Mindfulness Is Associated With Physical And Psychological Health In Patients Withknee Osteoarthritis During The Covid-19 Pandemic: A Cross-Sectional Analysis

Purpose: Previous evidence suggests that increased mindfulness is associated with lower levels of pain and less psychological stress among chronic musculoskeletal pain patients. However, the impact of the COVID-19 pandemic on knee osteoarthritis outcomes and its correlation to facets of mindfulness has not been clearly delineated. Therefore, we examined the impact of the COVID-19 pandemic on physical and psychological outcomes in knee osteoarthritis (OA) patients and tested whether this relationship is mediated by mindfulness. Method(s): Cross-sectional analysis was performed on baseline data from a randomized trial for knee OA. We measured COVID-19 impact (Epidemic-Pandemic Impacts Inventory [EPII]), mindfulness (Five Facet Mindfulness Questionnaire [FFMQ]), pain and physical function (Western Ontario and McMaster University Index [WOMAC]), and psychological symptoms (Hospital Anxiety and Depression Scale [HADS], Perceived Stress Scale). Pearson's correlation coefficients estimated associations between the COVID-19 pandemic's impact, mindfulness, and physical and psychological factors. We evaluated whether mindfulness mediated associations between the COVID-19 pandemic impacts and psychological health. Result(s): A total of 40 diverse knee OA patients were included in the analysis, age 66+/-8 years;60% women;43% non-white;body mass index 31+/-7 kg/m2. Table 1 summarizes correlations. Higher negative COVID-19 impact was associated with higher anxiety (p<0.05, r=0.41) and depressive symptoms (p<0.05, r=0.38). Mindfulness did not mediate the association, shown in Figure 1. However, higher total mindfulness was associated with lower WOMAC-pain (r=-0.36, p<0.05, r=-0.32, p<0.05), less depressive (p<0.01, r =-0.49) and anxiety symptoms (p<0.05, r = -0.38). Conclusion(s): Higher negative COVID-19 impact is associated with worse psychological wellbeing in knee OA patients. Consistent with our previous findings, higher levels of mindfulness are associated with less pain, depression, and anxiety. This cumulative evidence warrants longitudinal studies exploring how mind-body therapies aiming to cultivate mindfulness may impact the well-being of patients with knee OA. [Formula presented] [Formula presented]Copyright © 2023

Propofol-Related Hypertriglyceridemia as a Risk Factor for Pancreatitis in Patients with Covid-19

INTRODUCTION: Hypertriglyceridemia is a known complication of propofol infusion, and higher levels of triglycerides are known to be associated with pancreatitis. Patients with severe COVID-19 pneumonia often require prolonged mechanical ventilatory support and often undergo prolonged sedation with medications such as propofol. In our study we looked to identify safe cut offs for triglyceride levels as well as cumulative dosing of propofol in order to minimize the risk of developing pancreatitis. METHOD(S): Utilizing our COVID-19 database from hospitals in the Steward Health Care Network we conducted a retrospective multi-center review to evaluate the instances of pancreatitis in critically ill patients with COVID-19 pneumonia who received propofol for sedation while intubated. We chart reviewed each patient and collected data regarding the number of days over which propofol was administered, cumulative doses of propofol, peak triglyceride levels, lipase levels, symptoms of pancreatitis and abdominal CT imaging consistent with pancreatitis. For the data analysis we used ROC analysis in conjunction with Youden's index to identify the optimal thresholds for propofol administration parameters and triglyceride levels that would offer maximal sensitivity and specificity for predicting pancreatitis. RESULT(S): We reviewed 499 cases of COVID-19 pneumonia and found 154 patients that were on propofol for sedation for a sufficient period of time. Among these we identified 6 cases of suspected pancreatitis. Using the ROC analysis and Youden's index we identified optimal cut-offs for peak triglyceride levels (688 mg/dl), number of days on propofol (4.5 days), Average daily propofol dose (3007 mg/ day), cumulative propofol dose (24,113 mg) to indicate low risk of pancreatitis. The NPVs for suspected pancreatitis for these cut-offs were found to be from 0.98 to 1. CONCLUSION(S): Our study suggests that patients who have triglyceride levels less than 688 mg/dl, have been on propofol for less than 4.5 days, received less than 3007 mg of propofol per day or have received less than 24113 mg in total of propofol may have a lower risk of developing pancreatitis. While these results are encouraging, larger prospective studies with more confirmed cases of pancreatitis are still necessary.

