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In this fast-paced world, education is the passport to a better future, as tomorrow belongs to those who prepare for it today. This research aims to bridge the gap between tutees and tutors. It also aims to develop the mind of tutees in order to shape their future character, calibre, and character. COVID-19 has altered our perspective regarding education;based on our research, illiteracy is a significant problem in Pakistan. In addition, finding a mentor with the right skills, experience, and reliability is the most challenging aspect of finding mentorship for yourself or your children. Our in-person and online survey analysis revealed that peer tutoring allows for higher student response rates and feedback, leading to better academic achievement. In addition, it provides students with more opportunities to practice specific skills, which leads to higher retention rates. With the help of the peer-Tutoring concept, when a student teaches another student a topic, it also helps the tutor and tutee gain a deeper understanding of it. There is a positive impact on education in Pakistan because of peer tutoring. As a result, we incorporate this approach into the application to provide tutees with an education and the idea of training their minds to think from tutors who have more experience and knowledge about the relevant field. It would be helpful to identify factors that could make these campaigns more effective with further research. © 2023 IEEE.
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Lung cancer services have been reportedly affected in several ways by C19 across the UK. The early diagnosis oflung cancer is pivotal for better prognostic outcomes. EBUS-TBNA is a vital step in diagnosis and staging of lungcancer in patients with mediastinal disease. The aim of this single centre retrospective review was to determine theimpact of C19 on the number of EBUS cases and the sampling to histology turn-around time (HTT). Weretrospectively collected data of 682 patients whom underwent EBUS between 2015 and 2021 and did a detailedanalysis of the years 2016, 2018, 2020 and 2021 for comparison of HTT.The number of EBUS cases declined steeply in 2020 and 2021 to 42 and 69 respectively whilst median proceduresdone in preceding years were 118 (IQR 114-119). The HTT was interestingly less severely affected in 2020 whenmedian time was 7 (IQR 6-12) days (compared to median time of 6 (IQR 5-8) and 7 (IQR 6-9) days in 2016 and 2018respectively). The median time for HTT increased to 10 days (IQR 7.75 - 20.25) in 2021. These results could be dueto less procedures and lower C19 related sickness absences in 2020. The longest HTT in the years 2016, 2018,2020 and 2021 were 23, 28, 22, 34 days respectively.Our review confirms the detrimental effects of C19 on EBUS services in our centre, where the procedure numbersplummeted in 2020 and 2021 and HTT increased significantly. More importantly, it shows the longer term effects of C19 on the services, given the HTT is worst in 2021 despite the resumption of regular EBUS services.
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Hospitals throughout the country have utilised different strategies in the management of COVID pneumonitis. Our hospital established a Respiratory High Care Unit (RHCU) to provide CPAP to patients deteriorating despite Standard Oxygen Therapy (SOT). Patients were considered to be either for full escalation (intubation and mechanical ventilation) or to have CPAP as a ceiling of care. Our aim was to assess CPAP success in those not eligible for mechanical ventilation. We retrospectively analysed patients admitted to RHCU who had a CPAP ceiling of care. Between 1st June 2020 and 31st March 2021, 156 patients were admitted, with 144 notes available for analysis. Patients were transferred to RHCU following review by respiratory consultant and met Trust criteria for CPAP. 75 patients (52%) had a ceiling of care of CPAP. 8 patients were excluded. Average age was 75.1 years. Mean Clinical Frailty Score (CFS) was 3.6. 70% were male. 97% were admitted with FiO2 >=40%. Mortality in patients with CPAP as ceiling of care was 79%. Patients that survived had a mean age was 74.6 years, a mean CFS of 3.1 and a pO2 on admission of 7.8kPa, as compared to a mean age of 75.2 years, a mean CFS of 3.7 and pO2 on admission of 7.7kPa in those that died. Demographics between the two cohorts of patients were similar, making it difficult to predict who would survive with CPAP therapy. 21% of patients not suitable for mechanical ventilation survived with CPAP. In other centres, these patients may have only been eligible for SOT alone. The data suggests that offering CPAP may increase survival in patients that would not be suitable for mechanical ventilation.
