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Due to the COVID-19 pandemic, university teaching had to be kept up in spite of severe contact restrictions. Virtual teaching of animal nutrition was implemented at the Veterinary Faculty of the Ludwig-Maximilians-Universität (LMU) München, Germany, for both lectures and practical courses. Live online classes were held via Zoom®, and recordings were accessible afterwards. Animal nutrition is taught in the 5th and 6th term of the veterinary studies, followed by an oral state exam about subjects from both terms. In this study, the success of classroom vs. virtual teaching in veterinary animal nutrition was evaluated by comparison of exam results. Two exam cohorts (2019, before the pandemic;2020, with one term of virtual teaching during the pandemic) were evaluated. The results indicated no significant difference of teaching method on the grades. However, there was a significantly higher probability of students not taking or failing the exam in the 2020 exam cohort, suggesting a general effect of the pandemic on the students. Additionally, two surveys were distributed among the students during summer term 2020 and winter term 2020/21, when virtual teaching due to the pandemic had been implemented for the first time. The survey results provide insights into the students' view of benefits and problems of virtual teaching in animal nutrition at the LMU. The majority was in favor of the live online format for lectures and courses in computed-based ration calculation, whilst feedstuff demonstrations were preferred in classroom setting. Copyright © 2022 Böswald, Pankratz, Dobenecker, Herbst, Klein, Alf and Kienzle.
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Background: Unselected data of nationwide studies of hospitalized patients with COVID-19 is still sparse, but these data are of outstanding interest not to exceed hospital capacities and to avoid overloading of national health-care systems. Purpose(s): Thus, we sought to analyze seasonal/regional trends, predictors of in-hospital case-fatality and mechanical ventilation (MV) in patients with COVID-19 in Germany. Method(s): We used the German nationwide inpatient sample to analyze all hospitalized patients with confirmed COVID-19 diagnosis in Germany between January 1st and December 31st in 2020 (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2020, own calculations). Covid-19-inpatients with MV vs. without MV and survivors vs. non-survivors were compared. Logistic regression models were calculated to investigate associations between patients' characteristics as well as adverse events and i) necessity of MV and ii) in-hospital death. Result(s): We analyzed data of 176,137 hospitalizations of patients with confirmed COVID-19-infection. Among those, 31,607 (17.9%) died, whereby in-hospital case-fatality grew exponentially with age. Cardiovascular comorbidities were common in hospitalized patients with confirmed COVID-19-infections: Overall, almost half of the patients (46.8%;n=82,480) had arterial hypertension and 25,574 (14.4%) had a diagnosis of coronary artery disease. In 60.7% (n=106,913) of the hospitalizations, pneumonia was reported, 8.6% (n=15,061) had an acute infection of the upper or lower airways other than pneumonia, and 6.6% (n=11,594) suffered from an acute respiratory distress syndrome (ARDS) during hospitalization Age >=70 years (OR 5.91, 95% CI 5.70-6.13, P<0.001), pneumonia (OR 4.58, 95% CI 4.42-4.74, P<0.001) and acute respiratory distress syndrome (OR 8.51, 95% CI 8.12-8.92, P<0.001) were strong predictors of in-hospital death. Most COVID-19-patients were treated in hospitals in urban areas (n=92,971) associated with lowest case-fatality (17.5%) as compared to hospitals in suburban (18.3%) or rural areas (18.8%). MV demand was highest in November/December 2020 (32.3%, 20.3%) in patients between 6th and 8th age-decade. In the first age-decade, 78 of 1861 children (4.2%) with COVID-19-infection were treated with MV and five of them died (0.3%). Conclusion(s): The results of our study indicate seasonal and regional variations concerning number of COVID-19-patients, necessity of MV and casefatality in Germany. These findings may help to ensure flexible allocation of intensive care (human) resources, which is essential for managing enormous societal challenges worldwide to avoid overloaded regional healthcare systems.
