Healthcare Providers as Cultural Guests of Patients and Their Loved Ones During the Dual Pandemic of COVID-19 and Racism: Establishing Trust in the ICU (Sci233)

Outcomes: 1. Learners will identify cultural barriers to the establishment of trust between patients' loved ones and the healthcare provider team and integrate methods to reduce cultural barriers. 2. Through this presentation healthcare providers will strengthen ability to understand how to be a cultural guest of patients, and their loved ones, in healthcare settings. In the stressful environment of the intensive care unit (ICU), cultural differences between healthcare providers and patients' loved ones can prevent the establishment of trust. Healthcare providers can address this barrier by respecting cultural practices utilized as comfort mechanisms by patients and their loved ones. The objective of this research is to determine how healthcare providers can be genuine cultural guests of patients and their loved ones in the ICU setting. We employed a qualitative descriptive design with 22 family caregivers. Semi-structured, audio-recorded phone interviews were conducted between February 2021 and October 2021, with caregivers whose family member had been in the ICU between May 2019 and August 2020. The sample included a majority of female (87%), Black (53%) caregivers with an average age of 53. The research team employed a conventional and directed qualitative content analysis to code transcribed interviews, followed by the development of a formative categorization matrix, and theoretical labeling of the main categories and subcategories. We identify four pillars that facilitate the cultural guest mindset: form genuine connection, build trust, establish expectations, and respect culture. The formation of genuine connection entails healthcare provider investment, specifically by keeping the patient's family regularly updated on the patient's condition. Building trust also necessitates that healthcare providers engage in frequent open communication with the family, while avoiding the use of complex medical jargon. Establishing expectations requires healthcare providers to assess the culture of patients and their loved ones in order to understand how to best support the family's needs. Finally, respect of cultural practices can foster a sense of collaboration with patients and their families, who may feel that the healthcare providers are on an opposing team. Implementing these practices, healthcare providers can provide medical services in a way that complement patients' culture, enhancing the patient and caregivers' ICU experience.Copyright © 2023

X-Ray Analysis of Donor Lungs within an Ex Vivo Lung Perfusion System (EVLP): A Pilot Study for the Assessment of the Brixia Score to Predict Transplantability

Background: Ex vivo lung perfusion (EVLP) is a safe and effective technique for lung evaluation and reconditioning of marginal donor lungs (DLs). The assessment of the DLs during EVLP is crucial for the transplantability decision making. There are a limited number of studies regarding the radiographic analysis of EVLP lungs. Furthermore, there are only few Xray grading scores available. The Brixia score is a proven radiological score for the severity grading of lung abnormalities with confirmed predictive power of the clinical outcome that was successfully used in pneumonia patients during the COVID-19 pandemic. It was the aim of our study to evaluate the X-ray findings of DLs within EVLP and investigate the prognostic potential of this score regarding transplantability and clinical outcome. Method(s): This is a retrospective observational pilot study. Between 2016 and 2022, a total of 277 double-lung transplantations (DLTx) were performed in our department. X-Rays of the last ten consecutive EVLP-DLs were blindly evaluated regarding the severity of interstitial and alveolar infiltrates and the Brixia score was calculated. Furthermore, the results (transplantability, severe primary graft dysfunction PGD, survival, hospital stay) and EVLP parameters (delta pO2) of these EVLP-DLs cases were analyzed and compared with the Brixia score for each case. Result(s): A range of Brixia score values from min 4 to max 18 was determined. Seven DLs were transplanted (mean delta pO 391 mm Hg, mean Brixia score 6.7) while three were rejected (mean delta pO 211 mm Hg, mean Brixia score 6). The two EVLP-DLs cases with the higher Brixia score (mean 15) were transplanted after EVLP. Postoperative PGD Grade 3 at 48 hours was recorded in one case without correlation to the Brixia score (Brixia score 4). All patients survived hospital discharge with a mean ICU and hospital stay of 9 and 30 days, respectively. Conclusion(s): In our pilot study, the Brixia score did not predict transplantability or postoperative function during EVLP. Additional studies are needed to further evaluate the use and clinical prognostic power of radiologic assessment with this or other scores in the EVLP lung assessment.