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INTRODUCTION: Previous randomized trials suggest the benefit of inhaled budesonide for COVID-19 patients in outpatient settings. We evaluated available studies on the effect of the therapeutic use of inhaled corticosteroids (ICS) on mortality and pertinent clinical outcomes. METHOD(S): A comprehensive literature search was conducted across the WHO, LitCOVID, and EMBASE databases from inception until June 30th, 2022. The primary outcome was overall mortality and secondary outcomes included symptom-based clinical improvement rates at day 14, ER visits or hospitalization, and adverse events. Data analysis was performed using Review Manager Software, version 5.2, to evaluate the combined odds ratio (OR) with 95% confidence intervals (CI) using a random-effects model. RESULT(S): Nine studies (7 RCTs (3 budesonide, 3 ciclesonide, 1 fluticasone RCTs), & 2 observational studies) were included in the mortality meta-analysis. Of the 3,934 patients included, 103 patients died (44 out of 1925 in the ICS group and 59 out of 2009 in the non-ICS group). The odds of mortality in the therapeutic ICS use group were lower compared to the non-ICS therapy group (OR 0.78, 95% CI 0.48-1.28, p-value=0.33, I2=0%). The result was statistically insignificant, possibly due to the low mortality rate. But therapeutic ICS showed statistically significant clinical improvement rates at day 14 (5 RCTs;3 Ciclesonide, 2 Budesonide) (OR 1.56, 95% CI 1.31-1.86, p < 0.0001, I2=0%). The number of ED visits/Hospitalization rate, and adverse events were not statistically significant between the groups (OR 0.73, 95% CI 0.32-1.70, p= 0.47 I2=75% and OR 1.10 95% CI 0.67-1.82, p=0.70, I2=28%). CONCLUSION(S): This meta-analysis shows that the therapeutic use of ICS in COVID-19 is associated with higher symptom-based clinical improvement rates. Although the reduction in mortality odds remained insignificant, as the overall mortality rates were low which increased the confidence interval overall. Early administration of ICS showed a trend towards the reduced likelihood of urgent care needs. Well-designed trials are needed to explore ICS efficacy in patients with a high risk of disease progression and in reducing the incidence of long-term COVID-19 symptoms or post-acute sequelae of SARS-CoV-2.
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INTRODUCTION: Studies of hospitalized patients with COVID-19 have found varying clinical outcomes associated with underlying respiratory conditions and inhaled corticosteroid use. We performed a systematic review to summarize the effect of the pre-hospital use of inhaled corticosteroids on the clinical outcomes in patients with COVID-19. METHOD(S): A comprehensive literature accrual was conducted across the WHO, CDC, and LitCovid PubMed COVID-19 databases from inception until June 30th, 2022. The Overall mortality was the primary outcome, and the secondary outcomes were the need for intensive care unit (ICU) admission and the need for invasive mechanical ventilation (IMV). All included studies were observational and reported the desired outcomes with pre-hospital use of ICS in COVID-19 patients. Data analysis was performed using Review Manager Software, version 5.2 to evaluate the combined odds ratio (OR) with respective 95% confidence intervals (CI) using a random-effects model. RESULT(S): Nineteen studies assessed mortality and were included in the meta-analysis. A total of 1,122,329 patients were included, of which 10,466 patients died (2,289 out of 824,005 in ICS arm patients and 8,177 out of 298,324 in the non-ICS arm), resulting in the unadjusted odds of death (OR 1.36, 95% CI 1.09-1.70, I2=82%). However, In the subgroups analyses of COPD patients (8 studies;598 out of 106,659 in the ICS arm and 353 out of 44,496 in the non-ICS arm) and Asthma patients (7 studies;705 out of 714,126 in the ICS arm and 179 out of 222,577 in the non-ICS arm), significantly increased risk of death was not shown (OR 1.20, 95% CI 0.93-1.57, I2=32%, OR 1.61, 95% CI 0.97-2.66, I2=82% respectively). There were no significantly increased odds in the assessed secondary outcomes;ICU admission (13 studies, OR 1.11, 95% CI 0.82-1.51, I2=84%), need for mechanical ventilation (7 studies, OR 1.21, 95% CI 1.00-1.45, I2=0%). CONCLUSION(S): Prehospital use of ICS in COVID-19 patients is associated with higher odds of overall mortality in unadjusted analysis. However, this was not shown in the subgroup of patients with a history of COPD or Asthma. Other clinical outcomes such as the need for ICU admission and mechanical ventilation show similar trends. Future research with well-designed clinical trials is needed to validate our findings.