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Background: Although a high prevalence of pulmonary embolism (PE) has been reported as a complication during severe COVID-19 infections in critical ill patients, nationwide data of hospitalized patients with COVID-19 with PE is still limited. Thus, we sought to analyze seasonal trends and predictors of in-hospital case-fatality in patients with COVID-19 and PE in Germany. Method(s): We used the German nationwide inpatient sample to analyze all data on hospitalizations for COVID-19 patients with and without PE in Germany during the year 2020 and to compare changes of PE prevalence to 2019. Result(s):We analyzed data of 176,137 hospitalizations because of COVID- 19 in 2020. Among those, PE was recorded in 1.9% (n=3,362) of discharge or death certificates. Almost one third of patients with COVID-19 and PE died during the in-hospital course (28.7%). The case-fatality rate increased with patients' age peaking in the 9th life-decade. Regardless of COVID-19, 196,203 inpatients were diagnosed with PE in Germany between 2019 and 2020. The number of PE hospitalizations were widely equally distributed between both years (98,485 vs. 97,718), while the case-fatality rate of all patients with PE was slightly lower in 2019 compared to 2020 (12.7% vs. 13.1%, P<0.001). In contrast, considerable differences in prevalence and case-fatality were demonstrated in 2020 regarding PE patients with and without COVID-19 infection (28.7% vs. 13.1%, P<0.001) (Figure 1). A COVID-19-infection was associated with a 2.8-fold increased risk of casefatality in patients with PE (OR 2.81, 95% CI 1.66-2.12, P<0.001). Conclusion(s): In Germany, the prevalence of PE events complicating hospitalizations was similar in 2019 and 2020. However, the fatality rate among patients with COVID-19-associated PE was substantially higher than that in those without either COVID-19 or PE, indicating an additive prognostic effect of these two conditions.
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Introduction La pandémie a particulièrement mis en danger nos patients immunodéprimés et questionne notre place dans l'organisation de l'administration des anticorps monoclonaux à titre préventif et curatif. L'objectif de l'étude a été d'évaluer l'activité d'une cellule régionale mise en place pour évaluer l'indication, organiser le traitement prophylactique ou curatif par anticorps monoclonaux ou par antiviraux, quelle que soit la pathologie chronique des patients concernés. Matériels et méthodes La cellule « anticorps monoclonaux et traitements du COVID », composée d'un médecin coordonnateur, de médecins retraités, et d'une secrétaire médicale, a été mise en place début janvier 2022 grâce à un financement par l'ARS. Tous les médecins ont été informés par l'ARS et les URPS, des critères d'éligibilité aux anticorps monoclonaux et du rôle de la cellule dans l'évaluation de l'indication, l'aide apportée pour la demande d'accès précoce et la logistique (injections en hospitalisation de jour ou en hospitalisation à domicile (HAD)). Les structures d'HAD ont été spécifiquement formées aux formalités de prescription, à l'administration et au suivi de ces patients. Les patients ayant reçu un traitement prophylactique ont été recontactés par la cellule la semaine suivant l'injection, 3 mois et 6 mois suivant l'injection. Des questionnaires ont été adressés aux médecins généralistes pour évaluer leur perception concernant les anticorps monoclonaux et les antiviraux. Résultats Au total, 216 patients (dont 121 patients ayant des facteurs de risque cardiovasculaire) ont reçu un traitement prophylactique par anticorps monoclonaux (Evusheld), pour les indications suivantes : 110 patients transplantés d'organe, 95 patients traités par anti-CD20, 2 patients traités par chimiothérapie, 8 patients ayant d'autres facteurs d'immunodépression et 1 contre-indication au vaccin. Les sollicitations de la cellule dans cette indication émanaient quasi exclusivement de médecins spécialistes. Avec un suivi médian de 6 mois, aucun événement indésirable (EI) grave, y compris cardiovasculaire, n'est survenu. Des EI non graves ont été observés chez 50 patients (23 %). Trente patients (14 %) ont été infectés par le SARS-CoV-2, dont 2 ont été traités par anticorps monoclonaux à titre curatif et 2 par Paxlovid. Aucun patient n'a été hospitalisé pour COVID, aucun n'a développé de COVID sévère. Sur les 214 patients recontactés pour une ré-administration d'anticorps à visée prophylactique, 12 (5 %) l'ont refusée. Au total, 85 patients ont été traités par anticorps monoclonaux à visée curative dont 3 par Ronapreve, 68 par Xevudy, 14 par Evusheld, dont 53 (62,3 %) en HAD et 30 patients ont été traités par Paxlovid. Les sollicitations de la cellule dans cette indication émanaient le plus souvent de médecins généralistes. Aucun effet indésirable grave n'a été observé. Conclusion La coordination régionale pour l'aide au traitement par anticorps monoclonaux et antiviraux est utile pour faciliter la prescription de ces traitements. Le suivi prospectif confirme leur tolérance très satisfaisante. Cette coordination a également permis d'évaluer les difficultés rencontrées par les médecins généralistes, en partie liées au caractère innovant, aux difficultés logistiques ou aux contraintes administratives de ces traitements.