Development of placental lesions after recovery from COVID-19 during pregnancy: case-control study.

OBJECTIVE: To study whether the occurrence and type of placental lesions vary according to the time of onset of COVID-19 in pregnant women. DESIGN: Case-control study. SETTING: Departments of Gynaecology-Obstetrics and Pathology, Strasbourg University Hospital, France. POPULATION: Cases were 49 placentas of women with COVID-19. Controls were 50 placentas from women who had a past history of molar pregnancy. COVID-19 placentas were categorised based on whether birth occurred at more or less than 14 days post-infection. METHODS: Comparison between case and controls. MAIN OUTCOME MEASURES: Maternal and neonatal outcomes were recorded. Macroscopic and microscopic examination of the placentas was performed. RESULTS: The rate of vascular complications was higher in the COVID groups than in the controls (8 [16.3%] versus 1 [2%], p = 0.02). Signs of fetal (22[44.9%] versus 13 [26%], p = 0.05) and maternal (44 [89.8%] versus 36 [72.0%], p = 0.02) vascular malperfusion and signs of inflammation (11 [22.4%] versus 3 [6.0%], p = 0.019) were significantly more common in the COVID-19 groups than in the control group. Fetal malperfusion lesions (9 [39.1%] versus 13 [50.0%], p = 0.45) and placental inflammation (4 [17.4%] versus 7 [26.9%], p = 0.42) rates were not significantly different between the two COVID-19 groups. Chronic villitis was significantly more common when the delivery occurred >14 days after infection than in the group that delivered <14 days after infection (7 [26.9%] versus 1 [4.4%], p = 0.05). CONCLUSIONS: Our study suggests that SARS-COV-2 induces placental lesions that evolve after disease recovery, especially with the development of inflammatory lesions, such as chronic villitis.

COVID-19 hos børn og unge

Children and adolescents infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are usually asymptomatic or have mild coronavirus disease (COVID-19) with low rates of hospitalization and death. Multisystem inflammatory syndrome in children (MIS-C) is a rare and severe complication of SARS-CoV-2 infection. This paper reviews an excerpt of the literature on disease burden and complications following COVID-19 in children and adolescents aged 0-17 years, in addition to the effects and adverse drug reactions of BNT162b2 and mRNA-1273 vaccinations among children and adolescents aged 5-17 years © 2022. Ugeskrift for Laeger.All Rights Reserved.

[The golden period for suturing of traumatic woundsCOVID-19 among children and adolescents]

Children and adolescents infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are usually asymptomatic or have mild coronavirus disease (COVID-19) with low rates of hospitalization and death. Multisystem inflammatory syndrome in children (MIS-C) is a rare and severe complication of SARS-CoV-2 infection. This paper reviews an excerpt of the literature on disease burden and complications following COVID-19 in children and adolescents aged 0-17 years, in addition to the effects and adverse drug reactions of BNT162b2 and mRNA-1273 vaccinations among children and adolescents aged 5-17 years.

Subcorneal pustular dermatosis with temporary autoimmune features during COVID-19 pandemic. (Special Issue: Coronavirus disease (COVID-19).)

Subcorneal pustular dermatosis, Sneddon-Wilkinson, is an uncommon neutrophilic dermatosis of unknown etiology. We report on a 51-year-old woman who presented with multiple superficial erythematous erosions surrounded by annular arranged sterile pustules concentrated on the trunk, the neck, and the proximal extremities during the coronavirus disease-19 pandemic. Larges pustules and flaccid bullae showed a hypopyon. There were no fever and no pruritus, general health was unaffected. Laboratory investigations revealed leukocytosis, neutrophilia, lymphopenia, and increased C-reactive protein. Initially, antinuclear antibodies, pemphigoid antibodies, and antibodies to BP 230 were positive, but negative 5 days later. Nasopharyngeal swabs were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA tested by real-time reverse-transcriptase-polymerase chain reaction. A diagnostic skin biopsy showed epidermal spongiotic vesiculation and subcorneal pustulation with acantholysis and an inflammatory infiltrate composed of neutrophils and lymphocytes. The confirmed diagnosis was subcorneal pustular dermatosis Sneddon-Wilkinson. She was treated by dapsone and corticosteroids with the latter tempered down. Clinical response was rapid. We suggest that the autoimmune features seen on admission may be due to an undefined viral infection, but not SARS-CoV-2.