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INTRODUCTION: The reduction of mortality in COVID-19 has been clinically established only for Dexamethasone and Tocilizumab to date, but the overall mortality in COVID-19 remains high. Baricitinib is a Janus Kinase 1/2 Inhibitor with known anti-inflammatory and anti-viral properties. The US FDA recently approved Baricitinib for the treatment of hospitalized adults with COVID-19 requiring either supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). We performed a meta-analysis of Randomized Controlled Trials (RCT) and observational studies assessing the effect of Baricitinib on mortality outcomes in hospitalized patients with COVID-19. METHOD(S): A systematic literature search was conducted on electronic databases including NIH LitCovid, WHO COVID-19 database, EMBASE, and Cochrane Central from inception until June 30th, 2022. Randomized Controlled Trials and observational studies evaluating the efficacy of Baricitinib in hospitalized patients with COVID-19 were screened for the assessment of all-cause mortality as the outcome. RESULT(S): Twenty-three studies (18 observational and 5 RCTs) were included in the mortality meta-analysis. Of the 16,390 patients (4,565 observational, 11,825 RCTs), 2,139 patients died (903 out of 7,610 in the Baricitinib arm and 1,236 out of 8,780 in the non-Baricitinib arm). Using the random-effects model, the odds of mortality in the therapeutic Baricitinib use showed a statistically significant reduction in all-cause mortality in hospitalized COVID-19 patients (OR 0.67, 95% CI 0.50-0.90;p=0.008, I2=79%). A similar trend of decreased mortality was observed in the subgroup analysis by study design (Observational OR 0.59, 95% CI 0.35-0.97, p=0.04, I2=83%;RCTs OR 0.72, 95% CI 0.56-0.93, p=0.01, I2=53%). CONCLUSION(S): Baricitinib used along with the standard of care treatments is associated with a reduction in mortality in hospitalized patients with COVID-19 disease.
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INTRODUCTION: There is published literature about COVID-19 disease associated coagulopathy in hospitalized patients. We aim to study association of early heparin use among adult patients with COVID-19 and sepsis and hospital outcomes. METHOD(S): Retrospective study utilizing the EMR (electronic medical record) data at a large tertiary care academic center with ICU patients admitted for COVID-19 and sepsis and received therapeutic heparin for anticoagulation. We reported nominal variables in (gender, exposure - yes/no, etc) as number and percentage. And reported continuous (age, length of stay, etc) as median (IQR). We used Chi Square test and t-test as appropriate for nominal and continuous data analysis. This study was IRB approved. RESULT(S): A total of 230 patients with age >=18 years were included in final analysis. Out of these, 183 (79.6%) patients received heparin within 48 hours of ICU admission and 47 (20.4%) after 48 hours. The median (IQR) age was 67.5 years (58-77) with majority being caucasian (73.9%) male (68%) patients. Overall, 59 (26%) patients had died, 86 (37%) had been discharged home without assistance, 12 (5%) discharged home, with home health from the hospitals. In univariable analysis, early (< 48 hours) administration of heparin was associated reduced utilization of invasive mechanical ventilation (IMV) (OR 0.23, p=< 0.01) and non-IMV (NIMV) (OR 0.49, p=0.03) and reduced ICU (MD -1.64, SE 0.58, p=< 0.01 and hospital length of stay (LOS) (MD-4.15, SE 0.93, p=< 0.01. This association remained significant when model was adjusted for age, gender, BMI, race, ethnicity, SOFA score on day 1, APACHE-III score on ICU admission: IMV utilization (aOR 0.12, p=< 0.01), NIMV utilization (aOR 0.47, p=0.35), ICU LOS (MD -1.65, SE 0.57, p=< 0.01) and hospital length of stay (MD -4.43, SE 0.95, p=< 0.01). The hospital mortality was observed to be not statistically significant (unadjusted OR 0.68, p=0.28 and adjusted OR 0.67, p=0.32) due to small sample size. CONCLUSION(S): Early administration of heparin in patients with moderate to severe COVID-19 sepsis was associated with reduced utilization of IMV and NIMV and reduced hospital LOS. Association with reduced hospital mortality did not reach the statistical significance.
