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We describe the adaptation of services to allow flexible and practical responses to the coronavirus-19 (COVID-19) public health crisis by four Consultation-Liaison Psychiatry (CLP) services; Galway University Hospital (GUH), Beaumont Hospital, University Hospital Waterford and St Vincent's University Hospital (SVUH) CLP services. This article also illustrates close collaboration with community adult mental health services and Emergency Department (ED) colleagues to implement effective community diversion pathways and develop safe, effective patient assessment pathways within the EDs. It highlights the high levels of activity within each of the CLP services, while also signposting that many of the rapidly implemented changes to our practice may herald improvements to mental health patient care delivery in the post-COVID-19 world, if our psychiatry services receive appropriate resources.
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Two and a half years ago COVID-19 spread to the United States. Following the federalism model (New State Ice Co. vs Liebmann;Cheng and Lee 2019), the 50 states and their governors and legislators made many of their own pandemic policy choices to mitigate the damage from the virus. States learned from one another over time about what policies worked most and least effectively in terms of containing the virus while minimizing the negative effects of lockdown strategies on businesses and children. This study is an expanded and updated version of an October 2020 report card of how pandemic health, economy, and policy varied across the 50 states and the District of Columbia (Committee to Unleash Prosperity 2020). It examines three variables: health outcomes, economic performance throughout the pandemic, and impact on education. We find no relationship between reduced economic activity during the pandemic and mortality. © 2023 Informa UK Limited, trading as Taylor & Francis Group.
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How the COVID-19 pandemic, and the deaths that occurred during the acute phase of the pandemic (2020–2021), will be remembered is yet to be determined. Writing from a UK perspective, this short article reflects on the way in which memory, narratives and death are constructed, contested and (re)produced. Drawing on the authors' respective sociological sub-fields, it makes a case for an ongoing sociological appraisal of emergent COVID-19 narratives, that can encompass and intertwine understandings of temporality, accountability and loss. © The Author(s) 2023.
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Background The European Human Biomonitoring Initiative (HBM4EU) is a program protecting humans from the health effects of chemicals. The goal of HBM4EU is to make use of human biomonitoring (HBM) to assess human exposure to chemicals in Europe to better understand the associated health effects for citizens and to improve chemical risk assessment. Harmonisation and sustainable implementation of the HBM programme across Europe are important aims. In parallel to HBM studies, health examination surveys (HESs), dietary surveys, and disease specific health surveys are conducted in many European countries. In HESs, information collected by questionnaire(s) is supplemented with physical examinations and analysis of biomarkers from biological samples. HBM and HES use similar sample and data collection methods and infrastructures hence combining the two is being explored. Methods Within HBM4EU, three feasibility studies (Finland, Germany, and UK/England) were conducted to evaluate opportunities and obstacles in combining HBM and health studies. We describe the contents and differences of these feasibility studies, and discuss the matters of shared benefits, obstacles, and lessons learned. Results Benefits of combining HBM and HESs include the use of shared infrastructures, participants receiving additional health information from HES, and higher participation rates. Obstacles can be encountered when obtaining ethical approval and during time-consuming and complicated preparatory phases. Recruitment of participants and low participation rates are common concerns and designing participant-friendly questionnaires is important. Unexpected events such as the COVID-19 pandemic can cause challenges to studies. Furthermore, experiences from several countries demonstrated that long-term funding for combined studies can be difficult to obtain. Conclusions In the future, incorporating HBM modules into HESs can provide a feasible and cost-effective method to conduct HBM studies. Key messages • The European Human Biomonitoring Initiative (HBM4EU) protects humans from the health effects of chemicals in Europe. HBM4EU uses human biomonitoring (HBM) to evaluate human exposure to chemicals. • In addition to HBM studies, health examination surveys (HESs) are conducted. In the future, incorporating HBM modules into HESs can provide a feasible and cost-effective method to conduct HBM studies.