3D-printed simulator for nasopharyngeal swab collection for COVID-19.

OBJECTIVES: Diagnosis of COVID-19 is essential to prevent the spread of SARS-CoV-2. Nasopharyngeal swabs (NPS) remain the gold standard in screening, although associated with false negative results (up to 30%). We developed a 3D simulator of the nasal and pharyngeal cavities for the learning and improvement of NPS collection. PATIENTS AND METHODS: Simulator training sessions were carried out in 11 centers in France. A questionnaire assessing the simulator was administered at the end of the sessions. The study population included both healthcare workers (HCW) and volunteers from the general population. RESULTS: Out of 589 participants, overall satisfaction was scored 9.0 [8.9-9.1] on a scale of 0 to 10 with excellent results in the 16 evaluation items of each category (HCWs and general population, NPS novices and experienced). The simulator was considered very realistic (95%), easy to use (97%), useful to understand the anatomy (89%) and NPS sampling technique (93%). This educational tool was considered essential (93%). Participants felt their future NPS would be more reliable (72%), less painful (70%), easier to perform (88%) and that they would be carried out more serenely (90%). The mean number of NPS conducted on the simulator to feel at ease was two; technical fluency with the simulator can thus be acquired quickly. CONCLUSION: Our simulator, whose 3D printing can be reproduced freely using a permanent open access link, is an essential educational tool to standardize the learning and improvement of NPS collection. It should enhance virus detection and thus contribute to better pandemic control.

ConTra Corona: Contact Tracing against the Coronavirus by Bridging the Centralized–Decentralized Divide for Stronger Privacy

Contact tracing is among the most important interventions to mitigate the spread of any pandemic, usually in the form of manual contact tracing. Smartphone-facilitated digital contact tracing may help to increase tracing capabilities and extend the coverage to those contacts one does not know in person. Most implemented protocols use local Bluetooth Low Energy (BLE) communication to detect contagion-relevant proximity, together with cryptographic protections, as necessary to improve the privacy of the users of such a system. However, current decentralized protocols, including DP3T [T+20], do not sufficiently protect infected users from having their status revealed to their contacts, which raises fear of stigmatization. We alleviate this by proposing a new and practical solution with stronger privacy guarantees against active adversaries. It is based on the upload-what-you-observed paradigm, includes a separation of duties on the server side, and a mechanism to ensure that users cannot deduce which encounter caused a warning with high time resolution. Finally, we present a simulation-based security notion of digital contact tracing in the real–ideal setting, and prove the security of our protocol in this framework. © 2021, International Association for Cryptologic Research.

Healthy ecosystems for human and animal health: Science diplomacy for responsible development in the Arctic: The Nordic Centre of Excellence, Clinf.org (Climate-change effects on the epidemiology of infectious diseases and the impacts on Northern societies)

Climate warming is occurring most rapidly in the Arctic, which is both a sentinel and a driver of further global change. Ecosystems and human societies are already affected by warming. Permafrost thaws and species are on the move, bringing pathogens and vectors to virgin areas. During a five-year project, the CLINF – a Nordic Center of Excellence, funded by the Nordic Council of Ministers, has worked with the One Health concept, integrating environmental data with human and animal disease data in predictive models and creating maps of dynamic processes affecting the spread of infectious diseases. It is shown that tularemia outbreaks can be predicted even at a regional level with a manageable level of uncertainty. To decrease uncertainty, rapid development of new and harmonised technologies and databases is needed from currently highly heterogeneous data sources. A major source of uncertainty for the future of contaminants and infectious diseases in the Arctic, however, is associated with which paths the majority of the globe chooses to follow in the future. Diplomacy is one of the most powerful tools Arctic nations have to influence these choices of other nations, supported by Arctic science and One Health approaches that recognise the interconnection between people, animals, plants and their shared environment at the local, regional, national and global levels as essential for achieving a sustainable development for both the Arctic and the globe.