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INTRODUCTION: Coagulopathy and thromboembolic events are poor prognostic indicators of COVID-19 disease. There is a discrepancy in the results of different studies regarding the effects of chronic anticoagulation on clinical outcomes. This systematic review aims to summarize the evidence on the impact of chronic anticoagulation on clinical outcomes in COVID-19. METHOD(S): A Literature search was performed on LitCovid PubMed, WHO, and Embase databases from inception (December 2019) till May 2022. Our eligibility criteria included original studies that reported the association between prior use of anticoagulants for unrelated indications at the time of COVID-19 diagnosis and the patient outcomes in adults suffering from COVID-19. The risk of thromboembolic events in COVID-19 infected patients on chronic anticoagulation is the primary outcome and severity of COVID-19 disease in terms of ICU admission or invasive mechanical ventilation/intubation requirements, and all-cause mortality were the secondary outcomes. Random effects models were used to compute crude ODDs ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals (CIs). RESULT(S): A total of 44 observational studies met our inclusion criteria. In unadjusted analysis, prior anticoagulation was not associated with reduced risk of thromboembolic events in COVID-19 patients (N=43851, 9 studies, OR 0.67 [0.22, 2.07];p= 0.49;I2= 95%). However, pre-hospital use of anticoagulants significantly increase the risk of allcause mortality in COVID-19 patients (N= 580601;37 studies, OR 1.56 [1.22, 2.01];p=0.0005;I2= 97%). There was no statistically significant association between prehospital anticoagulants usage and COVID-19 disease severity (N=186239;20 studies, OR 0.96 [0.70, 1.33];p= 0.82;I2= 88%). Pooling adjusted estimates revealed no statistically significant association between pre-hospital use of anticoagulants and risk of Thromboembolic events in COVID-19 patients (aOR= 0.85 [0.34, 2.12];p= 0.72), COVID-19 related mortality (aOR= 0.93 [0.82, 1.07];p= 0.32), and the severity of COVID-19 infection (aOR= 0.96 [0.72, 1.30];p= 0.81). CONCLUSION(S): Prehospital use of anticoagulation was not significantly associated with reduced risk of thromboembolic events, improved survival, and lower severity of disease in COVID-19 patients.
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Hospitals throughout the country have utilised different strategies in the management of COVID pneumonitis. Our hospital established a Respiratory High Care Unit (RHCU) to provide CPAP to patients deteriorating despite Standard Oxygen Therapy (SOT). Patients were considered to be either for full escalation (intubation and mechanical ventilation) or to have CPAP as a ceiling of care.Our aim was to assess CPAP success in those not eligible for mechanical ventilation.We retrospectively analysed patients admitted to RHCU who had a CPAP ceiling of care. Between 1stJune 2020 and 31st March 2021, 156 patients were admitted, with 144 notes available for analysis. Patients were transferred to RHCU following review by respiratory consultant and met Trust criteria for CPAP. 75 patients (52%) had a ceiling of care of CPAP. 8 patients were excluded.Average age was 75.1 years. Mean Clinical Frailty Score (CFS) was 3.6. 70% were male. 97% were admitted with FiO2 ≥40%. Mortality in patients with CPAP as ceiling of care was 79%.Patients that survived had a mean age was 74.6 years, a mean CFS of 3.1 and a pO2 on admission of 7.8kPa, as compared to a mean age of 75.2 years, a mean CFS of 3.7 and pO2 on admission of 7.7kPa in those that died. Demographics between the two cohorts of patients were similar, making it difficult to predict who would survive with CPAP therapy.21% of patients not suitable for mechanical ventilation survived with CPAP. In other centres, these patients may have only been eligible for SOT alone. The data suggests that offering CPAP may increase survival in patients that would not be suitable for mechanical ventilation.
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During the pandemic, our hospital established a RHCU to provide level 2 care for patients with severe Covid-19. Mortality rate was 54% over the first year. We designed a questionnaire around Patient Health Questionnaire-9 to assess the emotional impact upon our workforce. We also evaluated burnout, using the Oldenburg Burnout Inventory.Staff retrospectively rated their pre-pandemic mental health (Feb 2020) and current mental health (Jan 2022). 60 questionnaires were circulated with 83% completed.Doctors encompassed 28% of respondents, nurses 38%, HCAs 18%, and 16% were other clinical and administrative staff. 62% had worked on RHCU for ≥12 months.72% felt their mental health had deteriorated. 94% reported their physical health had been negatively impacted.In Jan 2022, 51% reported feeling depressed, 71% anxious, 46% tearful and 69% irritable, half the time or more. All figures had increased ≥2 fold compared to pre-pandemic levels.The pandemic has affected personal life too, showing a 3.6 fold increase in strain on personal relationships compared to pre-pandemic. 70% reported difficulty with sleep pattern.Worryingly, 71% scored high/very high using the Oldenburg Burnout Inventory. Levels of burnout were notably increased in junior doctors (88%) and staff nurses (89%), demonstrating high/very high levels of burnout. 75% of junior doctors and 56% of staff nurses were unsure or would not continue in their current role. These figures are incredibly concerning, considering that junior doctors and staff nurses make up one third of RHCU staff.Our results highlight the need for urgent intervention for RHCU staff to prevent further burnout and improve mental health.
