ABSTRACT
Introduction: Positive airway pressure (PAP) is the gold standard therapy for OSA. However, patient follow-up and adherence to PAP therapy remains variable. With the onset of the COVID-19 pandemic, many sleep centers shifted towards telemedicine. In order to evaluate the impact of telehealth, we assessed the rates of follow-up and PAP adherence among patients newly diagnosed with OSA prior to and after the onset of the COVID-19 pandemic. Methods: Patients aged 18-75 years enrolled in our military sleep center who met eligibility criteria were divided into a pre-pandemic group and a pandemic group. For the pre-pandemic group, initial and follow-up clinic appointments occurred via face-to-face encounters. For the pandemic group, these clinic appointments occurred via telephone encounters. PAP follow-up was defined as a clinic appointment occurring within 6 months of the initial OSA diagnosis and the onset of PAP therapy. Adequate PAP adherence was defined as usage of the device ≥ 4 hours per night on ≥ 70% of nights during a consecutive 30-day period. Differences among the two groups regarding PAP follow-up, PAP adherence, and demographic data were analyzed. Results: Eligible patients (n=234) were divided into a pre-pandemic group (n=117) and a pandemic group (n=117). Demographic data for the pre-pandemic group vs. pandemic group included the following: mean age 42.2 vs. 40.3 years;78.6% vs. 88.0% male;60.7% vs. 76.9% active duty military, mean BMI 30.1 vs. 30.1;mean AHI 28.5/hr vs. 27.7/ hr;mean Epworth Sleepiness Scale score 11.7 vs. 12.0;mean Insomnia Severity Index 16.9 vs. 16.8. The rates of PAP follow-up were 59.0% (prepandemic group) vs. 41.0% (pandemic group). The rates of adequate PAP adherence were 34.8% (pre-pandemic group) vs. 25.0% (pandemic group). Conclusion: There were higher rates of PAP follow-up and PAP adherence among patients seen via face-to-face encounters occurring prior to the onset of the COVID-19 pandemic. While utilization of telehealth in our center did not result in improved outcomes, there may still be utility in offering telehealth to the sleep patient population. Additional studies are needed to identify effective interventions that can be implemented to improve rates of PAP follow-up and PAP adherence.
ABSTRACT
The web of lies surrounding COVID-19 has been purposefully exacerbated by hostile actors, with researchers, analysts, and policymakers alike attempting to keep pace with unfolding disinformation narratives and subsequent effects on citizens. While the content of hostile disinformation narratives is relatively well-researched, how these narratives interact and are amplified to generate psychological effects requires further scrutiny. To address this gap, this study uses Russian COVID-19 disinformation combined with network methodologies to contextualize a novel hypothetical model of this process. Specifically, we conduct a content analysis of known disinformation articles about COVID-19 (N = 65) from Russian news sources (e.g. RT, Sputnik, New Eastern Outlook). Using co-occurrence network visualizations, we map the nexus between narrative and psychological effects to provide new insights and testable models of the effects of COVID-19 disinformation. Main findings show how hostile anti-Western narratives primarily target the emotions of anger, disgust, and confusion with the aim of undermining citizens’ trust in (supra-) governmental institutions and the media. This is the first step in a research agenda that can help media practitioners develop interventions and aid policymakers in bolstering societal resilience to hostile disinformation campaigns. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
COVID-19 mitigation measures (e.g., stay-at-home orders and public mask mandate) and fundamental public health interventions (e.g., case investigations and contact tracing with prompt isolation or quarantine) are primary approaches to preventing and controlling SARS-CoV-2 community transmission. State-mandated stay-at-home orders and public mask mandates coupled with case investigations with contact tracing contributed to an 82% reduction in COVID-19 incidence, 88% reduction in hospitalizations, and 100% reduction in mortality in Delaware during late April-June. The combination of state-mandated community mitigation efforts and routine public health interventions can reduce the occurrence of new COVID-19 cases, hospitalizations, and deaths.
ABSTRACT
While the content of hostile disinformation narratives is relatively well-researched, how these narratives interact and are amplified to generate psychological effects requires further scrutiny. To address this gap, this study uses Russian COVID-19 disinformation combined with network methodologies to contextualize a novel hypothetical model of this process. Specifically, we conduct a content analysis of known disinformation articles about COVID-19 (N = 65) from Russian news sources (e.g. RT, Sputnik, New Eastern Outlook). Using co-occurrence network visualizations, we map the pathways from narrative to psychological effects to provide new insights and testable models of the effects of COVID-19 disinformation. Main findings show that hostile anti-Western narratives primarily target the emotions of anger, disgust, and confusion to undermine citizens' trust in (supra-) governmental institutions and the media. This is the first step in a research agenda that can help media practitioners develop interventions and aid policy makers bolster societal resilience to hostile disinformation campaigns. © 2021 IEEE.
ABSTRACT
RATIONALE: COVID-19 activity continues to cause a high disease burden, and hospitals are vulnerable to ventilator scarcity. Crisis standards of care aim to maximize lives saved and to minimize clinician distress from bedside rationing. 26 states have allocation guidelines. 15 use the Sequential Organ Failure Assessment (SOFA) score. SOFA predicts mortality in hospitalized patients and provides objective data to reduce the risk of introducing bias. We use data from the COVID-19 surge in New York City (NYC) to model performance of a protocol based on SOFA scores and NY State guidelines. Although these guidelines were not implemented, we estimate the hypothetical outcomes had they been required. METHODS: This is a chart review of a random sample (205) of all intubated patients (1002) in three NYC hospitals between 25 March 2020 and 29 April 2020. Patients with and without COVID-19 were included. SOFA scores were calculated upon intubation, 48-, and 120-hours post-intubation. We calculated mortality and proportion of patients categorized into four groups: blue (ventilator not offered or removed), red (highest priority), yellow (intermediate priority), and green (weaned or ventilation not indicated) at each interval. RESULTS: 65 (32%) patients survived to discharge (Figure). 117 patients (57%) were categorized blue at least once;28 (24%) of those ultimately survived hospitalization. Patients ever in blue category had higher mortality (76%) compared with those never categorized blue (58%;p<0.01). Of expired patients, 89 (63%) were ever categorized as blue. CONCLUSIONS: Since over half of all patients met exclusion criteria at one or more time points, clinical judgment may still be needed to decide which patients would be excluded first. This re-introduces bias and moral distress;issues effective triage protocols should address. More specific scoring systems, such as 4C mortality score, may improve performance. Alternative strategies including first-come, first-served, randomization, clinician judgement, and triage committees lack empirical data and have ethical shortcomings. Our findings differ from a recent retrospective cohort study, which found few patients outside of the pandemic met New York State guideline blue category criteria among more than 40,000 ICU admissions. Our sample more closely reflects the acuity of pandemic conditions when this allocation guideline would be activated. The data from this preliminary study suggest that the SOFA score offers limited utility in triage, raising the question of whether sufficient ethical justification exists to impose a life-ending decision on a subset of patients to offer potential benefit to a modest number of others.