exist within IR. We plan to explore this avenue as a means to increase patient turnover. Further work in training and creation of standard operating procedures is required before this can be implemented. (Table Presented).

The impact of perceived organizational support on professional commitment: a moderation of burnout and mediation of well-being

Purpose: In today’s challenging world, achieving professional commitment among healthcare workers is becoming the need of time. Drawing on self-determination theory, the current study examines how and under which boundary conditions perceived organizational support affects professional commitment. Design/methodology/approach: Data was collected from doctors and nurses employed in public and private sector hospitals by employing a split-questionnaire design. Findings: The authors’ study findings demonstrate that perceived organizational support has a positive and indirect effect on the professional commitment of nurses and doctors via mediating the role of subjective well-being. The authors also found that these findings depend on healthcare workers’ burnout levels. The positive relationship between perceived organizational support and subjective well-being is attenuated by burnout syndrome. Practical implications: The current study poses implications for policymakers and administrators of healthcare institutions as well as to develop a supportive culture to evoke more professional commitment among healthcare workers. Implications for nursing managers and policymakers are discussed in light of the study findings. Originality/value: Healthcare institutions are increasingly paying attention to raising the professional commitment of their workforce, especially in the wake of a crisis like the COVID-19 outbreak. The current study will add to the body of literature on nursing management, healthcare studies and organizational psychology in the South Asian context by explaining the relationship between POS and professional commitment, drawing on self-determination theory. © 2022, Emerald Publishing Limited.

Enhancing the perceived organizational support, perceived ethical-philanthropic CSR and subjective well-being: the role of ethical leadership

Purpose: This study aims to examine the impact of ethical leadership style on the subjective well-being of health-care workers by examining the sequential mediating effects of perceived organizational support and perceived ethical-philanthropic corporate social responsibility (CSR). Design/methodology/approach: Data were collected from frontline health-care workers (i.e. doctors and nurses). Further, to cope with the response burden during the acute wave of the coronavirus pandemic, this study used split-questionnaire design for data collection. Findings: This study’s findings fully support the hypothesized framework of the study, illustrating that ethical leadership positively influenced the subjective well-being of health-care workers. Moreover, this study found that the ethical leadership and well-being relationship is sequentially mediated by perceived organizational support and perceived ethical-philanthropic CSR. Practical implications: This study possesses practical implications for health-care institutions to encompass the agenda of developing ethically appropriate conduct in their administration and become genuinely concerned about health-care workers and society as well. Social implications: By highlighting the role of ethical leadership in participating in ethical and philanthropic CSR activities, this study possesses social implications for the well-being of health-care workers and society at large. Originality/value: A positive and strong chain of perceptions about organizational support accorded to employees specifically and society at large emerges as an important sequential mediating mechanism that helps ethical leaders in hospital administration in building subjective well-being in their followers amid the COVID-19 pandemic. © 2022, Emerald Publishing Limited.

ANCHORING BIAS DURING THE COVID-19 PANDEMIC

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Patients presenting in New York City, the epicenter for COVID in the United States, with severe hypoxic respiratory failure in the past year with acute respiratory distress syndrome (ARDS) signs were thought to exclusively have COVID-19 pneumonia. Even if initial tests were negative, physicians often anchored on the diagnosis of COVID as the disease was rapidly spreading and hospitals were at maximum capacity. We present a case of a young male who presented with severe hypoxic respiratory failure in the early stages of the pandemic who was found to be negative for COVID-19 and subsequently found to have pneumocystis jiroveci pneumonia (PJP). CASE PRESENTATION: This is a 42 year-old male with a past medical history of controlled diabetes mellitus type 2, hypertension, and a previous smoker who presented with worsening progressive shortness of breath for three days. On admission, the patient was found to be tachycardic, tachypneic and hypoxic. Chest x-ray showed bilateral diffuse infiltrates most consistent with ARDS. ABG revealed severe hypoxia with PO2 of 39 on room air. He was initially placed on bi-level with minimal improvement and was subsequently intubated. Initial oropharyngeal and nasopharyngeal COVID-19 swabs were negative. His influenza PCR also resulted as negative. Sputum cultures, endotracheal aspirate and blood cultures all returned back negative. On day three of his admission, the patient was tested for HIV and found to be positive with CD4 count <50. He was started on TMP-SMX and methylprednisolone for suspected PJP pneumonia. Due to fears from the ongoing and heightening pandemic, the patient was tested yet again for COVID swab and it resulted negative. He underwent a bronchoscopy with BAL which confirmed the diagnosis of PJP. Patient continued to improve on antibiotics, was eventually extubated, and started on antiretroviral therapy with improvement of CD4 at three month follow-up. DISCUSSION: Physicians have become blinded from the COVID pandemic and often anchor to the diagnosis of severe hypoxic respiratory failure from COVID-19. Other diseases such as PJP can present similarly and prompt treatment is necessary. PJP has a high morbidity and mortality rate amongst immunocompromised patients and remains a leading opportunistic infection in AIDS patients. Our patient was a school teacher who denied any intravenous drug abuse or high-risk sexual encounters. CONCLUSIONS: Although many patients present with severe hypoxic respiratory distress and require mechanical ventilation during the ongoing COVID-19 pandemic, it is important to rule out other infectious causes of ARDS such as PJP which can also lead to morbid outcomes if not treated appropriately. REFERENCE #1: Gaborit BJ, Tessoulin B, Lavergne RA, et al. Outcome and prognostic factors of Pneumocystis jirovecii pneumonia in immunocompromised adults: a prospective observational study. Ann Intensive Care. 2019;9(1):131. Published 2019 Nov 27. doi:10.1186/s13613-019-0604-x REFERENCE #2: Harris, J.R., Balajee, S.A. & Park, B.J. Pneumocystis Jirovecii Pneumonia: Current Knowledge and Outstanding Public Health Issues. Curr Fungal Infect Rep 4, 229–237 (2010). https://doi.org/10.1007/s12281-010-0029-3 DISCLOSURES: No relevant relationships by Sahar Ilyas, source=Web Response No relevant relationships by Navim Mobin, source=Web Response No relevant relationships by Nisha Patel, source=Web Response No relevant relationships by Michal Tokarski, source=Web Response