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Right from the start of the COVID pandemic in January 2020, the entire tourism sector was put under immense pressure because of its assumed role in SARS-CoV-2 transmission and infection dynamics. Based on reports of single superspreading events in the early days of the pandemic, the hotel industry appeared in a bad light that impaired a strategic risk-assessment of existing transmission risks between tourists and employees. We prospectively analysed samples of 679 employees of 21 hotels and restaurants from July 2020 to December 2020, a time during which more than 1.5 million tourists visited the Lübeck/Ostholstein Baltic Sea vacation area in Northern Germany. Employees were tested up to three times for an acute SARS-CoV-2 infection (PCR from nasopharyngeal swabs) and the presence of SARS-CoV-2 specific antibodies, and were asked to complete a short questionnaire. Despite the massive increase in tourist influx, no significant increase in SARS-CoV-2 cases was observed amongst employees of the tourism sector from July to September 2020. In a cluster-outbreak analysis of 104 study participants of one single hotel in the Lübeck/Ostholstein region in October 2020 being employed in the low-wage sector "housekeeping" could be determined as major risk factor for becoming infected. In conclusion, in a low incidence setting, touristic activities are safe under COVID-related hygiene measures for both the local population and employees of the tourism sector. Whereas, the field of work is a potential risk factor for increased infection dynamics.
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Introduction: Exhaustion, cynicism or negative feelings related to work and reduced professional performance are the characteristics of Burnout syndrome, which has a high prevalence among health professionals, even more susceptible to professionals who have a more stressful work routine, such as in ICU. Discussion: Burnout among doctors is on the rise, and studies show that the risk and clinical features of the syndrome vary according to the specialty and conditions to which the professional is exposed, such as workload, emotional aspects of the patient and family, mortality rates, etc. Therefore, intensive care medicine is particularly highlighted in the presence of emotional and physical strain, a fact that was greatly aggravated at the time of the COVID-19 pandemic. Several distinct characteristics influence mental exhaustion, psychological imbalance and professional frustration related to intensive care doctors, including female professionals, with a higher prevalence. It was found that there are repercussions for both the professional's quality of life, such as emotional lability and susceptibility to other diseases, as well as impairment to medical care, a consequence of the professional's exhaustion.
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Background and aims: Register studies and cohort analyses of clinical data are essential to study neurological manifestations of COVID-19 at a large scale. Methods: We analyzed neurological manifestations in COVID-19 patients, diagnosed before Aug 25th 2020, and registered in the European multinational LEOSS registry. Results: Of the 3127 COVID-19 patients, 95.2% were hospitalized. In 54.4% at least one neurological symptom, and in 3.3% a new neurological complication occurred. Preexisting neurological comorbidities were reported in 18.1% of the patients. Neurological symptoms were excessive tiredness (27.6%), headache (15.3%), nausea/emesis (14.0%), muscular weakness (13.2%), smell (6.9%), taste disorder (8.3%) and delirium (6.3%). Intracerebral bleeding occurred in 1.2%, ischemic stroke in 0.5%, and meningitis/ encephalitis in 0.4%. Overall, the death rate was 17.5%. It was higher in patients with the following neurological comorbidities: dementia 38.0%, movement disorders 32.8%, and prior cerebrovascular disease 32.3%. A multivariable logistic regression model found age (OR 1.53), cardiovascular diseases (OR 1.74), muscle weakness (OR 1.40), pulmonary diseases (1.49) and male gender (OR 1.52) to be associated with a significantly increased risk for a critical COVID-19 disease course, failed recovery, and death. Conclusion: The neurological manifestations revealed in COVID-19 patients of this study are mostly in agreement with previously published data. Several neurological conditions, such as prior cerebrovascular diseases or dementia appeared to be associated with a higher risk in unadjusted analyses, which was not confirmed in a multivariable analysis adjusting for confounding variables such as age and sex. These findings contrast previously published studies and stress the importance of considering putative confounds in medical statistics carefully.
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BACKGROUND: Child burns rank among the most frequent domestic accidents in France. COVID-19 lockdown between March 16th and May 11th of 2020 increased time spent at home by children. MATERIAL: This retrospective, observational study described the epidemiological impact of COVID-19 lockdown on child burns in a pediatric surgery department compared with previous five years. Child burns in the previous five years constituted the "before COVID-19 group" as the reference group. Child burns during the first lockdown formed the "COVID-19 group". Demographics characteristics, the delay before first attendance at the surgery department, burns characteristics, the place of the incident, need of skin graft, and child reactions to trauma or isolation were recorded for these two groups. RESULTS: A total of thirty-seven children were included, 16 of them in the COVID-19 group. In the COVID-19 group, burned children were mainly boys, with a median age of 18 months. The median time before first attendance was four days. Main burns characteristics were to be deep partial thickness burns, involved lower limbs, caused by scalding. All burns occurred at home. Half parents reported child reactions to trauma or isolation among their children before burn injury. CONCLUSION: The incidence of child burn injuries in the COVID-19 group was higher compared to the before COVID-19 group, but no increased delay to attendance recorded. Time spent at home and psychosocial impact of lockdown might partially explain this high incidence rate of child burns. LEVEL OF EVIDENCE: IV.
