ABSTRACT
Laboratory skills assignments were developed as a novel approach to providing students with the opportunity to engage in hands-on laboratory skills development outside of the lab during the COVID-19 pandemic. Initially, the assignments were implemented within a second-year forensic chemistry course of 48 students and redesigned and modified to be implemented within a large in-person second-year analytical chemistry course of 208 students as a complement to the laboratory experiments. Five laboratory skills were chosen to coincide with those used within the laboratory experiments of the course: pipetting, quantitative transfer, serial dilutions, buret use within titrations, and weight-by-difference mass measurements. Each skills assignment consisted of two videos demonstrating the selected skill: one in which the skill was performed properly and one in which deliberate errors have been included. For each skills assignment, students were tasked with distinguishing between the two videos along with identifying the included errors and the consequences each error would have on either the accuracy and reproducibility of the collected data or the safety of the experimental procedure. Student feedback on the skills assignments is also reported. © 2023 American Chemical Society and Division of Chemical Education, Inc.
ABSTRACT
Despite improvements in cancer outcomes over time, significant disparities remain between Black and White cancer survivors. Medical care is estimated to account for 10-20% of health outcomes, while other modifiable factors explain as much as 80-90% of outcomes. These disparities may thus be driven by multiple factors including social determinants of health, differences in treatment or follow up, or attitudes and behaviors of care teams. As part of a larger project, we conducted a qualitative study to understand cancer survivor preferences for and experiences with social needs screening and referrals. The results of this assessment will inform the delivery of social risk screening for breast and prostate cancer survivors in the multi-site study. Semi-structured interviews were conducted in English between March and April 2022 with breast and prostate cancer survivors from two cancer institutes in Washington DC. Patients were purposively recruited to ensure diversity in age, race, and cancer stage (I-III). Each interview lasted 60 minutes. Transcripts were reviewed for consensus and preferences for social needs screening. Thirteen survivors participated in the interviews. Participants were mostly breast cancer survivors (n=10), African American (n=6), were equal in stages I and II at time of diagnosis (n=5), and ranged in age from 34 to 81 with a median age of 64. Most patients (n=7) did not report social needs screening during their treatment, though all patients welcomed having these conversations with their care team. The majority of patients (n=9) desired face-to-face conversations as opposed to on paper (n=1) or through the patient portal (n=1). Similarly, most patients (n=7) did not mind who on their care team held the conversations. There was difference in opinion on how often social needs should be discussed, with four participants suggesting every appointment to another patient suggesting once at diagnosis. When asked about the needs patients experienced during treatment, food insecurity and nutrition were most cited (n=6), followed by transportation (n=4) and emotional resources (n=4). Only one patient reported not desiring social needs referrals during treatment. Other avenues for seeking out social resources included self-initiated research online or through books (n=2), and another patient described utilizing their local church (n=1). Finally, patients also spoke about challenges in receiving treatment and transitioning to survivorship due to the COVID-19 pandemic, including hospital staff turnover and care team inconsistency (n=1), bringing loved ones to appointments (n=1), and transportation challenges for individuals who relied on public transport to and from the clinic (n=1). This research reveals important insight to the perspective on social needs screening among a group of breast and prostate cancer survivors in the Washington DC region and highlights the ways in which patients have experienced and desire screening for social needs. In future work we will expand the number of interviews and apply these findings into practice.
ABSTRACT
Using a nationally representative sample of young adults, this study examines COVID-induced financial hardship and its association with suicide risk (N = 1,087). About 40% experienced one or more financial hardship, a third reported having suicidal ideation, and 1.57% reported suicide attempt. The association between financial hardship and suicide risk was cumulative: Those reporting four or more financial hardships were 2.61 times more likely to report suicidal ideation and 24.27 times more likely to report a suicide attempt. The finding that COVID-related financial insecurity was associated with drastically elevated suicide risks highlights the need to assess financial hardship for suicide risk.