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There has been much debate on how best to manage COVID pneumonitis. We established a Respiratory High Care Unit (RHCU) to provide CPAP for hypoxic patients as an intermediate between standard oxygen therapy (SOT) and mechanical ventilation (MV). In some centres, CPAP was not offered outside trial settings, meaning deteriorating patients went straight from SOT to MV.The RECOVERY-RS trial has found that CPAP reduces the need for MV in severe COVID. This study reported for every 12 people treated with CPAP, in comparison to SOT, 1 patient avoided MV.1Between 1/6/20 and 30/3/21, we admitted 156 patients to the RHCU. All patients met local Trust criteria for CPAP. Out of these, 69 patients (48%) were considered to be suitable for full escalation (intubation and mechanical ventilation on ITU). 1 patient died of non-COVID causes and was excluded. Of the remaining 68 patients, 72% improved with CPAP, with all patients surviving until discharge. 28% were transferred to intensive care for MV.Patients that avoided intubation had a mean age of 53.8 years, an average clinical frailty score (CFS) of 1.3 and a pO2 on admission to RHCU of 9.1kPa versus an age of 63.5 years, CFS of 1.5 and pO2 of 8.0kPa in those intubated.This analysis showed that CPAP was an effective modality of treatment, with 72% of patients avoiding going on to MV, which was the standard care provided in some other centres. For every 1.4 patients given CPAP, 1 MV was avoided. This data strongly supports emerging evidence on the benefit of CPAP in avoiding MV in COVID patients.Perkins G, Ji C, Connolly B, Couper K, Lall R, Baillie J et al. An adaptive randomized controlled trial of non-invasive respiratory strategies in acute respiratory failure patients with COVID-19. 2021.
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Background of the study: All over the globe anxiety was present among young adolescence. They are fear of infection and away from real education and fewer confidants to manage Covid pandemic situation.Objectives: Study investigated to assess the pre and posttest level of knowledge on social anxiety among First year nursing students in Covid-19 pandemic.Material and Methods: Experimental study done to assess the effectiveness of level of knowledge on reduction of social anxiety among first year nursing students in Covid-19 Pandemic among 100 Basic BSc 1st year nursing students. Self-prepared questionnaire selected as a tool for pre and post intervention which was validated by the expert .Ethical permission taken before conduction of study .samples chosen as per inclusion criteria of the study. Samples were explained well the purpose of the study .Pre taken with help of questionnaire and after seven days post taken and data analyzed as per objectives of the study.(Level of knowledge score was good8-29 ,average 4-7and poor 0-3 )Results: In this study pretest knowledge score was 16%, 72% and 12% as poor, average and good knowledge .post-test knowledge score was 0 %, 16% and 84% as poor, average and good knowledge. Pretest test SD1.565 and posttest SD 1.1.69 which was extremely significant.(p<0.ooo1)Conclusion: Finding of the study shows that self-instructional module was effective to increase the level of knowledge among the 1st year Basic B.Sc. student in covid-19 Pandemic.