Massive pulmonary embolism post decannulation from Extra Corporeal Membrane Oxygenation: an unexpected complication

Introduction: Massive pulmonary embolism is a rare complication following Veno-Venous Extra Corporeal Membrane Oxygenation (VV-ECMO) decannulation. Management can be challenging. The authors present a case that required VV-ECMO re-cannulation and catheterdirected thrombolysis. Main body: 58-year-old gentleman, background of hypertension and asthma, admitted with severe respiratory failure secondary to COVID-19 pneumonitis. Due to lack of improvement with conventional ARDS treatment, he was referred and retrieved on VV-ECMO. After being off sweep gas for more than 24 hours he was decannulated on day 7. Five hours after decannulation the patient acutely deteriorated. He became tachycardic, hypotensive and hypoxic. A bedside TTE showed severely dilated and impaired right ventricle. The patient was started on milrinone and nitric oxide. Nevertheless, he deteriorated further and became profoundly hypoxic and hypercapnic, and a decision was made to start him on VV-ECMO. A TOE was done to guide cannulation and showed a thrombus in the RV and in the left pulmonary artery. Next day, a CT-pulmonary angiogram (CTPA) was done which showed saddle-shaped pulmonary embolism, with a large occlusive clot in the left main pulmonary artery causing complete non-perfusion of the left lung. After a multi-disciplinary team discussion, the patient had catheterdirected thrombolysis, with some haemodynamic improvement. Within 48 hours, TTE was repeated showing no significant improvement on RV function. CTPA showed very mild decrease of the clot burden. Decision was made to repeat catheter-directed thrombolysis and partial thrombectomy. Repeated imaging revealed decrease in the size of the left main pulmonary artery thrombus. It is thought that the massive pulmonary embolism could have been caused by showering of ECMO cannulas-related thrombi, which were dislodged during decannulation. Patient remained on VV-ECMO for 32 days and was decannulated successfully afterwards and was discharged home on apixaban and long-term pulmonary hypertension follow-up. Conclusion: ECMO cannulas related thrombi are not uncommon complications because of prolonged stay and coagulopathy related to ECMO circuit. However, massive embolism is rarely seen. The use of echocardiography was paramount on the differential diagnosis. In this TTE study, the right ventricle looks significantly dilated with severely impaired both longitudinal and radial functions. Additionally noted septal flattening in systole indicating RV pressure overload, diastolic notching of RVOT doppler trace consistent with significantly raised pulmonary artery pressure and mild to moderate tricuspid regurgitation. Otherwise, the left ventricle is small and has preserved function. (Figure Presented).

Coronavirus disease 2019 (COVID-19) in long-term care facilities: A review of epidemiology, clinical presentations, and containment interventions.

Long-term care facilities (LTCFs) and their populations have been greatly affected by the coronavirus disease 2019 (COVID-19) pandemic. In this review, we summarize the literature to describe the current epidemiology of COVID-19 in LTCFs, clinical presentations and outcomes in the LTCF population with COVID-19, containment interventions, and the role of healthcare workers in SARS-CoV-2 transmission in these facilities.

Predicting asymptomatic severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection rates of inpatients: A time-series analysis.

Asymptomatic SARS-CoV-2 infections are often difficult to identify because widespread surveillance has not been the norm. Using time-series analyses, we examined whether COVID-19 rates at the county level could predict positivity rates among asymptomatic patients in a large health system. Asymptomatic positivity rates at the system level and county-level COVID-19 rates were not associated.

SARS-CoV-2 Cycle Thresholds, Poverty, Race, and Clinical Outcomes

BACKGROUND: Poverty and high viral load are associated with worse outcomes among COVID-19 patients. METHODS: We included patients admitted to Froedtert Health between March 16 and June 1, 2020. SARS-CoV-2 viral load was proxied by cycle-threshold values. To measure poverty, we used Medicaid or uninsured status and residence in socially disadvantaged areas. We assessed the association between viral load and length of stay and discharge disposition, while controlling for demographics and confounders. RESULTS: Higher viral load was associated with longer length of stay (coefficient -0.02;95% CI, -0.04 to 0.01;P = 0.006) and higher likelihood of death (coefficient -0.11;95% CI, -0.17 to -0.06;P < 0.001). Poverty, residence in disadvantaged areas, and race were not. DISCUSSION: This study confirms a relationship of viral load with in-hospital death, even after controlling for race and poverty.

Prevalence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Asymptomatic Infections in 2 Large Academic Health Systems in Wisconsin.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) asymptomatic infections may play a critical role in disease transmission. We aim to determine the prevalence of asymptomatic SARS-CoV-2 infection at 2 hospital systems in 2 counties in Wisconsin. The SARS-CoV-2 prevalence was 1% or lower at both systems despite the higher incidence of coronavirus disease 2019 (COVID-19) in Milwaukee County.

Elastomeric Respirators for COVID-19 and the Next Respiratory Virus Pandemic: Essential Design Elements.