ABSTRACT
SESSION TITLE: Rare Pulmonary Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: Aspergillus is a group of opportunistic endemic fungal species that causes pathology within the respiratory tract and sinuses of individuals with predisposing factors, such as immunosuppression. While less frequently discussed, aspergillosis thyroiditis represents the most common fungal thyroiditis. We present a case of this condition that was misdiagnosed as amiodarone induced thyrotoxicosis. CASE PRESENTATION: A 54-year-old male was evaluated in outpatient pulmonary clinic after a chest CT revealed new upper lobe mass-like pleural based infiltrates with accompanying symptoms of dyspnea on exertion and fevers. His medical history was significant for orthotopic heart transplant 6 months ago due to a combination of non-ischemic cardiomyopathy with further decompensation from COVID-19 infection. After transplant, he was diagnosed with thyrotoxicosis secondary to amiodarone that was being treated with prednisone and methimazole. Given the concern for infection on imaging, he was admitted to the hospital and underwent urgent bronchoscopic evaluation. During the procedure, he was noted to have severe extrinsic tracheal compression. His neck imaging was consistent with a nodular goiter. The BAL revealed Aspergillosis fumigatus and he was subsequently treated with isavuconazium. Given the compression on the trachea and persistent dyspnea, the decision was to pursue total thyroidectomy. Surgery occurred 2 months after treatment was initiated for the Aspergillosis and with improvement on serial chest CTs. Pathologic examination of the thyroid tissue revealed extensive invasive aspergillus with abscesses involving both lobes. DISCUSSION: Aspergillus infection leading to disseminated disease typically occurs in individuals that have a compromised immune system such as seen in malignancy, solid organ transplant, chronic steroid use, and poorly controlled diabetes mellitus. Recently, it has been cited that up to 15% of hospitalized COVID-19 patients requiring intensive care develop aspergillus infection. After initial aspergillosis infection has been established, the thyroid gland is a site for dissemination due to its rich vascular supply. In addition, due to the angioinvasive properties of the pathogen, the fungus can breakdown tissue planes and easily travel from its site of origin. Thereby a primary infection in the respiratory tract can lead to dissemination to the neck structures due to its proximity. When thyroid invasion occurs, the common complaints are neck pain and swelling. Thyroid laboratory findings encompass the full spectrum including hyperthyroidism, hypothyroidism, and euthyroid. Given these non-specific findings, clinicians need to be conscious of this disease entity. CONCLUSIONS: In patients with immunocompromising conditions, findings of neck pain, swelling, and abnormal thyroid laboratory values should broaden the differential for clinicians to include aspergillosis thyroiditis. Reference #1: Alvi, Madiha M et al. "Aspergillus thyroiditis: a complication of respiratory tract infection in an immunocompromised patient.” Case reports in endocrinology vol. 2013 (2013): 741041. doi:10.1155/2013/741041 Reference #2: Marui, Suemi, et al. "Suppurative thyroiditis due to aspergillosis: a case report.” Journal of Medical Case Reports 8.1 (2014): 1-3. Reference #3: Kuehn, Bridget M. "Aspergillosis Is Common Among COVID-19 Patients in the ICU.” JAMA 326.16 (2021): 1573-1573. DISCLOSURES: No relevant relationships by A. Whitney Brown, value=Honoraria Removed 04/03/2022 by A. Whitney Brown No relevant relationships by A. Whitney Brown, value=Honoraria Removed 04/03/2022 by A. Whitney Brown No relevant relationships by A. Whitney Brown, value=Consulting fee Removed 04/03/2022 by A. Whitney Brown No relevant relationships by Kristen Bussa Advisory Committee Member relationship with Boehringer Ingelheim Please note: 2019-2021 Added 04/03/2022 by Christopher King, value=Consulting f e Advisory Committee Member relationship with Actelion Please note: 2019-2022 Added 04/03/2022 by Christopher King, value=Consulting fee Advisory Committee Member relationship with United Therapeutics Please note: 2019-2022 Added 04/03/2022 by Christopher King, value=Consulting fee Speaker/Speaker's Bureau relationship with Actelion Please note: 2019-2022 Added 04/03/2022 by Christopher King, value=Consulting fee Speaker/Speaker's Bureau relationship with United Therapeutics Please note: 2020-22 Added 04/03/2022 by Christopher King, value=Consulting fee No relevant relationships by Haresh Mani No relevant relationships by Mary Beth Maydosz No relevant relationships by Alan Nyquist No relevant relationships by Anju Singhal No relevant relationships by Amy Thatcher
