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Introduction: The annual National Diabetes Inpatient Audit (NaDIA and NaDIA-Harms) in the UK continues to show significant problems with patient care. During the COVID pandemic patient care has been even more difficult. New initiatives are urgently required to improve inpatient safety for people with diabetes. Method: The Joint British Diabetes Societies for Inpatient Care (JBDS-IP) organised the seventh national Rowan Hillson In-patient Safety Award on the theme of "the best interventions: redesigning, rebuilding and maintaining safe inpatient diabetes care during COVID". Result: The winner was the DEKODE team, led by Dr Punith Kempegowda from University Hospitals Birmingham NHS Foundation Trust, for their innovative quality improvement project across hospitals during COVID to improve diabetes-related ketoacidosis (DKA) management and study DKA in people with COVID. Adherence to national guidance improved in some hospitals, with falls in hypoglycaemia, and overall there was a significant improvement in awareness about DKA amongst junior doctors. The King's College NHS Foundation Trust team, led by Adrian Li and colleagues, received the highly commended award for their innovative project of remote blood glucose (BG) monitoring across healthcare boundaries. This improved diabetes control and tackled health inequalities. Summary and conclusion: These and similar schemes need to be developed, promoted and shared to improve safety for people with diabetes admitted in hospital during COVID times.
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Introduction: The SARS-CoV-2 pandemic accelerated health disparities in chronic kidney disease (CKD). Here, we describe risk factors and access to care surrogates (area deprivation index-ADI) for clinical outcomes among SARS-CoV-2-tested patients in the Center for Kidney Disease Research, Education, and Hope (CURE-CKD) Registry. Method(s): We formed a COVID-19 Sub-Registry within CURE-CKD (1/1-6/30/2021;N=171,988) of patients with CKD, diabetes (DM)/pre-DM, or hypertension (HTN) with SARS-CoV-2 testing at UCLA Health (UCLA;N=17,884) and Providence St. Joseph Health (PSJH;N=154,104). Statistical analyses and fitted multivariable logistic regression models were adjusted for age and sex. The UCLA cohort included analyses for acute kidney injury (AKI), area deprivation index (ADI, for poor housing, education, income), Charlson Comorbidity Index (CCI), and severe COVID-19 disease. Result(s): We determined the odds ratios and 95% confidence interval (OR[95%CI[) of COVID-19 positivity for the combined UCLA + PSJH population, as well as OR of having severe COVID-19 disease in the UCLA cohort (Table 1) only. OR[95%CI] for AKI was higher for ages >=80 years (1.77[1.14-2.46]), ADI by state (1.12[1.06-1.18]), CKD (12.20[8.46-17.58]) and pre-existing DM (3.65[2.62-5.08]), p<0.001. In the UCLA CURE-CKD population, AKI was associated with severe COVID-19 (r=0.26) and ICU admissions (r=0.29). Mortality was associated with severe COVID-19 disease (r=0.5). [Formula presented] Conclusion(s): Non-White and/or LatinX race/ethnicity, ADI, CKD, DM, and older age were associated with higher risks of COVID-19 positivity, disease severity, and mortality in CURE-CKD. Efforts on viral screening, timely COVID-19 diagnosis, and optimal care delivery for patients with or at-risk of CKD are needed. Conflict of interest Potential conflict of interest: SBN is supported by NIH research grants R01MD014712, RF00250-2022-0038, U2CDK129496 and P50MD017366, and CDC project number 75D301-21-P-12254 receives research support from Bayer AG for the submitted work, Goldfinch Bio, Travere and Terasaki Institute of Biomedical Innovation, and personal fees and other support from AstraZeneca, Bayer AG, Gilead, NovoNordisk and Boehringer Ingelheim/Lilly. KBD is supported by an NIH research grant R01MD014712 and CDC project number 75D301-21-P-12254 and reports other support from Bayer AG for the submitted work, and Goldfinch Bio and Travere outside the submitted work. CRJ is supported by an NIH research grant R01MD014712 and CDC project number 75D301-21-P-12254 and reports other support from Bayer AG for the submitted work, and Goldfinch Bio and Travere outside the submitted work. KCN is supported in part by NIH research grants UL1TR001881, P30AG021684, U2CDK129496 and P50MD017366. KRT is supported by NIH research grants R01MD014712, U2CDK114886, UL1TR002319, U54DK083912, U01DK100846, OT2HL161847, UM1AI109568 and CDC project number 75D301-21-P-12254 and reports other support from Eli Lilly personal fees and other support from Boehringer Ingelheim personal fees and other support from AstraZeneca grants, personal fees and other support from Bayer AG grants, personal fees and other support from Novo Nordisk grants and other support from Goldfinch Bio other support from Gilead and grants from Travere outside the submitted work.Copyright © 2023
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Education, Medical, Undergraduate , Schools, Medical , Curriculum , Humans , Medical Oncology/educationABSTRACT
