Geographic variations in opioid overdose patterns in Pennsylvania during the COVID-19 pandemic.

The convergence of the opioid epidemic and the COVID-19 pandemic has created new health challenges throughout the United States. Since the onset of the pandemic, media attention and scholarly research have drawn attention to the intersections of addiction and COVID-19. However, there remain few empirical studies that examine the direct impacts of the COVID-19 pandemic for opioid overdose patterns. Even fewer have integrated quantitative and qualitative methods to detail the place-specific dynamics shaping opioid overdose and addiction treatment during the COVID-19 pandemic. This article measures and maps change in the age-adjusted rate of opioid-related overdose incidents at the county level from 2018 to 2020. These analyses are combined with interviews conducted since December 2020 with public health providers in the state of Pennsylvania to identify the key factors influencing opioid misuse and transformations in addiction treatment practices.

Description and Functional Outcomes of a Novel Interdisciplinary Rehabilitation Program for Hospitalized Patients With COVID-19.

OBJECTIVES: The aims of the study were to describe an interdisciplinary inpatient rehabilitation program for patients recovering from COVID-19 and to evaluate functional outcomes. DESIGN: This is an analysis of retrospective data captured from the electronic health record of COVID-19 patients admitted to the rehabilitation unit (N = 106). Rehabilitation approaches are described narratively. Functional gain was evaluated using the Activity Measure for Postacute Care 6 Clicks, basic mobility and daily activities. RESULTS: Interdisciplinary approaches were implemented to address the medical, physical, communication, cognitive, and psychosocial needs of COVID-19 patients. COVID-19 patients exhibited significant improvements in basic mobility (Activity Measure for Postacute Care for basic mobility, P < 0.001, Cohen d = 1.35) and daily activities (Activity Measure for Postacute Care for daily activities, P < 0.001, Cohen d = 1.06) from admission to discharge. There was an increase in ambulatory distance as well as the percentage of the patients who were able to breathe on room air. At discharge, fewer patients required supplemental oxygen on exertion. Eighty percent of the patients were discharged home after an average length of stay of 17 days. Greater functional improvement was associated with younger age, longer intubation duration, and participation in psychotherapy, but not a history of delirium during hospitalization. CONCLUSIONS: Early rehabilitation is associated with improved mobility and independence in activities of daily living after COVID-19.

COVID and Cognition: Preliminary Findings of a NYC Inpatient Rehabilitation Unit

Research Objectives To investigate the impact of COVID-19 on cognition and independence with functional tasks of patients admitted to an inpatient rehabilitation unit (IRU). Design Cross-sectional observational study with assessments at admission and discharge of 94 COVID-19 patients admitted to an urban inpatient rehabilitation unit (IRU) between March 2020 - August 2020. Setting This study took place in an urban acute care hospital 22-bed IRU. Participants 94 individuals admitted to the IRU with a diagnosis of COVID-19. 77 patients received an admission cognitive assessment, 45 also received discharge cognitive assessment. All received admission and discharge Quality Indicator for Self-Care (QI SC) Score. Interventions Not applicable. Main Outcome Measures Montreal Cognitive Assessment (MoCA) administered to identify cognitive impairment. The Uniform Data System (UDS) Quality Indicators (on Self-Care (QI-SC) scored for functional status. Results 75/77 (97%) patients received an admission cognitive assessment coded as independent with ADL and cognitive tasks prior to admittance. 62/77 (80.5%) patients demonstrated cognitive deficits on the MoCA at admission: 39/77 (50.6%) mildly impaired, 20/77 (26%) moderately impaired, and 3/77 (3.9%) severely impaired. 32/45 patients discharge scores improved and met the MoCA minimally clinically important difference (MCID);however, 35/45 continued to score in the impaired range. Patients who met the MoCA MCID demonstrated significantly greater QI-SC score gains than those that did not meet the MCID. 70/77 (91%) were discharged home with recommendation for continued therapy services. Conclusions Cognitive impairment is common amongst patients requiring prolonged hospitalization and acute inpatient rehabilitation for COVID-19. Most patients admitted to the IRU demonstrated intact independence and cognition prior to disease onset and hospitalization. Although most patients on the IRU showed improvements in cognition according to the MoCA;these patients were recommended for continued therapy and/or assistance for functional tasks post discharge. Since cognitive deficits were still present at discharge, the need for standardized assessment and follow-up is indicated, especially given the association with functional outcome. Author(s) Disclosures None.

Cognitive impairment and functional change in COVID-19 patients undergoing inpatient rehabilitation.

Cognitive impairment is increasingly recognized as a sequela of COVID-19. It is unknown how cognition changes and relates to functional gain during inpatient rehabilitation. We administered the Montreal Cognitive Assessment (MoCA) at admission to 77 patients undergoing inpatient rehabilitation for COVID-19 in a large US academic medical center. Forty-five patients were administered the MoCA at discharge. Functional gain was assessed by change in the quality indicator for self-care (QI-SC). In the full sample, 80.5% of patients exhibited cognitive impairment on admission, which was associated with prior delirium. Among 45 patients with retest data, there were significant improvements in MoCA and QI-SC. QI-SC score gain was higher in patients who made clinically meaningful changes on the MoCA, an association that persisted after accounting for age and delirium history. Cognitive impairment is frequent among COVID-19 patients, but improves over time and is associated with functional gain during inpatient rehabilitation.

Assessing the Relationships Between COVID-19 Stay-at-Home Orders and Opioid Overdoses in the State of Pennsylvania

COVID-19 is compounding opioid use disorder throughout the United States. While recent commentaries provide useful policy recommendations, few studies examine the intersection of COVID-19 policy responses and patterns of opioid overdose. We examine opioid overdoses prior to and following the Pennsylvania stay-at-home order implemented on April 1, 2020. Using data from the Pennsylvania Overdose Information Network, we measure change in monthly incidents of opioid-related overdose pre- versus post-April 1, and the significance of change by gender, age, race, drug class, and naloxone doses administered. Findings demonstrate statistically significant increases in overdose incidents among both men and women, White and Black groups, and several age groups, most notably the 30–39 and 40–49 ranges, following April 1. Significant increases were observed for overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids, and carfentanil. The study emphasizes the need for opioid use to be addressed alongside efforts to mitigate and manage COVID-19 infection. [ABSTRACT FROM AUTHOR] Copyright of Journal of Drug Issues is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)