ABSTRACT
SESSION TITLE: COVID-19 Infections: Issues During and After Hospitalization SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: It has been established that recipients of solid organ transplants have worse outcomes compared to the general population from COVID-19 infections. We sought to determine the course and outcomes of lung transplant recipients (LTR) with COVID-19 infections based on vaccination status and treatments. METHODS: We performed a retrospective study of all LTR from Inova Fairfax Hospital with COVID-19 infections. Infection was confirmed based on symptoms and testing from an urgent care, hospital, or home kit. Patients with presumed but unconfirmed COVID-19 infections were excluded. The study timeframe was the two-year period: 3/1/2020 - 2/28/2022. Data collected included patient demographics, transplant type, immunosuppression, immunization status, episodes of rejection, donor derived cell-free DNA (dd-cfDNA) values (where available), spirometric data, outpatient/inpatient treatments, hospitalization data, and outcomes including death, infections, and other complications. The severity of illness was based on the 8-point ordinal scale. RESULTS: There were 45 LTR who tested positive during the study period;22 male and 23 female, average age of 57 and mean time from transplant of 4 years. 11 of the patients were unvaccinated (UV), 2 partially vaccinated (PV), 11 vaccinated non-boosted (VNB), and 21 vaccinated and boosted (VB). In total, 34 (76%) LTR required hospitalization. Of those hospitalized: 7 UV, 1 PV, 11 VNB, and 15 FV. In addition, 7 of those hospitalized required intubation with only 1/7 surviving to discharge. Overall, 8/45 (17.8%) patients died from COVID-19: 3 UV, 1PV, 1 VNB, 3VB. Infectious complications included 3 cases of PCP, 1 empyema, and 1 reactivation of CMV. For individuals who had spirometry at least 2 weeks after diagnosis (n =25), FVC decreased in 17 LTR by an average of 0.17 L, the FEV1 decreased in 14 LTR by an average of 0.14 L. On repeat spirometry testing (n=14), FVC further decreased in 9 LTR by 0.25 L and the FEV1 further decreased in 7 LTR by 0.13 L. CONCLUSIONS: A large proportion of LTR with COVID-19 infections require hospitalization (76%) with a high associated mortality rate and a sustained lung function decline seen in many who survive. The high mortality was independent of vaccination status, likely reflecting the inability of LTR to mount an immune response. A high index of suspicion and monitoring for superimposed infections, especially PCP, appears prudent. The sustained decline in lung function raises the notion of COVID-19 as a precipitating factor for chronic lung allograft dysfunction (CLAD). CLINICAL IMPLICATIONS: LTR who contract COVID-19 infection represent a high-risk population, even in those fully vaccinated, with potential for hospitalization, death, loss of lung function, and infectious complications. In this population, new algorithms for immunosuppression, monitoring and treatments may help to improve outcomes. DISCLOSURES: No relevant relationships by Shambhu Aryal No relevant relationships by A. Whitney Brown, value=Honoraria Removed 04/03/2022 by A. Whitney Brown No relevant relationships by A. Whitney Brown, value=Honoraria Removed 04/03/2022 by A. Whitney Brown No relevant relationships by A. Whitney Brown, value=Consulting fee Removed 04/03/2022 by A. Whitney Brown No relevant relationships by Jessica Chun No relevant relationships by Meg Fregoso No relevant relationships by Vikramjit Khangoora Advisory Committee Member relationship with Boehringer Ingelheim Please note: 2019-2021 Added 04/03/2022 by Christopher King, value=Consulting fee Advisory Committee Member relationship with Actelion Please note: 2019-2022 Added 04/03/2022 by