A Multicenter Evaluation of the Feasibility, Patient/Provider Satisfaction, and Value of Virtual Spine Consultation During the COVID-19 Pandemic.

OBJECTIVE: To assess the feasibility, patient/provider satisfaction, and perceived value of telehealth spine consultation after rapid conversion from traditional in-office visits during the COVID-19 pandemic. METHODS: Data were obtained for patients undergoing telehealth visits with spine surgeons in the first 3 weeks after government restriction of elective surgical care at 4 sites (March 23, 2020, to April 17, 2020). Demographic factors, technique-specific elements of the telehealth experience, provider confidence in diagnostic and therapeutic assessment, patient/surgeon satisfaction, and perceived value were collected. RESULTS: A total of 128 unique visits were analyzed. New (74 [58%]), preoperative (26 [20%]), and postoperative (28 [22%]) patients were assessed. A total of 116 (91%) visits had successful connection on the first attempt. Surgeons felt very confident 101 times (79%) when assessing diagnosis and 107 times (84%) when assessing treatment plan. The mean and median patient satisfaction was 89% and 94%, respectively. Patient satisfaction was significantly higher for video over audio-only visits (P < 0.05). Patient satisfaction was not significantly different with patient age, location of chief complaint (cervical or thoracolumbar), or visit type (new, preoperative, or postoperative). Providers reported that 76% of the time they would choose to perform the visit again in telehealth format. Sixty percent of patients valued the visit cost as the same or slightly less than an in-office consultation. CONCLUSIONS: This is the first study to demonstrate the feasibility and high patient/provider satisfaction of virtual spine surgical consultation, and appropriate reimbursement and balanced regulation for spine telehealth care is essential to continue this existing work.

Characteristics, clinical course, and outcomes of veterans admitted with Covid-19 in Detroit, Michigan

Background The deaths due to coronavirus disease (Covid-19) in Michigan have been disproportionately centered in the city of Detroit. We sought to characterize hospitalized veterans with Covid-19 infection in Detroit, MI and compare them to inpatients previously reported. Methods A retrospective observational study of 79 veterans admitted to a veteran's hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 10, through April 6, 2020. Each patient had at least 30 days of follow-up. Results The median age of 79 enrolled patients was 69.0 years (interquartile range, 57.0-75.0 years) and 74 (94%) were men. Twenty-four (30%) had a recent emergency department visit. Respiratory symptoms were present in 67 (85%). Gastrointestinal symptoms were common (49 [62%]), including diarrhea (27 [34%]) and loss of appetite (31 [39%]). Only 30 (38%) patients had fever on admission. Comorbidities included hypertension (73 [92%]), diabetes (48 [61%]), obesity (42 [53%]), chronic obstructive pulmonary disease (30 [38%]), coronary disease (28 [35%]), and obstructive sleep apnea (25 [32%]). Nine patients were admitted to the intensive care unit, and 18 (26%) of 70 required intensive care unit transfer. Twenty-Four (30%) were intubated;of which 3 were extubated and 20 (83%) died. Of the 57 (72%) patients discharged alive, 22 (39%) required supplemental oxygen and 8 (14%) were readmitted within 30 days. Conclusions Detroit veterans were primarily older African American men with more comorbidities than inpatients previously described. Gastrointestinal symptoms were twice as common as fever. Rates of mortality and readmission were higher than those previously reported in populations with shorter follow up. © Wolters Kluwer Health, Inc. All rights reserved.