Purpose: To evaluate the effectiveness, uptake and improved learning of medical students following the introduction of a novel online radiology teaching program integrated within a medical student curriculum. Background(s): Traditional medical student teaching usually consists of system (anatomy, physiology, etc) or problem-based learning1, meaning that specific radiology teaching can be not focussed on as much as other specialties. This is supported by the literature that suggests that the lack of focus on radiology teaching in medical schools2 has often led to new medical graduates feeling ill-prepared for clinical practice3 when interpretation of medical images is required. The authors of this paper in collaboration with an Australian-based radiology education provider, DetectedX, have attempted to address this by creating an online, personalized chest Xray interpretation tool for medical students. Chest X-rays were prioritised in this project since they are the most ordered radiographic scan, have widespread relevancy across many specialties, and evidently there is an expectation that most graduating students should be able to interpret them4. Method(s): Pre-clinical medical students at a single tertiary institution were given several online modules that provided teaching on developing an approach to chest X-rays and recognising common pathology. Students were given access to these and were able to access these multiple times "on-demand" to create a personalized and selfdirected approach to their learning. Assessments on knowledge and surveys on the student's perception were performed prior to and at the conclusion of the module. Finding(s): Preliminary findings amongst medical students have found several benefits. Overall students have indicated that an online teaching program with set learning objectives, provided a more effective way to learn when compared to previous models. Additionally, the self-directed pace, as well as the ability to return to modules to revise topics further improved retention of, and reinforced interpretation principles. Preliminary survey findings report an increased willingness from students to use this online tool and increased receptiveness to further online, self-directed teaching modules. Students also reported better understanding when pathology was demonstrated within a clinical context reflecting alignment with other teaching that is problem-based. Conclusion(s): Traditional teaching often requires the student's physical presence at a scheduled location and time;however, the impact of Covid-19 has urged deliverers of medical education to consider effective online approaches. Our experience shows medical student willingness for further radiology teaching, and the use of an online, self-paced tool, demonstrates improved learning of concepts and retention of knowledge.
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Background: Thrombocytopenia is a common complication of COVID-19 (coronavirus disease 2019). The possible mechanisms include decreased platelet production, increased platelet destruction, and consumption. Thrombocytopenia indicates a poor prognosis in COVID-19 patients. Thrombocytopenia is often complicated in ECMO (extracorporeal membrane oxygenation) due to shearing force in the circuit and heparin-induced thrombocytopenia (HIT). COVID-19 patients on ECMO are at high risk of developing thrombocytopenia and bleeding. Aim(s): The balance between bleeding prevention secondary to thrombocytopenia and thromboembolic prophylaxis is challenging in managing COVID-19 patients. ECMO increases the risk of thrombocytopenia. Our study reports the incidences of thrombocytopenia and bleeding in COVID-19 patients on ECMO. Method(s): We retrospectively reviewed the data of twenty-three COVID-19 patients on ECMO. Thrombocytopenia is defined by platelet levels lower than 150,000/uL. Incidences of thrombocytopenia and complications were recorded and analyzed. Result(s): Twenty-three COVID-19 patients received ECMO. The mean age was 45-year- old. Eleven patients had at least one of the following pre-ECMO comorbidity: Ten patients had hypertension, eleven patients had diabetes and four patients had hyperlipidemia. None of the patients were active smokers or had chronic lung disease. Anticoagulation was initiated on the day of admission. Twenty-one patients developed thrombocytopenia and HIT was excluded. Eighteen patients had hemorrhage requiring transfusion, with the gastrointestinal tract being the most common site. Thromboembolic prophylaxis was held for active bleeding or platelet count below 30,000/uL. The overall mortality rate was 69.6%. Conclusion(s): In our study of ECMO-managed COVID-19 patients, 91.3% of patients developed thrombocytopenia and 78.3% of patients developed hemorrhage requiring transfusion. Anticoagulation is recommended to all hospitalized COVID-19 patients unless there are contraindications due to the high risk of thromboembolism. However, anticoagulation further increases the risk of bleeding, which may lead to sudden deterioration and death. Further investigation into the mechanisms, implications, and management of thrombocytopenia will lead to significantly improved outcomes for COVID-19 patients on ECMO. (Table Presented).