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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: Pneumothorax and pneumomediastinum (PTX/PM) has been associated with patients hospitalized with COVID-19 infections. The aim of our study was to assess the risk factors, hospital length of stay, and mortality of PTX/PM among hospitalized patients with COVID-19 infection in a matched case-controlled study. METHODS: Adult patients with confirmed COVID-19 infections who were hospitalized at 5 Mayo Clinic hospitals (Minnesota, Arizona, Florida, Wisconsin) between March 2020 and January 2022 were retrospectively screened. PTX and or PM in at least two consecutive imaging studies were included. They were matched to control patients based on age, gender, hospital admission period, severity on admission day and the day preceding the incident. Summary statistics, Mann Whitney-U, and chi-square tests were performed RESULTS: A total of 197 patients were included in the descriptive analyses.The median age was 61 years and the majority were men (70.8%). Patients with underlying pulmonary comorbidities was 2.27 (OR 1.42-3.62, p value < 0.001) times more likely to develop PTX/PM. Ten percent of the total cases had these complications present upon hospital admission.Patients who developed PTX/PM had a longer hospital length of stay compared to controls, 20 versus 12 days, OR 4.53 (p=0.002). On the day prior to developing PTX/PM, 42 (31%) of patients had been on high-flow nasal cannula only and 14 on non-invasive ventilation (10.4%). The highest recorded positive end-expiratory pressure, plateau, and driving pressures were recorded in our case group on the day before the complication and all were significantly higher than matched controls. In-hospital mortality in patients whose COVID-19 course was complicated by PTX/PM was 44.2% vs. those without, 21.1%, adjusted OR 2.71 (p=0.001). Sixty two percent were treated conservatively without any intervention. CONCLUSIONS: We have demonstrated in the largest study to date, that patients who were hospitalized with COVID-19 infection and had a PTX/PM had a longer hospital length of stay, were associated with higher mechanical ventilatory pressures, and had a higher in-hospital mortality, when compared with matched controls. CLINICAL IMPLICATIONS: Complications of PTX/PM in patients with COVID-19 infections can occur spontaneously and in barotrauma. Pre-existing lung disease is a risk factor for the development of these complications. Patients with PTX/PM have a longer hospital length of stay and higher in-hospital mortality which is in contrast with existing published data. DISCLOSURES: No relevant relationships by Natalya Azadeh No relevant relationships by Meghan Brown No relevant relationships by Rodrigo Cartin-Ceba No relevant relationships by Anusha Devarajan No relevant relationships by Juan Pablo Domecq No relevant relationships by Sandeep Khosa No relevant relationships by Amos Lal No relevant relationships by Shahraz Qamar No relevant relationships by Kenneth Sakata No relevant relationships by Mayank Sharma No relevant relationships by Nikhil Sharma No relevant relationships by Jamil Taji No relevant relationships by Fahimeh Talaei No relevant relationships by Aysun Tekin No relevant relationships by Diana Valencia Morales No relevant relationships by Stephanie Welle
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SESSION TITLE: Acute COVID-19 and Beyond: from Hospital to Homebound SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: To date, only dexamethasone, tocilizumab, and casirivimab/imdevimab have been shown to reduce mortality in COVID-19 patients. Baricitinib is a selective Janus kinase 1/2 inhibitor with known anti-inflammatory and anti-viral properties. We sought to perform a meta-analysis of RCTs assessing the role of baricitinib in hospitalized patients with COVID-19 disease. METHODS: Electronic databases such as MEDLINE, EMBASE, and Cochrane Central were searched till March 20, 2022, for randomized controlled trials evaluating the efficacy of baricitinib in hospitalized COVID-19 patients. The outcomes assessed were 28-day mortality, progression to respiratory failure needing positive pressure ventilation or death, progression to mechanical ventilation or ECMO, duration of hospitalization and time to discharge. RESULTS: Four studies (with 10,815 patients) were included in the analysis. In total, 5,477 patients received baricitinib, and 5,338 patients received standard care. Pooled analysis showed a significantly decreased risk of 28-day mortality (OR 0.85, 95% CI 0.76-0.96, p=0.006) and progression to invasive mechanical ventilation or ECMO (OR 0.80, 95% CI 0.69-0.94, p=0.005) in the baricitinib arm compared to standard therapy or placebo. In addition, there was a significant reduction in duration of hospitalization (MD -1.43, 95% CI -2.46, -0.40, p=0.007) and time to recovery (MD -0.88, 95% CI -1.34, -0.41, p=0.0002). CONCLUSIONS: Baricitinib improved the patient-centric outcomes of mortality and progression to severe disease i.e., need for invasive mechanical ventilation, in hospitalized patients with COVID-19 disease compared with standard therapy alone. CLINICAL IMPLICATIONS: Baricitinib may be used in conjunction with standard of care treatments to improve morbidity and mortality in hospitalized COVID-19 patients. DISCLOSURES: No relevant relationships by Gerardo Carino No relevant relationships by ARKADIY FINN No relevant relationships by Amos Lal No relevant relationships by VIJAIRAM SELVARAJ
