Factors Associated with Hospitalization with Symptomatic Coronavirus Disease 2019 among Pregnant Individuals: A Multicenter Retrospective Cohort Study

Background: Pregnant individuals are at increased risk of coronavirus disease 2019 (COVID-19) hospitalization and death, and primary and booster COVID-19 vaccination is recommended for this population. Method(s): Among a cohort of pregnant individuals who received prenatal care at 3 healthcare systems in the United States, we estimated the cumulative incidence of hospitalization with symptomatic COVID-19 illness. We also identified factors associated with COVID-19 hospitalization using a multivariable Cox proportional hazards model with pregnancy weeks as the timescale and a time-varying adjustor that accounted for severe acute respiratory syndrome coronavirus 2 circulation;model covariates included site, age, race, ethnicity, insurance status, prepregnancy weight status, and selected underlying medical conditions. Data were collected primarily through medical record extraction. Result(s): Among 19 456 pregnant individuals with an estimated due date during 1 March 2020-28 February 2021, 75 (0.4%) were hospitalized with symptomatic COVID-19. Factors associated with hospitalization for symptomatic COVID-19 were Hispanic ethnicity (adjusted hazard ratio [aHR], 2.7 [95% confidence interval {CI}, 1.3-5.5]), Native Hawaiian or Pacific Islander race (aHR, 12 [95% CI, 3.2-45.5]), age <25 years (aHR, 3.1 [95% CI, 1.3-7.6]), prepregnancy obesity (aHR, 2.1 [95% CI, 1.1-3.9]), diagnosis of a metabolic disorder (aHR, 2.2 [95% CI, 1.2-3.8]), lung disease excluding asthma (aHR, 49 [95% CI, 28-84]), and cardiovascular disease (aHR, 2.6 [95% CI, 1.5-4.7]). Conclusion(s): Although hospitalization with symptomatic COVID-19 was uncommon, pregnant individuals should be aware of risk factors associated with severe illness when considering COVID-19 vaccination. Copyright © 2022 Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Supporting People Receiving Substance Use Treatment during COVID-19 through a Professional-Moderated Online Peer Support Group

The COVID-19 pandemic exacerbated the ongoing opioid crisis in the United States. Individuals with a substance use disorder are vulnerable to relapse during times of acute stress. Online peer support communities (OPSCs) have the potential to decrease social isolation and increase social support for participants. In September 2020, we launched a private, professional-moderated OPSC using the Facebook Group platform to study its effects on the mental health wellness of women undergoing substance use treatment. This study was particularly meaningful as the participants were not able to join in-person treatment sessions due to the COVID-19 pandemic. Preliminary findings indicate that study participants reported decreased loneliness and increased online social support three months after initiating the OPSC. They tended to interact with content initiated by a clinical professional more than those generated by peers. © 2022 ACM.

Home spirometry is reliable and of consistent quality in children with cystic fibrosis

Background: Respiratory management of cystic fibrosis (CF) relies on accurate monitoring of trends in lung function. The COVID-19 pandemic accelerated uptake of home spirometers at our paediatric & adult CF centres. Objectives: To establish the reliability and consistency of home-measured spirometry compared to clinic spirometry in children with CF. Methods: A single centre retrospective study. A timeline was constructed for each individual consisting of 3 pre-pandemic hospital clinic sessions and 3 subsequent virtual sessions. The acceptable period between sessions was 3–12weeks. Remote deviceswere Nuvoair® Next or Spirobank® Smart. Control data from CF adults with concurrent clinic and home Nuvoair® data in 2019. Accepted FVC & FEV1session values were used to calculate coefficient of variance (CoV). Sessions graded as ‘F’ (ATS guidelines) were noted but excluded. GLI percent predicted values were used, with height values interpolated from growth charts if necessary. Results: Sequential spirometry data and baseline demographics are shown in table 1 (n = 139). The proportion of acceptable and unacceptable spirometry (ATS) did not differ between Nuvoair® and hospital measurements. There were more A grades and fewer F grades with hospital spirometry. (Table Presented) Conclusions: Routine home spirometry had acceptable variability and quality compared to hospital measures. The step-up in home spirometry measurements for children using Nuvoair® was not seen in pre-pandemic adult data. The differences between home and hospital measures in children suggest an influence of isolation above that of equipment differences.