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Vaccinations, conspiracy theories, and celebrities are all popular topics in contemporary society. Anti-vaccination attitudes and conspiratorial beliefs, especially, have emerged as more prevalent against the backdrop of the 2020 election and Covid-19 pandemic. Martinez-Berman et al. (2020), collected data on these topics prior to the emergence of the Covid-19 pandemic and found a positive relationship between anti-vaccination attitudes and celebrity admiration. Further, there were positive relationships between conspiratorial beliefs and dimensions of celebrity admiration. In this study, we replicated and extended this work to a university-aged sample, to document anti-vaccination attitudes and conspiratorial beliefs at a different time of the Covid-19 pandemic, and to conduct a validity check of the single-item Belief in Conspiracy Theories scale with a more sophisticated measure of conspiratorial belief, the General Conspiratorial Belief (GCB) scale. We discovered overall attitudes toward vaccinations to be similar to those in the prior study. However, participants in our study reported lower mistrust of vaccinations and greater concern for future effects of vaccinations than participants in the previous study. In contrast to the results of the prior study, we found that interest in celebrities was not a significant predictor of vaccination attitudes. We discussed the results in the context of the replication and extension nature of the project and present goals for future research into the relationships among the key variables. © NAJP.
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OBJECTIVES: The aim of the present study was to explore self-interest, kin altruism and non-kin altruism reasons that influence people to vaccinate against COVID-19. STUDY DESIGN: This was a cross-sectional study using a fully repeated measures design. METHODS: Participants (N = 178) answered questions on perceived threat and likelihood of infection, vaccination status and opinion on mandatory vaccination. Participants also rated a set of statements that asked how likely these would influence them and others to vaccinate against COVID-19. Statements reflected self-interest, kin altruism or non-kin altruism. RESULTS: Just more than half of the sample (50.8%) reported the likelihood of infection as somewhat or extremely likely, and almost three-fourths (74.2%) reported that COVID-19 posed a minor or moderate threat to their physical health. Almost three-fourths (74.3%) of the sample were vaccinated, with just more than half (56.2%) in favour of mandatory vaccination. A 2 (self/other) × 3 (self-interest/kin altruism/non-kin altruism) fully repeated measures analysis of variance showed that kin-altruistic reasons were rated most highly, regardless of whether this was regarding oneself or others. Participants rated others as having greater self-interest reasons for vaccination compared with oneself, whereas non-kin altruism reasons for vaccination were rated higher for oneself, compared with others. CONCLUSION: Highlighting the benefits of vaccination for close relatives and vulnerable others in the population would be a useful strategy for government to use when urging the public to vaccinate against COVID-19.
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Background: As we continue to treat patients during the ongoing opioid overdose epidemic, it is ever more important that providers have adequate experience in understanding and treating patients with addiction, substance use disorder and withdrawal states. Additionally, throughout the COVID-19 pandemic, there have been numerous reports demonstrating that substance use is exponentially increasing. This increases the likelihood that addiction medicine will occupy a more prominent position in our medical field. Until recently, addiction medicine education was not an ACGME program requirement for medical toxicology fellowship programs. We aimed to evaluate the percentage of bedside medical toxicology consultations addressing addiction-related issues, over time, at a tertiary care hospital system. Method(s): We reviewed bedside toxicology consults performed by a tertiary care hospital system's Division of Medical Toxicology consultation service between January 2017 and December 2021 for addiction, substance use, and withdrawal-related cases. Consultation data is entered by bedside toxicologists and maintained in a secure database. Descriptive statistics were analyzed for various variables and were compared between years, utilizing SPSS28. Result(s): Over the 5-year period, the toxicology service was consulted on a total of 4733 patients, of which, 2549 were addiction- related (53.9%). The majority of consults were male (65.6%), with 1 transgender (male-to-female) patient treated during this time. The proportion of addiction medicine consults increased steadily over the five-year time period. In 2017, there were 345 total consults, with 88 addiction-related (25.5%). In 2018, the service was consulted on 509 patients, of which 168 were addiction related (33%). In 2019, this trend continued to increase, with addiction medicine consults accounting for 52.8% of the total consults (478 of 905 consults). 58.7% of the toxicology services' consults were addiction related in 2020 (627 of 1069). As of this past year, of the 1905 total consults, 1188 were for addiction or substance-use complaints (62.4%). The most common primary reason for a medical toxicologist consult, was alcohol withdrawal (803 cases, 31.5%). In 2021, alcohol withdrawal accounted for 44.2% of the total consults, which was a 25.7% increase from pre-pandemic levels. Opioid withdrawal as the primary reason for consultation accounted for 9.1% of total consults across the time-period. In 2017, opioid withdrawal accounted for 2.3% of consults, but increased to 13.0% of the consultations by 2021. Opioid agonist therapy (buprenorphine, methadone) was initiated in 12.7% of total consults. In 2017, there were no cases where opioid agonist therapy was a topic of consultation, but this increased to 12.0% of consults throughout 2021. Conclusion(s): At a tertiary care hospital system, addiction medicine consults by bedside medical toxicologists have continued to increase disproportionately compared to other consults. As of this past year, addiction related complaints made up roughly two-thirds of all medical toxicology consults, increasing almost 40% over 5-years. This single center phenomenon could represent a national trend;however, larger-scale studies would need to assess this pattern. This data further supports the recent ACGME medical toxicology program requirement changes, emphasizing the importance of addiction medicine and its relationship to medical toxicology.