Respiratory viruses are transmitted via respiratory particles that are emitted when people breath, speak, cough, or sneeze. These particles span the size spectrum from visible droplets to airborne particles of hundreds of nanometers. Barrier face coverings ("cloth masks") and surgical masks are loose-fitting and provide limited protection from airborne particles since air passes around the edges of the mask as well as through the filtering material. Respirators, which fit tightly to the face, provide more effective respiratory protection. Although healthcare workers have relied primarily on disposable filtering facepiece respirators (such as N95) during the COVID-19 pandemic, reusable elastomeric respirators have significant potential advantages for the COVID-19 and future respiratory virus pandemics. However, currently available elastomeric respirators were not designed primarily for healthcare or pandemic use and require further development to improve their suitability for this application. The authors believe that the development, implementation, and stockpiling of improved elastomeric respirators should be an international public health priority.

Chaotic breathing in post COVID-19 breathlessness: a key feature characterised by approximate entropy

P142 Table 1Baseline characteristics and exercise measurements Post COVID-19 BPD (N = 20) Non-COVID BPD (N = 20) Healthy controls (N = 15) BASELINE CHARACTERISTICS Age/years 41 (10) 49 (14) 50 (18) Gender M:F 6:14 6:14 9:6 BMI (kg/m2) 25 (4) 26 (5) 25 (4) Nijmegen score (/64) 23 (12–44) 23 (14–41) - FEV1 (% pred) 111 (13) 107 (16) 96 (6) FVC (% pred) 118 (14) 114 (16) 107 (12) FEV1/FVC Ratio 80 (6) 78 (6) 75 (12) Resting SpO2 (%) 98 (95–100) 99 (94–100) 97 (96–99) Resting HCO3 − (earlobe) (mmol/L) 24 (5) 22 (3) 24 (2) Resting PaCO2 (kPa) 4.4 (0.8) 4.3 (0.7) 4.7 (0.5) Resting BORG CR-10 dyspnoea (/10) 0.7 (0.8) 1.4 (1.3) 0.2 (0.6) PEAK exercise CPET Variables Duration of test (minutes) 10 (4) 9 (2) 15 (3) Main reason cited for exercise cessation Legs = 6 Legs = 8 Legs = 6 Breathing = 14 Breathing = 12 Breathing = 4 BORG CR-10 dyspnoea (/10) End=5.3 (2.3) End=4.2 (1.5) End=4.1 (1.7) Peak VO2 (L/min) 2.18 (0.87) 1.52 (0.62) 2.77 (1.22) Peak VO2 (% predicted) 106.5 (33.1) 79.8 (17.5) 124.8 (27.3) Peak VO2 (mL/min/kg) 29.6 (7.6) 20.7 (7.1) 37.8 (14.8) Peak Heart Rate (beats/min) 170 (12.6) 141 (26) 167 (15) Heart Rate Reserve (beats/min) 20 (19) 30 (20) 2 (13) Peak VE (L/min) 89 (26) 60 (27) 96 (35) Peak Tidal Volume (L) 2.6 (1.3) 1.86 (0.88) 2.37 (0.71) Peak Breathing Frequency (/min) 43 (23) 31 (9) 33 (8) Peak SpO2 (%) 97 (93–100) 99 (94–100) 95 (73–98) PEAK exercise gas exchange values PaO2 (kPa) 13.3 (3.2) 13.8 (1.2) 13.7 (1.2) PaCO2 (kPa) 4.4 (1.1) 4.2 (0.7) 4.1 (0.7) PETCO2 (kPa) 4.4 (0.6) 4.3 (0.5) 4.8 (0.8) P(A-a)O2 difference (kPa) 2.8 (1.2) 2.1 (0.9) 2.6 (0.9) P(a-ET)CO2 difference (kPa) - 0.10 (0.25) −0.09 (0.37) −0.35 (0.53) Approximate entropy (ApEn) of ventilatory variables during incremental exercise ApEn Tidal Volume 1.61 (0.05) 1.28 (0.23) 1.02 (0.29) ApEn Breathing Frequency 1.40 (0.10) 1.41 (0.20) 1.32 (0.21) ApEn Minute Ventilation 1.22 (0.11) 0.97 (0.30) 0.65 (0.23) Data shown as mean (SD) or median (range);M:F: Male:Female;BMI: body mass index;FEV1: forced expiratory volume in the first second;FVC: forced vital capacity;SpO2;oxygen saturation;CPET: cardiopulmonary exercise test;VO2: oxygen consumption;VE:ConclusionsPost COVID BPD can be characterised by application of non-linear statistical modelling of exercise ventilatory data. This approach now needs further validation to facilitate application in automated CPET equipment, to identify and highlight this important differential diagnosis.