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SESSION TITLE: Optimizing Resources in the ICU SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: The COVID-19 pandemic has exposed worldwide heterogeneity in the application of fundamental critical care principles and best practices. New methods and strategies to facilitate timely and accurate interventions are needed. If built on a robust foundation of physiologic principles, a virtual critically ill patient (aka digital twin) could better inform decision making in critical care. When used in clinical practice, a digital twin may allow bedside providers to preview how organ systems interact to cause a clinical effect, providing the opportunity to test the effects of various interventions virtually, without exposing an actual patient to potential harm. Building on our previous work with a digital twin model of critically ill patients with sepsis, this current project focuses specifically on the respiratory system. METHODS: We assembled a modified Delphi panel of 36 international critical care experts. We modeled elements of respiratory system pathophysiology using directed acyclic graphs (DAG) and derived several statements describing associated ICU clinical processes. Panelists participated in three Delphi rounds to gauge agreement on 71 final statements using a 6-point Likert scale. Agreement was defined as >80% selection of a 5 (“agree”) or 6 (“strongly agree”). RESULTS: The first Delphi round included statements of pulmonary physiology affecting critically ill patients, eg pulmonary edema, hypoxemic and hypercapnic respiratory failure, shock, acute respiratory distress syndrome (ARDS), airway obstruction, restrictive lung disease, and ventilation-perfusion mismatch. Agreement was achieved on 60 (84.5%) of expert statements after completion of two rounds. After partial completion of the third round, agreement increased to 62 (87%). Statements with the most agreement included the physiology and management of airway obstruction decreasing alveolar ventilation and the effects of alveolar infiltrates on ventilation-perfusion matching. Lowest agreement was noted for the statements describing the interaction between shock and hypoxemic respiratory failure due to increased oxygen consumption and ARDS increasing dead space. CONCLUSIONS: An international cohort of critical care experts reached 87% agreement on our rule statements for respiratory system pathophysiology. The Delphi approach appears to be an effective way to refine content for our digital twin model. CLINICAL IMPLICATIONS: Expert consensus can be used to strengthen the respiratory physiology statements used to direct the ICU digital twin patient model. With a digital twin based on refined respiratory physiology statements, bedside providers may preview how organ systems interact to cause a clinical effect without exposing an actual patient to various interventions. DISCLOSURES: No relevant relationships by Ognjen Gajic, value=Royalty Removed 06/06/2022 by Ognjen Gajic No relevant relationships by Amos Lal No relevant relationships by John Litell No relevant relationships by Amy Montgomery
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Background: Because of the recent outbreak of Covid-19, the globe is now facing a number of difficult challenges. The morbidity and mortality rate varies depending upon numerous factors. Objective: The objective of the study was to find out the mortality and morbidity rate of Covid-19 in a tertiary care hospital of Swat Methodology: This descriptive cross-sectional study was carried out at the Department of Pathology, Swat Teaching Hospital, Swat, Khyber Pakhtunkha Pakistan for duration of one year from April 2020 to March 2021. Nasopharyngeal or Oropharyngeal swabs were taken from all the enrolled patients and sent to the national institute of health Islamabad or swat public health laboratory for the diagnosis of Covid-19. The rate of morbidity and mortality for all the enrolled patients was recorded. All the data analysis was done by using IBM SPSS version 23. Results: In the current study, totally 11609 patients were enrolled. There were 7329 (63.13%) males and 4280 (36.87%) females. The overall morbidity rate of covid-19 was 18.25% (n= 2089) whereas the overall mortality rate was13.16% (n=275) patients. Conclusion: Our study concludes that the rate of morbidity and mortality of covid-19 is high in district Swat Khyber Pakhtunkhwa, Pakistan. The burden of covid-19 was high in males as compared to females and the mortality rate increases with the increase in age. All the people residing in the district Swat should be vaccinated to decrease both the morbidity and mortality rate of covid-19.