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Purpose : Assessing the impact of COVID-19 on visual acuity (VA) in eyes treated for Diabetic Macular Edema. Methods : Anonymized data from 21 UK centers were extracted from Medisoft for eyes receiving treatment with aflibercept and with VA data in the pre-COVID baseline period (01/10/19 to 30/03/20, N=3,248). Comparisons for period 1 (01/04/20 to 30/09/20, N=2,077)-lockdown following RCOphth Medical Retinal Management Plan, period 2 (01/10/20 to 30/03/21, N=1,850)-intermittent lockdown and period 3 (01/04/21 to 30/09/21, N=1,111;20 centers)-easing of COVID-19 restrictions. VA change was compared for baseline VA, <7 vs. ≥7 injections before period 1 and for eyes losing ≥5 ETDRS letters in period 1. Results : The mean change in VA for eyes with a baseline VA of ≤35 letters, was +4.9, +2.5 and +1.7 letters from baseline to period 1, period 1 to 2 and period 2 to 3, respectively. For baseline VA of 36-55 letters, +0.6, +1.7 and -0.2 letters, from baseline to period 1, period 1 to 2 and period 2 to 3, respectively. For baseline VA of 56-75 letters, +1.9, zero and -0.5 letters, from baseline to period 1, period 1 to 2 and period 2 to 3, respectively. For baseline VA of >75 letters, -4.3, -0.5 and zero letters, from baseline to period 1, period 1 to 2 and period 2 to 3, respectively. For eyes receiving <7 injections before period 1, the mean change in VA was -1.9 letters (N=1,335) from baseline to period 1, +0.5 letters (N=992) from period 1 to 2 and +0.1 letters (N=592) from period 2 to 3. For ≥7 injections before period 1, the mean change in VA was -3.4 letters (N=742) from baseline to period 1, -0.4 letters (N=515) from period 1 to 2 and -1.1 letters (N=303) from period 2 to 3. For eyes losing ≥5 letters before period 1, the mean change in VA when receiving ≥1 injection in period 2 was +3.9 letters (N=283) from period 1 to 2 and -0.1 letters (N=140) from period 2 to 3. For eyes not retreated in period 2, the mean change in VA was -2.9 letters (N=162) from period 1 to 2 and zero letters (N=73) from period 2 to 3. Conclusions : Visual gain between time periods was more likely for lower baseline vision. For eyes with <7 or ≥7 injections before period 1, the mean VA change was a loss in vision in the first period with little change in later periods. For eyes with ≥5 letter loss in period 1, subsequent visual gain was more likely if treatment continued.