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Human dignity is the bedrock of the social work profession and underpins all other principles. COVID-19 and the health emergencies that came before it exposed those instances where human dignity was compromised or ignored. Not all people, or nations, were treated equally during COVID-19. Social workers were challenged to uphold their values and principles in the trying circumstances of this health emergency. This chapter further explores these issues in three case studies that discuss the experience of Native Americans, the Back Lives Matter movement, and LGBTQIA+ communities. © 2022 selection and editorial matter, Patricia Fronek and Karen Smith Rotabi-Casares;individual chapters, the contributors.
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This paper presents findings from a critical ethnographic study that spanned 3 years from 2018 to 2021 in a Canadian post-secondary context and engaged transdisciplinary quantum feminisms as a conceptual framework. The purpose of the study was to formulate an ethical frame of reference that could facilitate exchanges within university–community partnerships. This study was ongoing as the global COVID-19 pandemic unfolded, a time frame that also paralleled heightened social and political awareness of racial disparity in Canada, the United States, and around the globe. These factors prompted the authors to expand the scope of the project midway to also consider the impact of COVID-19 on university–community partnerships. Given this, a main research question guides this study: What qualifies university–community partnerships as ethical? It is contextualized by a secondary question: What is the impact of the COVID-19 pandemic on university–community partnerships? Findings from this study led to the development of an ethical frame of reference for university–community partnerships entitled Praxis-Poiesis: Intentional Allyship, Reciprocal Relationships, and Transilience. © 2021 Itinera. All rights reserved.
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Background/Aims There is increasing evidence from large observational cohort studies that rituximab may result in more severe COVID-19 disease and increase the risk of death. There is also concern that rituximab impairs response to the COVID-19 vaccination. We aimed to determine the outcome of patients with inflammatory arthritis treated with rituximab during the current COVID-19 pandemic. Methods We conducted a single-centre retrospective observational study of patients with rheumatoid arthritis (RA) or juvenile idiopathic arthritis (JIA) treated with rituximab under follow-up in a dedicated clinic from the start of the COVID-19 pandemic in February 2020 until September 2021. We assessed the outcomes of those with COVID-19 infection and serological response to COVID-19 vaccination in patients tested for SARS-CoV-2 Spike antibodies. Results So far, 139 patients have been included (82.0% female, mean age 63.0 [SD 15.6] years). 132 patients had RA and 7 had JIA. 18 patients (12.9%) reported testing positive for COVID-19 infection. Of these, 11 patients (61.1%) were hospitalised. 9 (50%) did not require supplemental oxygen, 2 (11.1%) required supplemental oxygen, 6 (33.3%) required non-invasive ventilation or high-flow oxygen, and 1 (5.6%) required invasive mechanical ventilation. 4 patients (12.2%) died, average number of days from COVID-19 symptom onset to death was 27 (SD 5.2). 8 patients (44.4%) made a full recovery, 6 patients (33.3%) were left with permanent health defects. There was a trend toward higher levels of care in patients who had received more rituximab cycles. Of 21 patients who received both COVID-19 vaccination doses and had COVID-19 serology performed, only 9 patients (42.9%) had positive COVID-19 serology post vaccination. There was a significant difference in the number of days from last infusion to second vaccination dose between those with a positive serological response (median 231.0, IQR [285.0-194.3] days) compared with those with a negative response (median 504.0, IQR [266.0-580.0] days) (p=0.007, Mann-Whitney U test). Of 3 patients who had not been vaccinated but had previously confirmed COVID-19 infection (positive PCR), only 1 patient had positive COVID-19 serology. Mean duration from positive PCR test to serology test 83.3 (SD 14.4) days. Since February 2020, at least 19 patients (13.7%) paused rituximab or switched to an alternative biologic due to concerns over COVID-19 risk. Of 17 patients that switched, the most common alternative biologics were abatacept (11), baracitinib (3) and sarilumab (2). 5 patients continued rituximab at a reduced dose of 1 gram per cycle. Conclusion Given the potential for an increased risk of severity of COVID-19 infection and reduced response to COVID-19 vaccination in patients treated with rituximab, 'pausing' or 'delaying' it and use of alternative therapies to maintain disease control should be considered. The risks and benefits need to be carefully considered on a case-by-case basis.