Christopher King, value=Consulting fee Advisory Committee Member relationship with United Therapeutics Please note: 2019-2022 Added 04/03/2022 by Christopher King, value=Consulting fee Speaker/Speaker's Bureau relationship with Actelion Please note: 2019-2022 Added 04/0 /2022 by Christopher King, value=Consulting fee Speaker/Speaker's Bureau relationship with United Therapeutics Please note: 2020-22 Added 04/03/2022 by Christopher King, value=Consulting fee Consultant relationship with Veracyte Please note: $1001 - $5000 by Steven Nathan, value=Honoraria Removed 03/29/2022 by Steven Nathan Consultant relationship with United Therapeutics Please note: $5001 - $20000 by Steven Nathan, value=Consulting fee Consultant relationship with Bellerophon Please note: $5001 - $20000 by Steven Nathan, value=Consulting fee Speaker/Speaker's Bureau relationship with Roche-Genentech Please note: $5001 - $20000 by Steven Nathan, value=Honoraria Speaker/Speaker's Bureau relationship with Boerhinger-Ingelheim Please note: $20001 - $100000 by Steven Nathan, value=Honoraria No relevant relationships by Alan Nyquist No relevant relationships by Michelle Schreffler Speaker/Speaker's Bureau relationship with United Therapeutics Please note: 2020-2022 Added 04/01/2022 by Oksana Shlobin, value=Consulting fee Speaker/Speaker's Bureau relationship with Bayer Please note: 2020-2022 Added 04/01/2022 by Oksana Shlobin, value=Honoraria Speaker/Speaker's Bureau relationship with Janssen&Janssen Please note: 2020-2022 Added 04/01/2022 by Oksana Shlobin, value=Honoraria Consultant relationship with Altavant Please note: 2020-2022 Added 04/01/2022 by Oksana Shlobin, value=Consulting fee Consultant relationship with Acceleron Please note: 2020-2022 Added 04/01/2022 by Oksana Shlobin, value=Honoraria Consultant relationship with United Therapeutics Please note: 2020-2022 Added 04/01/2022 by Oksana Shlobin, value=Honoraria No relevant relationships by Anju Singhal No relevant relationships by Christopher Thomas
ABSTRACT
Background: Although bullying and harassment among academic staff has been well researched, research on students bullying and harassing academic teaching staff (ie, contrapower harassment) is less common. Contrapower harassment has been on the rise in academia over the last decade, partly attributable to changes in the student– faculty staff relationship. This study aimed to understand better the extent and impact of students’ contrapower harassment on paramedic academic teaching staff within Australian universities, as well as actions and interventions to address it. Methods: This study used a two-phase mixed methods design. In phase 1, a convenience sample of paramedic teaching academics from 12 universities in Australia participated in an online questionnaire. In phase 2, an in-depth interview was conducted with nine participants from phase 1. Results: Seventy-six academic teaching staff participated in the study. Survey results showed that most academics surveyed had experienced harassment from paramedic students, with the highest incidence of harassment occurring during student assessment periods. Alarmingly, over 30% of the academics surveyed had been ‘stalked’ by a student and over 50% had felt powerless and helpless when students had attacked them on social media. Problematic students were identified as those who presented with an over-inflated sense of entitlement or with psychological states and traits that find it challenging to accept feedback and failure, and look to externalise their failures. Reasons for increases in contrapower harassment included a complex mix of consumer and demand-driven education, ondemand (and demanding) instant gratification and degree self-entitlement, and an increase in social media and online learning (particularly during the COVID-19 pandemic of 2020). Conclusion: Although most of the academics in this study experienced contrapower harassment by students, they also report that most students are level-headed and supportive, and do not carry out this type of harassment. Promoting student professionalism and reassessing student evaluations are starting points for addressing this type of harassment. Further research on the broader systemic issues that influence the contributors to contrapower harassment is needed.