Increasing patient and operator protection when using ophthalmic diagnostic devices during the COVID-19 pandemic

Purpose: Ophthalmic diagnostic devices require patient and operator to be physically close during the exam. Goal of this study is to develop and release protective measures to increase patient and operator protection during COVID-19. Methods: We applied recommendations by the World Health Organization (WHO), the Center of Disease Control (CDC) and the Environmental Protection Agency (EPA) to the situation in the ophthalmic exam room, and developed, released, distributed, and communicated the resulting protective measures. We report the number of website visits, document downloads, and parts distributed from March 2020 through February 2021. Results: Detailed instructions on remote control of ophthalmic devices using remote desktop software or extension on monitors were published, viewed 4,450 and downloaded 1,014 times. Custom breath shields separating operator and patient were developed and a total of 82,827 have been shipped, free of charge or at-cost. Third party order information for single-use plastic bags and dental barrier film that fit ophthalmic devices and can cover high touch surfaces has been published on a dedicated web page. All cleaning instructions have been published in one place (viewed 25,819 times, downloaded 11,781 times). Highly accelerated lifetime tests were performed to confirm that frequent cleaning and disinfection of the HFA bowl with a spray of atomized isopropyl alcohol will not damage or alter the performance of the bowl. Updated disinfection instructions have been published and downloaded 8,318 times. An additional highly accelerated lifetime test has shown that the bowl inside the HFA can be disinfected using UV-C radiation without damaging the functionality of the perimeter. Conclusions: In response to the COVID-19 pandemic, we have provided improved cleaning instructions for the HFA family of bowl perimeters, have developed and distributed over 80,000 breath shields, have identified protective coverings for high-touch areas, and have developed and communicated different ways to operate existing devices remotely. While we have not been able to quantify the effectiveness of the individual measures, it is our assumption that implementing these measures which are based on recommendations by the WHO, the CDC, and the EPA, have increased patient and operator protection.

Sars-cov-2 infections in four lung transplant recipients: A single-center experience

Introduction: To date, 23 lung transplant recipients have been described with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections worldwide. Eight had severe coronavirus disease 2019 (COVID-19), but none were placed on extracorporeal membrane oxygenation (ECMO) support. We aimed to describe our experience. Methods: Lung transplant recipients who were admitted to our hospital with SARS-CoV-2 infections from the beginning of the pandemia until May 25th, 2020 were included. Clinical charts were retrospectively retrieved and data analysed. Results: Four patients (3 males, 75%) with a median age of 58.5 years (47-66) were admitted for SARS-CoV-2 infections in our center. Three patients had double-lung transplantation for chronic thromboembolic pulmonary hypertension, idiopathic pulmonary fibrosis and cystic fibrosis. One patient had singlelung transplantation for non-specific interstitial pneumonia. SARS-CoV-2 infections were diagnosed by nasopharyngeal swabs in all patients within one month post-transplant (n=2), or after 13 months (n=1) and 15 years (n=1). Dyspnea was present in all patients. Worsening of symptoms occurred in three patients after a median of 8 days (1 to 8) after diagnosis. Imaging showed a highly variable degree of infiltrations. Mechanical ventilation was required in three patients. They all underwent prone positioning. Veno-venous ECMO was required in two patients. In all patients, immunosuppression consisted of prednisone and tacrolimus, while mycophenolate mofetil was stopped. Treatment with hydroxychloroquine was attempted in the first three patients. At last follow-up, one patient was discharged home and one was weaned from mechanical ventilation. Both ECMO supported patients died from multiple organ failure, despite ECMO could be weaned in one patient. Conclusion: A highly variable course of COVID-19 disease was observed in four patients after lung transplantation. More data is needed to better understand prognostic factors and management of this patient cohort.