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Purpose : To assess the impact of COVID-19 on eyes treated for neovascular AMD. Methods : Anonymized data from 21 UK centers were extracted from Medisoft for patients receiving treatment with aflibercept and VA data in the pre-covid baseline (01/10/19 to 31/03/20 n=8,313). Comparisons were made for period 1 (01/04/20 to 30/09/20 n=4,011)-lockdown following RCOphth Medical Retinal Management Plan during COVID-19, period 2 (01/10/20 to 31/03/21 n=4,551)-intermittent lockdown following updated RCOphth COVID-19 guidelines, and period 3 (01/04/21 to 30/09/21 n=2,630)-easing COVID-19 restrictions. VA change was compared for baseline VA, <7 vs. ≥7 injections before period 1 and for eyes losing ≥5 letter in period 1. Results : The mean change in VA for eyes with a baseline VA of ≤35 ETDRS letters was +0.7, +0.1 and -1.6 letters, 36-55 letters was -3.0, -1.2 and -1.3 letters, 56-75 letters was -2.1, -1.1 and -1.5, and >75 letters was -4.3, -0.7 and -0.4 letters in periods 1, 2 and 3 respectively. The median VA change was zero letters for all baseline VA groups and time periods except for the >75 letter group in period 1 (median 2 letter loss). The mean change in VA from baseline for eyes with <7 injections before period 1, was -2.0, -0.6 and -1.2 letters from 2,083, 2,465 and 1,420 eyes in periods 1, 2 and 3, and ≥7 injections before period 1, was -2.9 from 1,928 eyes in period 1 and -1.3 letters from 2,086 and 1,210 eyes in periods 2 and 3. For both groups and time periods the median VA change was zero letters. For eyes that lost ≥5 ETDRS letters before period 1 the mean change in VA for eyes receiving no injections was +2.3 letters (n=155) and -3.5 letters (n=107), 1-3 injections was +1.4 letters (n=740) and -1.3 letters (n=340), and >3 injections was +2.3 letters (n=199) and -0.8 letters (n=122) in periods 2 & 3 respectively. The median VA change was zero letters for all time periods and injection number groups except for >3 injection eyes in period 2 (median 3 letter gain) and no injection eyes in period 3 (median 1 letter loss). Conclusions : In period 1, a small VA loss was experienced by many eyes dependent on baseline VA. Similar VA changes were present for eyes receiving <7 and ≥7 injections before period 1. For eyes that lost ≥5 ETDRS letters during period 1, many had visual gain with more improvement linked to receiving more injections in period 2, falling back in period 3.
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Background: The coronavirus disease 2019 (COVID-19) has resulted in an unprecedented research response, demonstrating exceptional examples of rapid research and collaboration. There has however been an ongoing need for greater coordination, with limited resources for research and the shifting global pandemic.
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BACKGROUND: African-Americans (AA) are underrepresented in mobile health (mHealth) intervention research studies which can perpetuate health inequities and the digital divide. A community based, user-centered approach to designing mHealth interventions may increase their sociocultural relevance and effectiveness, especially with increased smartphone use during the COVID-19 pandemic. We aimed to refine an existing mHealth intervention via a virtual focus group series for use in a randomized controlled trial (RCT) aiming to improve cardiovascular health (CVH) in AAs. METHODS: AA community members (N=15) from churches in Minneapolis and Rochester, Minnesota were enrolled in a virtual, 3-session focus group series over 5 months to refine an existing CVH focused mHealth application (FAITH! App). Participants completed a baseline electronic survey capturing sociodemographics, mobile technology use, and electronic health information sources prior to start of focus groups. Participants accessed the FAITH! App via their smartphones and received a Fitbit synced to the app. Participants engaged with multimedia CVH focused education modules, a sharing board for social networking, and diet/PA self-monitoring. Participant feedback on app features prompted iterative revisions to yield a refined app. Primary outcomes were app usability (assessed via Health Information Technology Usability Evaluation Scale [Health-ITUES], range 0-5) and user satisfaction which were evaluated via electronic survey after the final focus group. A predetermined goal of mean overall Health-ITUES score of ≥4 was set for the app to advance for use in the RCT. RESULTS: Participants (mean age [SD] 56.9 [12.3] years, 13, 86.7% female) attended a mean 2.8 focus groups (80% attended all sessions). Participant feedback resulted in app refinements to increase visual appeal, increase diversity and gender balance in testimonial videos, further improve ease of diet/PA self-monitoring, and add fitness videos as well as a moderated sharing board. The revised FAITH! App achieved a mean overall Health-ITUES score of ≥4 (mean 4.39, range 3.20-4.95). Participants positively rated updated app content, visual appeal, and use of social incentives to maintain engagement. Increasing user control and further refinement of the moderated sharing board were identified as areas for future improvement. CONCLUSIONS: Virtual focus group data can improve usability and increase participant satisfaction in mHealth lifestyle interventions aiming to promote CVH in AAs.
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Background: The coronavirus disease 2019 (COVID-19) has resulted in an unprecedented research response, demonstrating exceptional examples of rapid research and collaboration. There has however been an ongoing need for greater coordination, with limited resources for research and the shifting global nature of the pandemics.
