ABSTRACT
Introduction: The COVID-19 pandemic has been associated with profound biopsychosocial changes for children, potentially affecting their health and wellbeing. Among these changes are altered sleep patterns and screen time use, however, no work has examined interactions between these two behaviors in the context of the pandemic. Here, we used longitudinal data from the Adolescent Brain Cognitive Development (ABCD) Study® to investigate changes in both sleep and screen time, and their relationship, from before and across the first year of the COVID-19 pandemic in young adolescents. Methods: More than 5000 adolescents (11-14 years;48% girls) completed digital surveys about their sleep and daily screen time use before the pandemic and across six timepoints during 2020- 2021, as part of the ongoing ABCD Study®. Random intercept linear mixed effect models (LMMs) were used to examine longitudinal associations between bedtime, wake-up time, and daily screen time use (social media, gaming), considering age, sex, and school effects. Results: Adolescents' wake up time was delayed (R2 = 0.51;~1.5 hour) during May-August 2020 relative to the pre-pandemic assessment (p<0.01), which was partially related to the summer break (p<0.01), before advancing to earlier times in October 2020. Bedtimes also delayed at all pandemic assessments (R2=0.62;~1 hour), even after starting the new school year (p<0.01), particularly in older adolescents (p<0.01) and girls (p<0.01). Recreational screen time was dramatically higher across the first year of the pandemic, relative to pre-pandemic (p<0.01;~45min social media, ~20min video gaming). More time spent with screen related activities was associated with later bedtimes and wake up times (p<0.01), across the pandemic, with effects being evident in male and female adolescents. Conclusion: Our findings show profound changes in sleep timing and screen time use across the pandemic in young adolescents, and critically, that excessive screen time negatively impacts sleep. As adolescents increasingly turn to more screen usage, these data highlight the need to promote their balanced and informed use of social media platforms, video games, and other digital technology to ensure adequate opportunity to sleep and maintain other healthy behaviors during this critical period of developmental change.
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Background: Prior to the covid-19 pandemic glucagon-like peptide (GLP-1) education was delivered face-to- face by diabetes specialist nurses. This service is now predominately virtual, with diabetes dietitians hosting online groups to deliver education. Aim: To evaluate the clinical outcomes of GLP-1 therapy education delivered online compared to face-to- face education sessions. Methods: Data were collated from 53 patients prior to the restrictions imposed by the covid-19 pandemic (Group A) and 53 patients who were educated virtually (Group B). The demographics of the patient group including duration of diabetes, gender, age, body mass index (BMI), Hba1c on referral and Hba1c change after four months of GLP-1 therapy were compared. Results: Group A was 45% male, with a mean age of 57 years, 10% had type 2 diabetes for over 10 years and 88% had a BMI between 30-39 kg/m2. The range of HbA1c at referral was 62-121mmol/ mol and mean improvement in HbA1c after 4 months of GLP-1 therapy in Group A was 24.3 ± 15.3mmol/mol. Group B was 55% male, with a mean age of 56 years, 43% had type 2 diabetes for over 10 years and 51% had a BMI of over 40 kg/m2. The range of HbA1c at referral was between 61-117mmol/ mol and the mean improvement in HbA1c after 4 months of GLP-1 therapy in Group B was 23.8 ± 17.5mmol/mol. Conclusions: The launch of virtual education for patients starting on GLP-1 therapy has been successful and maintained significant improvements in HbA1c after 4 months of treatment.
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Background: The COVID-19 pandemic has temporarily reduced capacity in many endoscopyunits, creating long backlogs, which have the potential to worsen patient outcomes. Aims:To evaluate the impact of two evidence-based strategies for offloading colonoscopy demandduring and after the first wave of the pandemic: (1) An “Extend” strategy, in which theinterval for low-risk adenoma (LRA) patients who are currently “due” is extended from 5years to 7 years;(2) An “Exchange” strategy, in which all referrals for screening colonoscopyare changed to fecal immunochemical testing (FIT);(3) a combination of “Extend+Exchange.”Methods: We developed a discrete-event simulation of an endoscopy unit in an integratedhealthcare system with a caseload of 110 procedures weekly. We assumed capacity initiallyfell to 5% of pre-COVID levels for 10 weeks (as a result of the pandemic), and incrementallyincreased back to 100% by 30 weeks. Each week, 113 patients were referred with thefollowing indications, in order of priority: diagnostic colonoscopy (23% of referrals) and upper endoscopy (28%), high-risk adenoma (HRA) surveillance (10%), LRA surveillance(17%), and screening colonoscopy (22%). The highest priority patients were always seenfirst, while others joined a queue. Outcomes included average wait time, number of patientsseen, and queue size at model’s end. The base unit of time was weeks. Model length was150 weeks. One-way sensitivity analyses were performed for all variables. Each strategy wassimulated 500 times in C++ and compared to a base case in which no offloading strategieswere used. Results: In the base case, 3,023 patients remained in queue at 150 weeks, andthe average wait time was 22.5 weeks overall. The wait time for screening colonoscopy was69.9 weeks. With the Extend strategy, 1,293 patients remained in queue at 150 weeks, theaverage wait time was 14.2 weeks overall, and the wait time for screening colonoscopy was41.6 weeks. With Exchange, no patients remained in queue at 150 weeks, and the averagewait time was 9.9 weeks. Because no screening colonoscopies were done, there was no waittime for this indication. The Extend+Exchange strategy yielded similar results, but the averagewait time was 5.3 weeks. In all four strategies, nearly equivalent numbers of patients wereseen for HRA surveillance (range 2,496-2,511), diagnostic colonoscopy (range 4,547-5,062),and upper endoscopy (3,749-3,759), with similar wait times. None of the strategies hadwait times for upper endoscopy or diagnostic colonoscopy exceeding 5 weeks. Conclusions:Without offloading strategies, prolonged queues and wait times developed, especially forscreening colonoscopies. Substituting FIT for screening colonoscopy (Exchange) is the singlestrategy with the greatest potential to mitigate these problems, without which patients maysuffer harm caused by limited access.(Figure Presented)Figure 1. Average wait time by indication under usual care, and three evidence-based strategies for offloading endoscopy demand during the COVID-19 pandemic.