Introduction

Digitalization has accelerated as a result of the pandemic, transforming our ways of working and communicating, socially distancing us as we struggle to maintain collaborative endeavors. Decreasing trust in the media has multiple causes. In some parts of the world, journalism and journalists have been under fire for controversial and morally questionable newsgathering practices involving unjustified deception and intrusion. From the early 20th century, journalists began grappling with how to balance commitments to truth-telling, minimizing harm, and professional autonomy. Scholars have already begun to explore the impact of the coronavirus crisis on citizens, societies, journalism, and ethical practice. Journalism ethics needs a combination of realism - to understand the landscape and forge ahead within it - and idealism - to give encouragement for continued work toward delivering on journalism's promise as an essential contributor to humankind's development. Working with our authors has been a great privilege and honor in these precarious and uncertain times. © 2022 selection and editorial matter, Lada Trifonova Price, Karen Sanders, and Wendy N. Wyatt. All rights reserved.

The effectiveness of hand hygiene interventions for preventing transmission or acquisition of viral infections in the community: Findings from a systematic review

Introduction: The World Health Organization recommends improving hand hygiene (HH) practices of the general public as one aspect of controlling the transmission of novel coronaviruses and influenza virus epidemics or pandemics. Objectives: To systematically review the evidence on the effectiveness of HH interventions for preventing transmission or acquisition of viral infections in the community. Methods: PubMed, MEDLINE, CINAHL and Web of Science databases were searched for empirical studies published between 2002-May 2020, on HH in the general public and acquisition or transmission of novel coronavirus infections or influenza. Study selection, data extraction and quality assessment were conducted by one reviewer, with all decisions checked by another. We conducted a sub-set analysis of intervention studies included in this review, by calculating the effect estimates. Results: The review identified four intervention studies, all of which used cluster randomised designs evaluating the effectiveness of HH education paired with provision of HH products or hand washing with soap and water (HW) against influenza transmission or acquisition amongst the populations of schoolchildren (n = 2) or the general public (n = 2). Three indicated a protective effect of HH interventions (Figure);yet, this effect was significant for only one school-based intervention, which consisted of the provision of HH education and performing HW twice a day (OR: 0.64;95% CI 0.51, 0.80). However, the risk of bias of this study was assessed as unclear;whereas the remaining three studies were assessed as high risk. Conclusion: There is some limited evidence demonstrating that hand hygiene interventions were effective in preventing influenza in school children. Thus, whilst provision of HH education to school children will be beneficial from a public health perspective, it's impact on influenza transmission is unclear. Research is needed to evaluate the effectiveness of HH interventions for prevention of respiratory infections, including SARS-CoV-2, amongst more diverse groups of the general public populations.

SARS-CoV-2 and Wisconsin Nursing Homes: Temporal Dynamics During the COVID-19 Pandemic.

OBJECTIVES: Evidence suggests that quality, location, and staffing levels may be associated with COVID-19 incidence in nursing homes. However, it is unknown if these relationships remain constant over time. We describe incidence rates of COVID-19 across Wisconsin nursing homes while examining factors associated with their trajectory during 5 months of the pandemic. DESIGN: Retrospective cohort study. SETTING/PARTICIPANTS: Wisconsin nursing homes. METHODS: Publicly available data from June 1, 2020, to October 31, 2020, were obtained. These included facility size, staffing, 5-star Medicare rating score, and components. Nursing home characteristics were compared using Pearson chi-square and Kruskal-Wallis tests. Multiple linear regressions were used to evaluate the effect of rurality on COVID-19. RESULTS: There were a total of 2459 COVID-19 cases across 246 Wisconsin nursing homes. Number of beds (P < .001), average count of residents per day (P < .001), and governmental ownership (P = .014) were associated with a higher number of COVID-19 cases. Temporal analysis showed that the highest incidence rates of COVID-19 were observed in October 2020 (30.33 cases per 10,000 nursing home occupied-bed days, respectively). Urban nursing homes experienced higher incidence rates until September 2020; then incidence rates among rural nursing homes surged. In the first half of the study period, nursing homes with lower-quality scores (1-3 stars) had higher COVID-19 incidence rates. However, since August 2020, incidence was highest among nursing homes with higher-quality scores (4 or 5 stars). Multivariate analysis indicated that over time rural location was associated with increased incidence of COVID-19 (ß = 0.05, P = .03). CONCLUSIONS AND IMPLICATIONS: Higher COVID-19 incidence rates were first observed in large, urban nursing homes with low-quality rating. By October 2020, the disease had spread to rural and smaller nursing homes and those with higher-quality ratings, suggesting that community transmission of SARS-CoV-2 may have propelled its spread.