Efficacy and safety of the EMS Swiss LithoClast® Trilogy for PCNL: results of the European multicentre prospective study on behalf of European Section of UroTechnology.

PURPOSE: PCNL requires a lithotrite to efficiently break stones, and some devices include active suction to remove the fragments. We set out to determine the efficacy and safety of the Swiss LithoClast® Trilogy, in a prospective European multicentre evaluation and compared it to published stone clearance rates for Trilogy based on surface area (68.9 mm2/min) and using the 3D calculated stone volume (526.7 mm3/min). METHODS: Ten European centres participated in this prospective non-randomized study of Trilogy for PCNL. Objective measures of stone clearance rate, device malfunction, complications and stone-free rates were assessed. Each surgeon subjectively evaluated ergonomic and device effectiveness, on a 1-10 scale (10 = extremely ergonomic/effective) and compared to their usual lithotrite on a 1-10 scale (10 = extremely effective). RESULTS: One hundred and fifty seven PCNLs using Trilogy were included (53% male, 47% female; mean age 55 years, range 13-84 years). Mean stone clearance rate was 65.55 mm2/min or 945 mm3/min based on calculated 3D volume. Stone-free rate on fluoroscopy screening at the end of the procedure was 83%. Feedback for suction effectiveness was 9.0 with 9.1 for combination and 9.0 for overall effectiveness compared to lithotrite used previously. Ergonomic score was 8.1, the least satisfactory element. Complications included 13 (8.2%) Clavien-Dindo Grade II and 2 (1.3%) Grade III. Probe breakage was seen in 9 (5.7%), none required using a different lithotrite. CONCLUSIONS: We have demonstrated that Trilogy is highly effective at stone removal. From a user perspective, the device was perceived by surgeons to be highly effective overall and compared to the most commonly used previous lithotrite, with an excellent safety profile.

From hospital to home: Virtually observed Administration of biologics in children with Severe asthma during covid-19

Introduction and Objectives Children with severe asthma receiving biologic injections, require 2-4 weekly hospital visits. Omalizumab and mepolizumab are licensed for home use, however data on the safety of home administration in children is lacking. In March 2020 due to Covid-19, services urgently needed to be redesigned to reduce footfall within the hospital and protect shielding patients and we trialled home administration. Methods Families suitable for home-administration were identified by the multidisciplinary team (MDT). If they accepted, they were then consented and attended hospital for a face to face, two-hour training session with the Clinical Nurse Specialist (CNS). Subsequent injections were supervised by video call with the CNS. Spirometry, measured using a home spirometer (Nuvoair®), Asthma Control Test (ACT), Paediatric Asthma Quality of Life Questionnaire (PAQLQ), oral corticosteroid (OCS) requirement and unscheduled healthcare visits were documented 4 weekly. Results Of 23 patients, 16 (70%) were identified by the MDT as suitable for home-administration;14 families agreed to this recommendation and 2 patients agreed to local services administering it. All were trained within four weeks. 7 patients were unsuitable (dose not licensed for home administration n=1;parent not wanting to administer n=2;safeguarding concerns n=2, previous mild reaction n=1;not fully established on biologic, n=1). We initially encountered some problems including parents not giving a full dose (1) and breaking the syringe (1). However, video call supervision ensured issues were addressed in real time and appropriate action taken. There were no adverse effects. Forced expiratory volume in one second (FEV1) remained unchanged, unscheduled healthcare visits and OCS courses did not increase with virtually observed home-administration of biologics. ACT and PAQLQ scores improved during the first 4 months of home-administration. Conclusions Virtually observed home-administration of omalizumab and mepolizumab is a feasible and safe option. To our knowledge we were the first UK paediatric centre to implement this model, with home spirometry and video calls supporting home-administration. Consequently, this has changed our practice and once established, virtually observed home-administration can be offered to suitable families, being mindful of the financial and time implications this high level service requires.