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Technology is an ever-increasing part of most people’s lives and it has been crucial for the delivery of support by domestic violence and abuse (DVA) services during the COVID-19 pandemic. Paradoxically, this same technology has provided perpetrators with new and growing opportunities to continue or escalate their abusive behaviours. This article draws on the experiences of a specialist DVA service for children and young people (CYP) in the United Kingdom reflecting on the use of technology in service delivery during the COVID-19 pandemic. We applied a safety systems approach – a failure modes and analysis (FMEA) to analyse the nature and impacts of service responses. The FMEA shed light on the risks within the environment in which children and young people engage with remote, digital-enabled support. Practitioners, for example, have been unable to determine potential ‘lurking’, whereby other people, including the abusive parent or partner, are present within the room, but out of sight. The FMEA generated 13 ‘corrective actions’ that will be helpful to specialist practitioners supporting children and young people experiencing DVA and to operational managers modifying current services and designing those for the future. © Centre for Gender and Violence Research University of Bristol 2022.
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BackgroundSelf-harm is a major public health concern with evidence suggesting that the rates are higher in the United Kingdom than anywhere else in Europe. Increasingly, policy highlights the role of school staff in supporting young people (YP) who are self-harming, yet research indicates that school staff often feel ill-equipped to provide support and address self-harm behaviors. Here, we assess the impact of a bespoke eLearning module for United Kingdom secondary school teachers on teacher's actual and perceived knowledge of self-harm, and their self-reported confidence in supporting and talking to YP who self-harm. MethodsTwenty-one secondary schools across the West Midlands and South East of England were invited to complete a 30-min web-based eLearning module on self-harm in schools. Participants completed pre-and post-intervention measures. ResultsOne-hundred and seventy-three teachers completed the eLearning, and pre-and post-measures. The eLearning significantly enhanced participants' perceived knowledge, actual knowledge, and confidence in talking to and supporting YP who self-harm. The majority of participants (90.7%) felt that eLearning was a good way to receive training. ConclusionThe 30-min eLearning module was rated highly and may be an effective way to increase secondary school teachers' knowledge of self-harm, and confidence in supporting and talking to YP who self-harm.
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Rationale: The ROSE trial was a multicenter unblinded randomized clinical trial comparing early neuromuscular blockade (NMB) to usual care in patients with moderate to severe ARDS (NEJM 2019). This trial (n=1006) was stopped early for futility yet a subgroup analysis found that among Hispanic/Latino participants the NMB intervention group had a significantly lower mortality (32%) compared to those in the control group (53.7% p=0.02 for interaction). To evaluate potential contributors to these differences we compared baseline clinical and biological characteristics among Hispanic/Latino participants in the intervention vs control group. Methods: We compared demographics primary ARDS risk factor illness severity ventilatory parameters comorbidities and plasma biomarkers at baseline between the NMB intervention and control group for all 118 Hispanic/Latino patients recruited to the ROSE trial (11.6% of the trial population). We used multiple logistic regression to examine whether the mortality difference by treatment group would persist after controlling for the factors that differed significantly between groups. Results: At baseline Hispanic/Latino participants randomized to the control group had greater disease severity scores (APACHE III SOFA;p<0.05 for both) and a higher prevalence of shock (p=0.01) compared to those randomized to the intervention. There were no significant differences between groups in causes of lung injury or baseline ventilatory parameters. In an unadjusted logistic regression model the NMB intervention was significantly associated with mortality (OR 0.42;95%CI 0.20-0.89 p=0.02). The NMB intervention was no longer significantly associated with mortality when adjusting for severity of by illness by either SOFA score (OR 0.53;95%CI 0.24-1.20 p=0.13), APACHE III (OR 0.51, 95%CI 0.20- 1.30 p=0.16) or shock as defined by the need for vasopressors (OR 0.48, 95%CI 0.22-1.03, p=0.06). Hispanic/Latino participants in the control group had significantly higher interleukin-8 (p=0.02) and lower bicarbonate (p=0.045) than those in the intervention group. Conclusion: Together these clinical and biomarker data support the conclusion that the lower mortality associated with NMB in the Hispanic/Latino subgroup may have been partially due to baseline imbalances in systemic severity of illness. This finding underscores the need to cautiously interpret apparent treatment benefits within small subgroups. The COVID-19 pandemic has highlighted ethnic and racial disparities in ARDS. Future trials will benefit from increased representation of populations that are disproportionately affected to minimize the impact of spurious findings related to small sample sizes while creating more statistical power to prospectively address disparities.