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Introduction: During the initial peak of the COVID-19 pandemic, many centers globally reported a significant decrease in volumes of emergencies including acute stroke (AS) and acute myocardial infarction (AMI). While the reason for this remains unknown, pandemic-driven anxiety among patients may have resulted in unwarranted refusals to transport when deemed necessary by EMS (Emergency Medical Services) providers. We sought to study the impact of COVID-19 pandemic on the patterns of Emergency Medical transport (EMTr) and patient refusals to transport when serious medical conditions were suspected by EMS personnel. Methods: In this retrospective, observational study of Grady Health System's EMS, we compared the rates of EMTr and refusals for adult patients with suspected diagnoses of AS, AMI, and other medical conditions in the first year of the pandemic (Y1, Mar 2020-Feb 2021) with the corresponding period in the year prior (Y0). We also compared the temporal trends for these variables across the different pandemic waves (1st , Mar-May 2020;2nd , Jun-Aug 2020;3rd, Sep 2020-Feb 2021) with the corresponding periods in the year before. Results: Grady EMS responded to 207,888 calls in Y1 compared to 201,968 in Y0. The overall rate of refusals for all diagnoses was 15.5% in Y1 vs 14.1% in Y0, that for AS was 2.25% in Y1 vs 1.77% in Y0 and 7.5% in Y1 vs 5.67% in Y0 for AMI (Figure). Conclusion: There were more refusals in the first two waves of the pandemic. While refusals were higher for AS and AMI, this was not statistically significant. Our study provides valuable insight into the behavioral patterns of patients seeking emergency care during the pandemic and emphasizes a need for public education and more research. (Figure Presented).
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The outbreak of COVID-19 caused by SARS-CoV-2 in Wuhan and other cities in China in 2019 has become a global pandemic as declared by the World Health Organization (WHO) in the first quarter of 2020. The delay in diagnosis, limited hospital resources and other treatment resources led to the rapid spread of COVID-19. Optimal control dynamical models with time-dependent functions are very powerful mathematical modeling tools to investigate the transmission of infectious diseases. In this study, we have introduced and studied a new mathematical model for COVID-19 disease using personal protection, hospitalization and treatment of infectious individuals with early diagnosis, hospitalization and treatment of infectious individuals with delayed diagnosis and spraying of the environment as time-dependent control functions. This new non-autonomous deterministic epidemic model for the 2019 coronavirus disease is an extension of a recently constructed and analyzed data-driven non-optimal control model. We investigated three control strategies for our model problem. From the numerical illustrations of the various control strategies, we realized that the third strategy, which captures all the four time-dependent control functions, yields better results. © 2022 the author(s).