ABSTRACT
Introduction: Neutrophil extracellular traps (NETs) are extrusions of intracellular DNA and granular material released by neutrophils as part of the host immune response. While intended as a defense mechanism, excessive production of NETs may play a role in the pathogenesis of ARDS. Fostamatinib appears to limit NET formation. A phase 2 study of fostamatinib for COVID-19 associated acute lung injury found fostamatinib to be associated with improved clinical outcomes. No patients in the clinical trial were on extracorporeal membrane oxygenator (ECMO) support. In this we report our experience with two critically ill patients on veno-venous (VV) ECMO treated with fostamatinib. Case 1: A 46-year-old male with no significant PMH was admitted with COVID-19 associated ARDS (CARDS). He required intubation on hospital day (HD) 10. Due to refractory hypoxemia, he was cannulated for VV ECMO that same day. By day 19, he had improved and was decannulated from ECMO. Following decannulation, he continued to struggle. He developed a pneumothorax which was addressed with a chest tube. Despite this he had refractory hypoxemia requiring neuromuscular blockade (NMB). Broad spectrum antibiotics were initiated. No superinfection was identified. He was again cannulated for VV ECMO on HD 30. On HD 36, fostamatinib was initiated at a dose of 150 mg bid for 14 days. The patient demonstrated fairly rapid improvement by HD 39, allowing for minimization of ECMO support. He was decannulated from VV ECMO on HD 46. He currently resides at home and has no need for oxygen. Case 2: A 53- year-old male with a PMH of psoriasis on etanercept was admitted with CARDS. He was intubated HD 1, but continued to require substantial support including prone positioning and NMB. On HD 5 he was cannulated for VV ECMO. He had early improvement and was decannulated on HD 10;however, he developed Staph aureus pneumonia resulting in marked clinical decline. On HD 12 he was placed back on VV ECMO support. He was also initiated on fostamatanib 150 mg twice daily for 14 days. He demonstrated fairly rapid improvement in oxygenation but required prolonged ECMO support for CO2 clearance. He was successfully decannulated from VV ECMO on HD 45. He is currently living at home. Conclusion: Fostamatinib appears safe to administer to COVID patients on ECMO. While it is speculative to make inferences with regards to efficacy, it is noteworthy that both critically ill COVID-19 patients treated with fostamatinib survived.
ABSTRACT
Learning Objectives:Our goal was to create a Quality and Patient Safety Curriculum for EM Residents that included interactive lectures, resident projects, infographic emails, and simulations. This curriculum was developed during COVID-19 and therefore was adapted for virtual and in-person socially distant education. : Introduction/Background: The American College of Graduate Medical Education (ACGME) requires residents develop skills to analyze quality assessment methods;identify system errors;and participate in quality improvement projects. When surveyed, 52% of EM residencies had <4 hours/year of quality education and 62% had <4 hours/year of risk education. Educational Objectives: Our goal was to create a Quality and Patient Safety Curriculum for EM Residents that included interactive lectures, resident projects, infographic emails, and simulations. This curriculum was developed during COVID-19 and adapted for virtual and socially distant education. Curricular Design: We created our Quality and Patient Safety curriculum based on initiatives important to our ED, such as sepsis care. We designed 4 main educational programs: 1) Quality Corner: Weekly, a colorful infographic on quality metrics, new patient safety initiatives, or EMR tips was emailed (Image 1: Example Quality Corners). 2) Monthly Lectures: A 45-minute interactive quality lecture was given monthly at conference. Residents were given case-based scenarios followed by an online poll;realtime results were displayed. This was followed by a 1-hour deep-dive on a patient case. 3) Resident Projects: Each resident was assigned to a group and focused on a quality metric. The groups were taught how to do a literature review;write an IRB;create a datasheet;and implement a project. 4) Quality Simulations: During resident shifts, a chief resident ran quality group and individual case simulations. Impact/Effectiveness: Residents completed anonymous surveys. For the residency lectures, 39 of 48 (81%) residents responded-82% stated they were helpful;84.6% learned something new;and 84.6% recommended they be continued. For the Quality Simulations, 28 of 30 (93%) residents responded-100% said they were helpful;93% learned something new;and 100% recommended they be continued.