ABSTRACT
Introduction: Older adults comprise an increasing proportion of emergency general surgery (EGS) admissions and face high morbidity and mortality. We created a geriatric surgical service with geriatric and palliative expertise to mitigate risks of hospitalization most hazardous to older patients. In this study, we identified geriatric surgical service interventions most relevant to EGS patients. Methods: We conducted a retrospective chart review of patients >75 years admitted to the EGS service at our urban tertiary care hospital with a score >3 by the FRAIL scale, a five-point frailty screening instrument, or history of dementia. The geriatric surgical service, led by a dually-board certified geriatric and palliative care specialist, consulted on these patients from January 2020-January 2021;a hiatus was taken for the COVID-19 pandemic. Consults included a comprehensive geriatric assessment and calculated a modified Rockwood Frailty Index. Hospital admission characteristics and consultation components were collected via chart review. Results: Forty patients were evaluated (median age 82 years (IQR 78-89), 55.0% female). The most common admission diagnosis was small bowel obstruction (32.5%). 62.5% of patients underwent >1 surgical procedure. Median time to geriatric consult from admission was 3 days (IQR 1.0-4.3). By Frailty Index, 58% were moderately or severely frail. Interventions included medication changes (97.5%), symptom management (82.5%), delirium prevention and management (65.0%), mobility and function recommendations (65.0%), serious illness conversations (55.0%), and code status change (17.5%). Conclusion: Geriatric service involvement identifies and addresses a high burden of both geriatric and palliative care needs in older adult EGS patients.
ABSTRACT
Introduction: Before the COVID-19 pandemic, 20-30% of family members had symptoms of Post-Traumatic Stress Disorder (PTSD) or anxiety, while 15-30% had symptoms of depression. Interventions supporting family members have reduced burden of these symptoms. COVID-19 has resulted in prolonged ICU stays, high morbidity/mortality, and hospital policies severely limiting family presence at the bedside. We hypothesized the combination of prolonged critical illness and the necessary reduction of family presence would lead to high rates of PTSD, anxiety, and depression;likely higher than observed in previous studies. Methods: This was a multicenter study including 12 US hospitals, 8 academic and 4 community-based hospitals. A consecutive sample of family members of all patients with COVID-19 receiving ICU admission during the spring US peak in 2020 were called 3-4 months after the patients' ICU admission, except for New York City hospitals where a random sample was generated given the large number of hospitalizations. Consented participants completed the Impact-of- Events Scale-6 (IES-6;scored 0-30, higher scores indicate more symptoms of PTSD), Hospital-Anxiety- Depression Score (HADS, scored 0-20 for anxiety and 0-20 for depression, higher scores indicate more symptoms), and a subset of questions from Family-Satisfaction in the ICU-27 (FS-ICU27;scored on a Likert scale 1 to 5, with higher scores indicating more positive responses) selected as most likely impacted by restrictive family presence.Results: There were 945 eligible family members during the study period. Of those, 594 were contacted and 269 (45.3%) consented and completed surveys. The mean IES-6 score was 12.6 (95% CI 11.8- 13.4) with 65.4% having a score of 10 or greater, consistent with high levels of symptoms of PTSD. The mean score on the HADS-anxiety was 9.4 (95% CI 8.8-10.1) with 59.5% having a score of 8 or greater, consistent with high levels of symptoms of anxiety. Finally, the mean score for the HADS-depression was 8.0 (95% CI 7.3-8.7) with 47.6% having scores of 8 or greater, consistent with high level of symptoms of depression. The mean response for the FSICU27 questions of “I felt I had control” was 3.5 (95% CI 3.3-3.6), “I felt supported” was 3.8 (95% CI 3.6-4.0), and “I felt included” was 4.3 (95% CI 4.2-4.4).Conclusion: The consequences of a family member admitted to the ICU with COVID-19 infection are significant. We identify rates of PTSD, anxiety, and depression higher than recorded in non-COVID population. Further analysis is warranted to understand modifiable risk factors for developing these symptoms.