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Background: Adolescents with overweight (OW) and obesity (OB) report profound psychological stressors. Yet, traditional adolescent behavioral weight control interventions have not focally targeted stress reduction. Mindfulness skills may benefit adolescents with OW/OB and enhance treatment outcomes by providing strategies to manage stress. The goal of this study was to integrate mindfulness and behavioral weight control for adolescents with OW/OB by obtaining feedback from a Youth Advisory Board (YAB) and conducting an open trial of a novel Mindfulness-Based Weight Control (MBWC) intervention. A secondary goal was to describe intervention adaptation intervention in response to the COVID-19 pandemic. Methods: Feedback on the intervention was obtained during 6 group meetings of the YAB (N = 9;M = 15.22 yrs, SD = 1.20;66.6% male;zBMI M = 1.97, SD = .34). The open trial included 2 cohorts (N = 14;M = 15.14 yrs, SD = 1.56;71.4% female;zBMI M = 2.08, SD = .26) both of which received 8 sessions of the group MBWC intervention. Cohort 1 was conducted in-person. Due to COVID-19, cohort 2 was adapted for virtual, synchronous delivery. Results: The YAB provided feedback on developmental and cultural fit of MBWC for adolescents with OW/OB. For the open trial, a small effect (Hedge's g = .16) was found in zBMI decrease from pre-( M = 2.02, SD = .26) to post-( M = 1.97, SD = .30) treatment. However, the pre-post change in zBMI failed to reach significance, t = 1.68(10), p >.05. Post-treatment, participants in both groups rated on a 10-point scale (0 = strongly disagree to 10 = strongly agree) that they were 'satisfied with the HEARTS program' (M = 7.92, SD = 1.38) and would 'recommend the HEARTS program to a friend' (M = 8.50;SD = 1.78). Conclusions: Open trial findings provide preliminary support for this novel adolescent mindfulness-enhanced group behavioral weight control intervention, with adaptation for real-time online delivery. Specifically, results support the acceptability of this MBWC intervention, run both in-person and virtually with adaptation due to COVID-19. Further evaluation of the full 16-week MBWC intervention with a larger sample is needed to examine the impact on adolescent zBMI change.
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The impact of Coronavirus disease 2019 (COVID-19) on outcomes in patients with cancer remains unclear. Acute Myeloid Leukemia (AML)/high-risk myelodysplasia (MDS) are common hematological malignancies resulting in profound immunosuppression, which is exacerbated by intensive and less-intensive chemotherapy. Importantly, venetoclax based regimens have been increasingly used during the pandemic as a strategy to reduce patient hospitalization however, there is little information concerning the impact of such regimens on COVID-19 infection rates. We therefore opened a prospective clinical study (PACE), at the start of the current pandemic in April 2020 to characterize the risk of COVID-19 infection in patients with AML/MDS-EB2 receiving intensive or non-intensive treatment, including patients treated with venetoclax-based regimens. The primary aim was to determine the incidence of COVID-19 in patients with AML /MDS-EB2 including both, prior to study entry and during treatment until 4 weeks after the last cycle of treatment. Secondary aims were to: characterize the presentation of COVID-19;define the severity and type of both non-COVID-19 and COVID-19 infections;and undertake an exploratory analysis to quantify the incidence of COVID-19 infection in patients receiving (less-intensive) venetoclax based regimens. All analysis conducted to date has been descriptive. 211/230 recruited patients had full treatment histories available, of whom 116 patients received intensive chemotherapy and 95 low intensity regimens. 48 patients received a venetoclax-based regimen. The median age of the non-intensive treatment arm was 72 years;(range 19.1-86.5) and of the intensive arm was 59 years (range 16.1-76.1). There were more cases of secondary AML and relapsed disease in the non-intensive arm as compared to the intensive arm. 25/226 evaluable patients tested positive for COVID-19 as defined by positive SARS-CoV2 PCR test, 10 with a prior diagnosis at study entry and 15 tested positive during the study. The incidence of COVID-19 infection for patients with AML/MDS-EB2 was 11.1% (90%CI: 7.8%-15.1%) (Table). A lower proportion of patients (n=6/91 6.6%) undergoing non-intensive treatment suffered COVID-19 as compared to those undergoing more intensive chemotherapy regimens (n=19/116, 16.4%). Specifically, only 3/48 (6.3%) patients undergoing a venetoclax regimen were infected with SARS-CoV2. The most common presenting symptoms of COVID-19 in this study, regardless of the intensity of chemotherapy, was fever and cough with 6/25 patients asymptomatic. The risk of death at 30 days following study entry in patients who had prior COVID-19 infection or who contracted COVID-19 during this period was 13.6%, compared to 3.9% in the overall cohort without COVID-19 infection. There was a lower incidence of non-COVID-19 related infections in patients receiving venetoclax-based