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Introduction The number of subjects infected with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) throughout the western hemisphere increased exponentially in the later months of 2020. With this increase in infection, the number of subjects requiring advanced ventilatory support increased concomitantly. We decided to compare the survival rates between coronavirus disease 2019 (COVID-19) subjects versus non-COVID-19 subjects undergoing intubation in the intensive care unit (ICU). We hypothesized that COVID-19 subjects would have lower rates of survival post-intubation. Methods We screened all subjects admitted to the adult critical care unit between January 2020 and June 2020 to determine if they met the inclusion criteria. These subjects were required to be spontaneously ventilating upon admission and eventually required intubation. Subjects were selected from our electronic health record (EHR) system EPIC© (Epic Systems, Verona, WI) through a retrospective ICU admission analysis. We identified and included 267 non-COVID-19 subjects and 56 COVID-19 subjects. Our primary outcome of interest was intubation-related mortality. We defined intubation mortality as unexpected death (within 48 hours of intubation). Our secondary outcomes were the length of stay in the ICU, length of time requiring ventilator support, and proportion of subjects requiring tracheostomy placement. Results Compared to non-coronavirus disease (COVID) subjects, COVID subjects were more likely to be intubated for acute respiratory distress. COVID subjects had longer stays in the ICU and longer ventilator duration than non-COVID subjects. COVID-positive subjects had a decreased hazard ratio for mortality (HR = 0.42, 95% CI: 0.20-0.87, P < 0.05) and increased chances of survival compared to non-COVID subjects. Conclusions We showed the rates of intubation survival were no different between the COVID and non-COVID groups. We attribute this finding to intubation preparation, a multidisciplinary team approach, and having the most experienced provider lead the intubation process.
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Background and aim: The Coronavirus 2019 (COVID-19) pandemic has affected the delivery of healthcare around the world. We assessed the impact of the COVID-19 pandemic on hospital presentations, reperfusion treatment and outcomes in a comprehensive stroke centre. Methods: In this observational study seven months of retrospective data from February 2020 at the beginning of the pandemic were compared to data collected for the same time frame in 2019. Results: There was a transient reduction in stroke presentation only at the beginning of the wave of COVID-19 community transmissions in Sydney. There were significantly more haemorrhagic strokes in the COVID- 19 period (n = 66, 15.4 % vs n = 95, 21.5 %, p = 0.02) and baseline stroke severity was higher (NIHSS median 3 vs 4, p = 0.049). Similar proportions of ischaemic stroke patients received reperfusion therapy in the two time periods (IV thrombolysis [n = 51, 17.3% vs n = 52, 17.9%, p = 0.838];and ECR [n = 38, 12.9% vs n = 46, 15.9%, p = 0.30]). The time from presentation to stroke bed admission was significantly shorter during the COVID-19 period (p = 0.031). Three-month follow-up Modified Rankin Score was 2 (median) in both periods (P = 0.92). Conclusion: There was no change in stroke presentations overall during the 2020 COVID 19 pandemic time period with the exception of the first phase of the pandemic. Baseline stroke severity scores were higher. There was no difference in the degree of disability at three-month follow-up.
ABSTRACT
The disruption caused by the pandemic and the rapid transition to online teaching brings into sharp focus the role of academic development within the institution and creates an opportunity to pause and reflect on the impact of the academic developer (AD) role. This reflection on practice explores how the AD role has transitioned through the Covid-19 pandemic with a view to considering future implications for the field. Short auto-ethnographic reflections capture academic developers’ experiences of their role at a time of crisis and their perception of the future of academic development. The data shows a lack of clarity and visibility of the role pre-Covid, with a variety of tasks being assigned without a central focus. This was amplified during the pandemic, with a broadened remit in response to an increased demand for support. While this initial support was reactionary, focusing on teaching online, a renewed and more holistic interest in teaching and learning emerged across institutions, with ADs playing a key role in this evolution. © 2022 Informa UK Limited, trading as Taylor & Francis Group.
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Music therapy was required to (a) evolve and expand its clinical service due to a significant rise in referrals across the hospital resulting in a dramatic increase in referrals outside clinically allocated streams, and (b) focus on supporting healthcare workers' wellbeing across the entire organisation with the formation of Scrub Choir. Introduction Established in 1998 at one of Victoria's major adult hospitals, our music therapy (MT) program centres on live music and guided songwriting at the bedside for rehabilitation, comfort, pain reduction, mood elevation, end of life care and increased quality of life (O'Brien 1999, 2003, 2005, 2006, 2012, 2014). In the following brief literature review, we have explored practice-based papers and surveys of MT COVID-19 services and technology, established literature on the impact of singing for wellbeing, and research into health care workers' (HCW) mental health. There were some insightful limitations to the study in a cultural and gender context specific to the participants group, which included preconceptions of gender roles, which the authors believed influenced participation (the researchers found male participants were less reluctant to access music and dance than female participants), and the access by female participants appeared to be influenced by their hometown origins (with a greater uptake by females in Northern areas of India).
ABSTRACT
INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is used to treat patients with refractory circulatory or respiratory failure as a bridge to recovery, long-term support device (e.g., ventricular assist device), or transplant. Patients on ECMO commonly receive large doses of analgesia and sedation, and prior in vitro studies have been equivocal when evaluating the effect of ECMO therapy on blood concentrations of these medications. Because dose escalations may result in excessive drug exposure, over-sedation, and drug side effects, we seek to quantify the impact of ECMO initiation on plasma concentrations of fentanyl. METHODS: This is preliminary data from a single-center, prospective trial of patients treated with ECMO to evaluate the effects of ECMO therapy on systemic fentanyl levels. Patients ≥ 18 years of age who were cannulated for ECMO and already receiving a continuous fentanyl infusion were considered for enrollment, while patients younger than 18 years of age, pregnant, and/or cannulated at another hospital prior to arrival at our institution were excluded. Whole blood samples were collected within 30 minutes of ECMO cannulation, at the time of initiating ECMO flow, and after initiating flow at 15-, 30-, and 60-minutes. RESULTS: Three patients (two male, one female) were included in this preliminary sample, and all were placed on VV-ECMO for refractory respiratory failure due to COVID-19 pneumonia. Mean fentanyl concentrations were reduced by 13% after 30 minutes and 5% after 60 minutes. However, one of the three patients received a bolus dose of fentanyl during the study period. When assessing fentanyl concentrations from the two patients not receiving an additional fentanyl bolus, mean fentanyl concentrations were reduced by 18% after 30 minutes and 19% after 60 minutes. CONCLUSIONS: In this preliminary data from three patients treated with ECMO for refractory respiratory failure, systemic fentanyl concentrations were reduced after 30- and 60-minutes. While this data is limited to three patients and a greater number of patients are needed to ascertain statistical significance, these data may provide quantitative evidence to support why patients on ECMO require increased doses of fentanyl to maintain adequate analgesia. This study is currently ongoing and enrolling additional patients.