Initiating home spirometry for children during the COVID-19 pandemic - A practical guide.

The COVID-19 pandemic has led to a rapid escalation in use of home monitoring and video consultations in children with a variety of chronic respiratory conditions. Our department set up a home spirometry service from scratch once it became evident that we needed to keep patients away from hospital clinics whenever possible. We faced a number of challenges but now have around 400 children using home spirometers. There are a number of portable spirometers available, some with online platforms. The technology, particularly the software/apps interface, has been improved by the companies in response to issues that have arisen. We believe the use of home monitoring is here to stay.

P95 From hospital to home: virtually observed administration of biologics in children with severe asthma during COVID-19

Introduction and ObjectivesChildren with severe asthma receiving biologic injections, require 2–4 weekly hospital visits. Omalizumab and mepolizumab are licensed for home use, however data on the safety of home administration in children is lacking. In March 2020 due to Covid-19, services urgently needed to be redesigned to reduce footfall within the hospital and protect shielding patients and we trialled home administration.MethodsFamilies suitable for home-administration were identified by the multidisciplinary team (MDT). If they accepted, they were then consented and attended hospital for a face to face, two-hour training session with the Clinical Nurse Specialist (CNS). Subsequent injections were supervised by video call with the CNS. Spirometry, measured using a home spirometer (Nuvoair®), Asthma Control Test (ACT), Paediatric Asthma Quality of Life Questionnaire (PAQLQ), oral corticosteroid (OCS) requirement and unscheduled healthcare visits were documented 4 weekly.ResultsOf 23 patients, 16 (70%) were identified by the MDT as suitable for home-administration;14 families agreed to this recommendation and 2 patients agreed to local services administering it. All were trained within four weeks. 7 patients were unsuitable (dose not licensed for home administration n=1;parent not wanting to administer n=2;safeguarding concerns n=2, previous mild reaction n=1;not fully established on biologic, n=1).We initially encountered some problems including parents not giving a full dose (1) and breaking the syringe (1). However, video call supervision ensured issues were addressed in real time and appropriate action taken. There were no adverse effects.Forced expiratory volume in one second (FEV1) remained unchanged, unscheduled healthcare visits and OCS courses did not increase with virtually observed home-administration of biologics. ACT and PAQLQ scores improved during the first 4 months of home-administration.ConclusionsVirtually observed home-administration of omalizumab and mepolizumab is a feasible and safe option.To our knowledge we were the first UK paediatric centre to implement this model, with home spirometry and video calls supporting home-administration. Consequently, this has changed our practice and once established, virtually observed home-administration can be offered to suitable families, being mindful of the financial and time implications this high level service requires.

The covid-19 pandemic and the impact on child mental health: A socio-ecological perspective

The COVID-19 pandemic poses an increased threat to the mental and behavioral health of children. There is an increasing prevalence of mental health problems in children, coupled with the variability of access to mental health services and the impact of trauma and adverse childhood experiences (ACEs) on child health. The prolonged duration of the current pandemic put children at increased risk for an even higher rate of mental and behavioral health problems. Prior to the pandemic, the mental health workforce was ill equipped to care for the grow-ing need and demand for child-specific services. As the pandemic continues to invade communities across the nation, it is vital for pediatric nurses to acknowl-edge COVID-19 as a major disruptor to the typical growth and development of children. The full impact of this COVID-19 pandemic on the mental health for children is uncertain. However, its impact on an already limited child-focused mental health workforce will indeed have a long-lasting impact on the health and well-being of children and their families. The socio-ecological impact of COVID-19 and its duration for those children with known mental health problems and those in whom such challenges will arise has implications for future models of care. Nurses are well-poised to both assess and intervene with mental health problems to reduce the long-term, potentially negative effect of COVID-19 on the health and well-being of children. © 2020, Anthony J. Jannetti Inc.. All rights reserved.