regimens, n=43 infections in 24 (50.0%) of patients;with 313 infections in 94 (81%) of intensively treated patients. The overall occurrence of non-COVID-19 infection in the non-intensive arm was 87 infections in 50 (54.9%) patients. Our multi-center study provides real-world estimates for the incidence and presentation of COVID-19 infection in a cohort of patients with AML/MDS-EB2, and indicates a higher risk of death at 30 days in patients with prior COVID-19 infection prior to, or during treatment. Venetoclax based, and other non-intensive, regimens, increasingly implemented during the pandemic, to minimize patient exposure and reduce usage of hospital beds, appeared to be associated with a low incidence of COVID-19. Further follow-up will be required to understand the long-term impact of this strategy. Analysis of immune responses to COVID-19 infection and vaccination is on-going. Acknowledgments: This study was funded by Cure Leukaemia under the Trials Acceleration Program (TAP), and grants from BMS and Blood Cancer UK. [Formula presented] Disclosures: Loke: Novartis: Other: Travel;Janssen: Honoraria;Amgen: Honoraria;Pfizer: Honoraria;Daichi Sankyo: Other: Travel. K apper: Pfizer: Consultancy, Speakers Bureau;Astellas: Ended employment in the past 24 months, Speakers Bureau;Jazz: Consultancy, Speakers Bureau;Novartis: Consultancy, Research Funding, Speakers Bureau. Khan: Abbvie: Honoraria;Astellas: Honoraria;Takeda: Honoraria;Jazz: Honoraria;Gilead: Honoraria;Novartis: Honoraria. Dillon: Amgen: Other: Research support (paid to institution);Astellas: Consultancy, Other: Educational Events, Speakers Bureau;Menarini: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees, Other: Session chair (paid to institution), Speakers Bureau;Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: educational events;Jazz: Other: Education events;Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Research Support, Educational Events;Shattuck Labs: Membership on an entity's Board of Directors or advisory committees. Culligan: AbbVie Ltd: Honoraria, Speakers Bureau;Celgene Ltd: Honoraria, Speakers Bureau;Gilead: Honoraria, Speakers Bureau;Jazz Pharma: Honoraria, Speakers Bureau;Takeda UK Ltd: Honoraria, Speakers Bureau. McMullin: Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees, Other: clinical trial support, Research Funding;Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;AbbVie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;AOP Orphan: Research Funding, Speakers Bureau. Murthy: Abbvie: Other: support to attend educational conferences. Craddock: Novartis Pharmaceuticals: Other: Advisory Board;Celgene/BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding.
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Purpose: This study correlates lung transplantation outcomes with pathologic diagnoses of explants and surveillance transbronchial allograft biopsies. Methods: A retrospective IRB approved review of archival material from explanted lung recipients from our Department of Pathology database during the period 2013- 2016 was performed. Demographic information, explant diagnoses, relevant clinical history, chronology of significant clinical events, and cause of death were retrieved. The results of surveillance allograft biopsies and serum donor specific antigen (DSA) antibodies were also reviewed. Log rank test was used to determine differences in survival among various groups. Results: 202 patients with end-stage lung disease underwent lung transplant during the 4-year study period. The most common explant diagnoses were emphysema (n=63, 31.2%), usual interstitial pneumonia (UIP;n=62, 30.7%), and cystic fibrosis (CF;n=22, 11%). Eighty-eight (43.6%) recipients died during the study period. The most common causes of death were chronic lung allograft dysfunction (n=25, 28.4%), malignancy (n=18, 20.5%), and infection (n=17, 19.3%). Three deaths were related to Coronavirus Disease 2019 (COVID-19). The overall survival rates at 3-year and 5-year were 74.3%, and 62.9%, respectively. Although overall survival rates did not correlate with explant diagnoses, patients with UIP and non-specific interstitial pneumonia (NSIP) tended to have worse outcomes than those with emphysema and CF, with lower survival rates in the first year post-transplant. Allograft rejection was identified in 139 patients (68.8%). Most cases of rejection showed acute cellular rejection (ACR, n=126), while antibody-mediated rejection (AMR) was seen in 29 patients, and a combination of ACR and AMR was found in 15 patients. Patients with early ACR (≤ 90 days post- transplant, n=80) had a lower overall survival rate compared to those with late ACR (> 90 days post-transplant, n=46) with a median survival of 68 vs. 88 months, respectively p<0.05 (Figure 1). In addition, patients with AMR alone tended to have lower survival than patients with both ACR and AMR (median survival 48 vs. 68 months), but not significant (p=0.07). Conclusions: This study demonstrates chronic obstructive pulmonary disease (COPD) as the most common indication for lung transplantation in our cohort. Early ACR was associated with adverse outcome by having lower overall survival rate. (Table Presented).