Subject(s)
Accidents, Home/statistics & numerical data , Burns/epidemiology , COVID-19/epidemiology , Communicable Disease Control , Adolescent , Age Distribution , Child , Child, Preschool , Female , France/epidemiology , Humans , Incidence , Infant , Infant, Newborn , Male , Pandemics , Retrospective Studies , Sex DistributionABSTRACT
Objectives: Over 50 million people in the USA are enrolled in a Medicaid Managed Care plan. If they do not select a primary care provider, they are auto-assigned to one. The impact of auto-assignment has largely been understudied outside the context of patient satisfaction with the insurance plan. The purpose of the study was to explore the association between auto-assignment and flu vaccination use, which will contribute to our understanding of factors influencing the COVID-19 vaccine uptake. Methods: Retrospective data from the Enterprise Data Warehouse of a health system were obtained for adult Medicaid enrolees assigned to a Midwestern health system in 2019. Descriptive statistics, independent t-tests and tetrachoric correlations were used to explore the relationship between auto-assignment and flu vaccine receipt among a large sample of Illinois residents (N = 7224). The sample was then divided into those who chose their provider (n = 6027) and those who were auto-assigned (n = 1197). Key findings: Individuals who selected their provider were deemed to have flu vaccine coverage over those who were auto-assigned (33.2% vs. 6.6%). Furthermore, among those who were auto-assigned, age, number of office visits and having chronic morbidities, including chronic obstructive pulmonary disease (P < 0.01), diabetes (P < 0.01) and heart failure (P < 0.01), were positively associated with flu vaccine receipt. Conclusions: Individuals who are auto-assigned to a primary care provider are less likely to be flu vaccine recipients than those who choose their provider. This suggests that auto-assignment is a risk factor that influences vaccine receipt. This research provides perspectives for outreach efforts that target individuals who are auto-assigned to a provider.
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Objectives: The objective of this presentation is to examine how visit completion rates were affected by the transformation of a large community-based pragmatic clinical trial (entitled Metformin for overweight and OBese chILdren with bIpolar spectrum disorders Treated with second-generation antipsYchotics [MOBILITY]) to remote follow-up visits with the use of telepsychiatry and virtual research methodology in light of a pandemic. Methods: MOBILITY is a Patient-Centered Outcome Research Institute (PCORI)-funded, large, randomized pragmatic clinical trial designed to examine the effectiveness of metformin and healthy lifestyle instruction vs healthy lifestyle instruction alone on BMI and other metabolic and clinically useful parameters. We examined visit completion rates of patients due for a study visit on April 1, 2020 performed in the remote care visit window (April 1, 2020 to May 31, 2020) by visit type (month 6, month 24, other visit) and institution type (community vs academic) to in-person visits from the coinciding preceding enrollment period (April 1, 2019 to May 31, 2019). Results: Of the total 603 patients in-window on April 1, 2020 for a visit, 180 patients (29.9%) had an in-window remote visit. Of the total 620 patients in-window on April 1, 2019 for a visit, 159 patients (25.6%) had an in-window in-person visit. There were no significant time x type interaction effects for visit type (p = 0.37) or institution type (p = 0.26). However, there were significant main effects for visit type and institution type, with higher month-24 in-window visits for remote visits vs in-person visits (2020 = 14.9% vs 2019 = 9.4%;p < 0.01) and higher overall visits in academic vs nonacademic centers (2020 = 34.4% vs 2019 = 27.7%). Conclusions: Overall visit completion rates comparing the pre-COVID-19 enrollment period in 2019 to the same period in 2020 did not show significant changes in visit completion rates. Despite the shift to remote visits, visit completion rates for this large, pragmatic study that are linked to clinical care visits did not suffer. However, month-24 visit completion rates were significantly improved. Academic institutions were able to hold or improve visit completion rates more effectively than community-based ones. Making virtual visits available in clinical effectiveness research may be beneficial by decreasing patient and caregiver burden, improving data quality, and reducing cost, although this may be more easily accomplished in academic centers. R, BRD, TVM