ABSTRACT
Introduction: During the COVID-19 pandemic, the FDA began allowing hospitals to use continuous glucose monitoring (CGM) on a "non-objection" basis in the inpatient setting to decrease direct patient contact and preserve personal protective equipment while increasing the availability of glucose date to inform patient management decisions in April of 2020. Our institution deployed CGM technology (Dexcom ™) in 55 patients across four inpatient hospital units beginning September 2020, with a median use of 6.5 days per patient. Objective: To explore perceptions and experience of nursing staff related to the use of CGM technology in patients with hyperglycemia admitted for COVID-19. Methods: A qualitative survey was distributed to 29 critical care nurses who routinely utilized CGM technology to obtain and interpret glucose trends impacting clinical decisions for patients during their admission with COVID-19. The survey included eight questions that used a 1 to 5 scale format, where 1 corresponds to "strongly disagree" and 5 corresponds to "strongly agree", and two open-ended questions (advantages and concerns). Results: 100% of the respondents "agree" or "strongly agree" that CGM technology is useful in glucose management and prefer when their patient has a CGM. 97% "agree" or "strongly agree" that CGM technology is user-friendly and its use minimized direct patient interaction or contact, thereby reducing utilization of personal protective equipment (PPE). 93% "agree" or "strongly agree" that they feel confident operating a CGM device and consider the CGM data reliable and accurate. 90% "agree" or "strongly agree" that the technical aspects of CGM technology are easy to manage and would like to see this technology offered to patients without COVID. The most significant benefits of CGM as rated by the survey participants include: fewer fingersticks, decreased COVID exposure, convenience, PPE preservation, continuous glucose monitoring, and improved glycemic management. Concerns include: calibration time, accuracy, potential malfunction, extended warm-up period, and protocol education. Discussion: This survey demonstrates that CGM technology previously primarily used in the outpatient setting can be easily adapted for inpatient use.Nurses eagerly accepted and competently integrated CGM technology into routine patient care, which, in turn, decreased exposure time in COVID-19 rooms and subsequently decreased PPE use. Proper education related to inpatient use of CGM technology and open communication between the nursing staff, the primary care team, and the endocrine consulting team have been identified as critical elements for a successful deployment and continued utilization.The use of inpatient CGM technology holds promise for improved glycemic control in hospitalized patients while increasing the safety of healthcare workers. Further studies demonstrating decreased exposure times and infection rates among healthcare workers caring patients with COVID-19, and measurable improvements in glycemic control in patients utilizing CGM technology should be explored to further demonstrate the benefits of inpatient CGM use.Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
ABSTRACT
In the COVID-19 outbreak we are living currently, the lung ultrasound can be considered as an advantageous tool to examine patients as it can be easily used by a maximum of two trained operators, at the bedside. Likewise, the Electrical impedance tomography is useful to monitor and optimize the patient’s ventilation strategies in real time. Here, we present the impact and implication of ultrasonography and electrical impedance as management tools for treating critical patients in times of COVID-19. Clinical Ultrasound has been used more and more in developing countries in Latin America such as Colombia, Argentina, and Uruguay among others, however it is still underutilized due to different issues amongst we found the absence of equipment or the lack of basic training from the medical staff and poor skills to use the machines despite their availability. The use of lung ultrasound and the Electrical impedance tomography is highlighted as a safe manner to manage COVID-19 patients, not as a replacement of a CT scan, but as an easy-to-use and fast complementary tool. © 2021 Sociedad de Anestesiologia de Chile. All rights reserved.
ABSTRACT
Introduction: Many authors have highlighted the management and outcomes of liver transplant patients with SARS -CoV2, however, there is a reduced experience identified with Hispanic or Latino patients [1]. We would like to share our experience with liver transplantation and SARS-CoV-2 infection (Real-time PCR identification) during 2020. Objectives: Describe the main infectious complications identified in patients with SARS-CoV2 and liver transplantation. Identify mortality rate among this group of patients and answer to therapies provided during their stay at the Hospital. Compare the mortality rate with other studies without Latin patients or with a reduced presence of them. Methods: This is an observational descriptive study carried out from May to August 2020 Results: 14 Hispanic patients were admitted to our institution (mean age 64 years;range: 57-76). Nine patients required hospitalization, and four patients were admitted to the intensive care unit (ICU). The most frequent risk factors were a history of arterial hypertension (n=8) and chronic kidney disease (n=6). The immunosuppression of these patients was based on antimetabolites (n = 9), calcineurin (n = 8), prednisolone (n = 4) and everolimus (n = 3). The onset of symptoms was six days approximately. All ICU patients receiving mechanical ventilation and renal replacement therapy for stage 3 acute renal failures. However, bacteremia caused by E. Coli, Citrobacter spp., and Staphylococcus aureus was present in three patients, an outcome that was not identified in the study population. The mortality rate was 28.5%. The mortality rate was higher than Webb et al 1 (18%) and other studies where rates were reported from 12% to 18%, and where the white population was predominant. The therapy provided in our institution was focused on tapering the immunosuppressive therapy attached with the use of dexamethasone. This treatment was given to six patients [4]. Conclusion: Our rate of mortality was higher compared with other similar studies. However, further future studies should include outcomes in the Hispanic population due to the social factors in addition to genetic factors that could be involved in higher mortality in ICU. Also, taking into account the increase in the number of cases, the follow-up of patients with liver diseases by telephone contact with transplant centers should be considered. Uncited references: [2,3,5]
ABSTRACT
Scholars rely on accurate population and mortality data to inform efforts regarding the coronavirus disease 2019 (COVID-19) pandemic, with age-specific mortality rates of high importance because of the concentration of COVID-19 deaths at older ages. Population counts, the principal denominators for calculating age-specific mortality rates, will be subject to noise infusion in the United States with the 2020 census through a disclosure avoidance system based on differential privacy. Using empirical COVID-19 mortality curves, the authors show that differential privacy will introduce substantial distortion in COVID-19 mortality rates, sometimes causing mortality rates to exceed 100 percent, hindering our ability to understand the pandemic. This distortion is particularly large for population groupings with fewer than 1,000 persons: 40 percent of all county-level age-sex groupings and 60 percent of race groupings. The U.S. Census Bureau should consider a larger privacy budget, and data users should consider pooling data to minimize differential privacy’s distortion. © The Author(s) 2021.