ABSTRACT
Purpose: COVID-19 pandemic presented an unprecedented challenge to health care systems. It disrupted the transplant processes including evaluations, especially in rural or other geographically challenged areas in terms of access to transplant care (outreach locations). Prompt utilization of telehealth may change how healthcare is delivered beyond pandemic. Methods: By April 2020, the healthcare disruption by the pandemic was evident;COVID-19 lockdowns were in full swing with a nationwide shortage of personal protective equipment, most staff working remotely, no in-person clinics, and all evaluation testing/elective surgeries on hold. We promptly converted all our transplant outreach clinics to telehealth based in April. The goal was to continue to connect, communicate, consent, educate, and evaluate our transplant referrals. Results: The telehealth platform provided safe care for the patients and providers (minimal physical exposure) with the least intrusive means of evaluation. Patients and their families were more open to communicating. It lessened the patient's initial commitment burden towards a visit to the center and helped with their time off from work, transportation, opportunity costs, and provided easy access to health care from their home with almost zero no-show rate. We were able to filter an increasing number of referrals to identify the need for support plans/transportation/weight issues/living donor education at a much earlier stage and continued to move patients through the transplant evaluation process. The challenges noted were: 1) Patient barriers which included access to technology adeptness, system issues, ability to seek technical support, or asking for help. 2) Healthcare system & Provider barriers included a steep learning curve, lack of physical exam/assessment, time-consuming process, missing “personal rapport”, lack of state licensure reciprocity across state lines, lower reimbursements/ work credits, and high technology costs. Figures 1 and 2 show trends in referrals, listings, and transplants in 2019 and 2020;despite the challenges in the pandemic, telehealth was able to achieve an increase in all activities in outreach locations. Conclusions: Pandemic and beyond, telehealth could be a viable standard option for increasing transplant referrals, screening, and initial evaluation. It adds value to transplant outreach clinics and increases patients' access to transplant centers. Licensure reciprocity, improvement in reimbursements, and utilizing more patientcentric platforms are needed to make such models sustainable. (Table Presented).
ABSTRACT
Despite the growing interest in macroscopic epidemiological models to deal with threats posed by pandemics such as COVID-19, little has been done regarding the assessment of disease spread in day-to-day life, especially within buildings such as supermarkets where people must obtain necessities at the risk of exposure to disease. Here, we propose an integrated customer shopping simulator including both shopper movement and choice behavior, using a force-based and discrete choice model, respectively. By a simple extension to the force-based model, we implement the following preventive measures currently taken by supermarkets;social distancing and one-way systems, and different customer habits, assessing them based on the average individual disease exposure and the time taken to complete shopping (shopping efficiency). Results show that maintaining social distance is an effective way to reduce exposure, but at the cost of shopping efficiency. We find that the one-way system is the optimal strategy for reducing exposure while minimizing the impact on shopping efficiency. Customers should also visit supermarkets less frequently, but buy more when they do, if they wish to minimize their exposure. We hope that this work demonstrates the potential of pedestrian dynamics simulations in assessing preventative measures during pandemics, particularly if it is validated using empirical data. © 2021 Chinese Physical Society.
ABSTRACT
Despite the growing interest in macroscopic epidemiological models to deal with threats posed by pandemics such as COVID-19, little has been done regarding the assessment of disease spread in day-to-day life, especially within buildings such as supermarkets where people must obtain necessities at the risk of exposure to disease. Here, we propose an integrated customer shopping simulator including both shopper movement and choice behavior, using a force-based and discrete choice model, respectively. By a simple extension to the force-based model, we implement the following preventive measures currently taken by supermarkets;social distancing and one-way systems, and different customer habits, assessing them based on the average individual disease exposure and the time taken to complete shopping (shopping efficiency). Results show that maintaining social distance is an effective way to reduce exposure, but at the cost of shopping efficiency. We find that the one-way system is the optimal strategy for reducing exposure while minimizing the impact on shopping efficiency. Customers should also visit supermarkets less frequently, but buy more when they do, if they wish to minimize their exposure. We hope that this work demonstrates the potential of pedestrian dynamics simulations in assessing preventative measures during pandemics, particularly if it is validated using empirical data.