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Background: Haematuria often requires investigation with an imaging test and flexible cystoscopy to rule out urinary tract cancers. With a reduction in diagnostic services due to the COVID-19 pandemic there is a risk of compromise in the care of patients referred with haematuria. We aimed to provide a pragmatic strategy that optimises the use of scarce resources by reducing patient visits to hospital and allocating the appropriate diagnostic tests according to risk of bladder cancer. Methods: The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of newly suspected urinary tract cancer. Patients underwent cystoscopy, imaging tests, urine cytology and transurethral resection of bladder tumour (TURBT), where indicated. We developed strategies using combinations of imaging and cytology as triage tests to flexible cystoscopy. These strategies aimed to maximise cancer detection within a pragmatic pathway in a resource-limited environment. Findings: 8112 patients (74 4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70 7%) patients had visible haematuria (VH) and 2375 (29 3%) had non-visible haematuria (NVH). Amongst all patients, 1474 (18 2%) had bladder cancer;1333 (23 2%) in VH group and 141 (5 94%) in NVH group. Diagnostic test performance was used to determine optimal age cut-offs for each proposed strategy. We recommended proceeding directly to TURBT for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients (threshold of 60-years-old with VH, or 70-years-old with NVH) to capture high risk bladder cancer. Interpretation: We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.
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Introduction: The opioid epidemic is a growing and significant public health concern in California's Fresno County. To prevent opioid misuse, overdoses, and deaths, health professionals must learn how to work collaboratively to rapidly identify overdose threats, reverse overdoses, link people to effective treatment and reduce harms associated with opioids. A traditional interprofessional in-person workshop was not feasible due to the COVID-19 pandemic;therefore, a virtual interprofessional workshop was developed and implemented. The faculty team who developed the workshop sought to discover if a virtual approach would promote learning and influence participants' attitudes toward opioid overdose. Research Question or Hypothesis: Does a virtual, synchronous, interprofessional workshop impact healthcare professionals' knowledge and attitudes toward opioid misuse? Study Design: A quantitative, quasi-experimental pre and post approach was used. The target population were healthcare professional providers and students. Methods: Participants attended a 4-hour online synchronous workshop focused on opioid overdose and Naloxone training. Firstresponder Naloxone kits were provided through California's Naloxone Distribution Project. Data were collected via an online survey platform using the Opioid Overdose Knowledge Scale (OOKS) using a pre/post method, and the Opioid Overdose Attitudes Scale (OOAS), using a retrospective pre/post method. Data were confirmed to be non-parametric, so Mann-Whitney U tests were performed to compare pre- and post-test OOKS overall score and risk, sign, action, and naloxone use subscales and OOAS overall score and competence, concerns, and readiness subscales (Bonferroni adjusted α=0.006). Results: A total of 80 providers, students, and faculty from a variety of specialties participated. All OOKS and OOAS scores, except the readiness subscale, were significantly improved following the workshop and Naloxone training (p<0.004). Conclusion: A 4-hour online synchronous workshop significantly improved knowledge of and attitudes toward opioid overdose among healthcare professional providers and students. These study findings will inform future curriculum development and enhancement of future virtual programs to efficiently train healthcare professionals about approaching an opioid overdose.