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RATIONALE: Enrollment and retention of participants for any research study is challenging. The unpredictable nature of the ICU environment coupled with tenuous physiological status of patients can significantly thwart clinical trial accrual goals. The COVID-19 pandemic has pushed ICU census numbers to unprecedented levels with severely ill patients experiencing lengthy hospitalizations, delaying turn-over of beds. Anecdotal reports suggest challenges in achieving trial recruitment goals. The aims of this study were to describe the impact of the pandemic on a non-COVID-19 ICU clinical trial's screening and accrual of patients receiving mechanical ventilatory support. METHODS: A descriptive, retrospective design was used to address the study aims. Screening and accrual data were obtained from a Midwestern academic medical center in North America's parent clinical trial (R01HL130881). The primary aims of the efficacy trial are to test if patient selfadministration of dexmedetomidine (n = 190) reduces anxiety, delirium, ventilator days and ICU stay. A 3-step screening process prior to informed consent consists of (1) electronic health record (EHR) automated ICU census reports of mechanically ventilated patients, (2) in-depth review of the EHR for inclusion criteria, then (3) bedside assessment of grip strength to use a push-button medication delivery device and ability to follow commands. Descriptive statistics and Chi-square were used to compare screening and accrual data from a pre-pandemic timeframe (8/27/2018- 3/15/2020) to a pandemic timeframe (3/16/2020-12/31/2021). RESULTS: Of 91 eligible patients, 49 were accrued (53.8%) during the pre-pandemic timeframe. Patients were not accrued due to patient/LAR declination (78%) or primary medical team declination (22%). The three most frequent reasons for ineligibility were unarousable (25%), hypotension (11%) and not following commands (9%). While the pandemic timeframe had 30 fewer eligible patients, 40 of 61 (67%) were accrued. Patients were not accrued due to patient/LAR declination (87%) or medical team declination (13%), similar to pre-pandemic timeframe (p = 0.7). Pandemic timeframe had significantly more unarousable patients (32%, p < 0.0001) with fewer patients hypotensive (7%, p < 0.0001) or not following commands (7%, p = 0.01). Once COVID-19 infection was resolved, lengthy ventilator days, higher sedation levels, and prolonged immobility contributed to extremely weak grip strength, precluding trial eligibility. CONCLUSIONS: These retrospective data confirm this trial's enrollment was hampered by the COVID-19 pandemic due to fewer eligible, unarousable patients. Declinations from patients/LARs were similar during both timeframes. Inability to meet accrual milestones risks continued.
ABSTRACT
The COVID-19 pandemic has exposed long standing deficiencies in critical care knowledge and practice in hospitals worldwide. New methods and strategies to facilitate timely and accurate interventions are needed. A virtual counterpart (digital twin) to critically ill patients would allow bedside providers to visualize how the organ systems interact to cause a clinical effect, offering them the opportunity to evaluate the effect of a specific intervention on a virtual patient before exposing an actual patient to potential harm. This work aims at developing a digital simulation that models the clinical pathway of critically ill patients. Using the mixed-methods approach with the support of multiprofessional clinical experts, we first identify the causal and associative relationships between organ systems, medical conditions, clinical markers, and interventions. We record these relationships as structured expert rules, depict them in a directed acyclic graph (DAG) format, and store them in a graph database (Neo4j). These structured expert rules are subsequently utilized to drive a simulation application that enables users to simulate the state trajectory of critically ill patients over a given simulated time period to test the impact of different interventions on patient outcomes. This simulation model will be the engine driving a future digital twin prototype, which will be used as an educational tool for medical students, and as a bedside decision support tool to enable clinicians to make faster and more informed treatment decisions. IEEE
ABSTRACT
Most governments have implemented restrictive policies in response to the global coronavirus outbreak to curb the pandemic and reduce the number of deaths. Air traffic suspension is one of the most important restrictive policies in terms of reducing global migration for short period, though it has major and long term impact on all economies of the world.The objective of this study is to analyse the impact global air travel ban on various aviation sectors. This required authors to collect and pre-process the passengers traffic worldwide via flights. Based on historical data from 1970 till 2019 (Source- data.worldbank.org), a predictive model is prepared and implemented to get a clear picture of the losses faced by the aviation sector in terms of air passenger traffic. Further we will be comparing the forecasted values with the real time values in order to study the effect of air travel ban on aviation and its supported sectors. In addition, a study of the economic impact of the air travel bans and the cumulative impact of the Covid-19 pandemic is being conducted by looking at real GDP levels (in percentages) and future estimates, measuring them all in percentages for the world economy and various industrialized countries, developed markets, and developing nations, and a comparison being made and then further analyzing them. In the near term, some countries will be more affected than others, and most airline businesses will lose because of the travel ban. We hope that these early findings will aid in the development of informed policies and exit plans for this global crisis. © 2022 Author(s).