Predictors of outcomes in patients hospitalised with COVID-19 pneumonitis

Introduction/Aim: Medium and long-term impacts of COVID-19 pneumonitis are being increasingly recognised. Our study aimed to evaluate outcomes of hospitalised COVID-19 patients with moderate-to-severe respiratory compromise. Method(s): Patients admitted to a tertiary centre with COVID-19 pneumonitis (March 2020-October 2022) were followed in the Post-COVID Respiratory Clinic at 6-24 weeks. Baseline demographics, admission details, pulmonary function tests (PFTs), and clinic data were collected. Univariable and multivariable logistic regression were performed to investigate for predictors of persisting respiratory symptoms (dyspnoea, cough, chest pain) and functional limitation (self-reported). Result(s): 125 patients (64.8%male, 63.2+/-16.7years, 42.5% former/current smokers, BMI 31.0+/-8.0kg/m2, 49.6% fully vaccinated) with median follow-up time of 85 [interquartile range (IQR) 64-131] days were included. Pre-existing conditions included lung disease (29.6%), immunocompromise (15.2%), diabetes (24.8%) and hypertension (43.6%). 35.2% required ICU care (14.4% mechanical ventilated, 4% ECMO), 44.8% received high flow nasal prong oxygen and/or continuous positive airway pressure (CPAP). At initial clinic follow up, 65.4% had persisting X-ray changes. Mean predicted FEV1, FVC, DLCO were 86.8+/-20.7%, 85.3+/-20.3%, 82.2+/-19.8% respectively. Symptoms included dyspnoea (63.2%), fatigue (24.2%), cognitive dysfunction (12.9%) and musculoskeletal complaints (10.5%). Univariate predictors of continued respiratory and/or functional disability included age [odds ratio (OR) 1.03, 95%confidence interval (CI) 1.01-1.06, p = 0.01), prior lung disease (OR2.98, 95%CI 1.05-8.48, p = 0.04), hypertension OR2.61, 95%CI 1.09-6.22, p = 0.03) and length of hospital stay (LOHS) (OR1.03, 95%CI 1.00-1.07, p = 0.04). On multivariable analysis, only LOHS was independently predictive of continued respiratory and functional limitations (OR1.03, 95%CI 1.00-1.07, p = 0.02). Conclusion(s): Patients recovering from COVID-19 pneumonitis have a large burden of disability at follow-up. Older age, hypertension, lung disease and LOHS are risk factors for delayed recovery.

The River and The Highway: How an Interceptor Failure Produced Solutions

The objective of emergency repairs for TRA is to put critical infrastructure that has failed back in to service immediately to prevent or reduce environmental impacts and to restore wastewater collection and transmission service for our customers. After significant rainfall event in March 2020, the Collection Systems Group for the Trinity River Authority of Texas inspected the external conditions of all of the major interceptor lines in the Central Regional Wastewater System for possible line breaks. On March 26, CSG staff identified a major pipeline failure on the 102-inch pipeline for the West Fork interceptor. The pipeline failed in a section immediately adjacent to the West Fork of the Trinity River while the river was in flood stage from the latest significant rain event. The interceptor was passing over 150 MGD of wastewater meant for the CRWS treatment facility, but a portion of the wastewater flow was escaping from the collapsed pipeline in to the river. Once CSG notified the Construction Services group, of the on-call construction contractor, Flow Line Construction, was contacted and immediately mobilized to stop wastewater leakage and to begin pipeline repairs on the collapsed portion of the pipeline. The solution for the emergency repair was multi-faceted: 1)Construction a massive sandbag wall between the failed pipe and the Trinity River to stop wastewater leaking in to the river and to keep the river from washing out the pipeline work are;2) Build a working surface for excavators to access the pipeline site and to setup of bypass pumps;3) Remove the failed section of pipe from the flow path of the wastewater;4) Install bypass piping and pumping equipment and divert flow from the failed pipeline section;5) Install new segments of pipe to restore the pipeline to serviceable conditions;6) Restore bypass flow back to the interceptor and remove bypass pumps and piping;and 7) Perform all of the work listed above while adhering to rapidly changing conditions due to COVID-19 pandemic without having losing one member of the work force to COVID-19. The Roles and Responsibilities of the project team were: 1) Inspection Supervisor – The owner representative that provides direction to the contractor and coordinates construction plans with in-house engineers;2) Engineer – Provided flow ranges for bypass pumping design, collaborated with the contractor to size and layout the bypass pumps, and oversaw the re-installation of the collapsed pipeline;3) Contractor – The contractor staff includes a professional engineer who collaborated with TRA staff to rapidly develop and implement a plan for demolition and reconstruction. In conclusion, while the work took place in a difficult to access area during a period of greater than normal rain and a pandemic, the pipeline was put back in to service in less than 3 weeks. This was through communication, cooperation, and coordination from the contractor, engineers, and inspection staff. Additionally, the river bank was stabilized and armored to prevent future erosion of the pipeline alignment. Copyright © 2021 Water Environment Federation

The Clinical Information Systems Response to the COVID-19 Pandemic.

OBJECTIVE: The year 2020 was predominated by the coronavirus disease 2019 (COVID-19) pandemic. The objective of this article is to review the areas in which clinical information systems (CIS) can be and have been utilized to support and enhance the response of healthcare systems to pandemics, focusing on COVID-19. METHODS: PubMed/MEDLINE, Google Scholar, the tables of contents of major informatics journals, and the bibliographies of articles were searched for studies pertaining to CIS, pandemics, and COVID-19 through October 2020. The most informative and detailed studies were highlighted, while many others were referenced. RESULTS: CIS were heavily relied upon by health systems and governmental agencies worldwide in response to COVID-19. Technology-based screening tools were developed to assist rapid case identification and appropriate triaging. Clinical care was supported by utilizing the electronic health record (EHR) to onboard frontline providers to new protocols, offer clinical decision support, and improve systems for diagnostic testing. Telehealth became the most rapidly adopted medical trend in recent history and an essential strategy for allowing safe and effective access to medical care. Artificial intelligence and machine learning algorithms were developed to enhance screening, diagnostic imaging, and predictive analytics - though evidence of improved outcomes remains limited. Geographic information systems and big data enabled real-time dashboards vital for epidemic monitoring, hospital preparedness strategies, and health policy decision making. Digital contact tracing systems were implemented to assist a labor-intensive task with the aim of curbing transmission. Large scale data sharing, effective health information exchange, and interoperability of EHRs remain challenges for the informatics community with immense clinical and academic potential. CIS must be used in combination with engaged stakeholders and operational change management in order to meaningfully improve patient outcomes. CONCLUSION: Managing a pandemic requires widespread, timely, and effective distribution of reliable information. In the past year, CIS and informaticists made prominent and influential contributions in the global response to the COVID-19 pandemic.

Telehealth in the COVID-19 Era: A Balancing Act to Avoid Harm.

The telehealth revolution in response to COVID-19 has increased essential health care access during an unprecedented public health crisis. However, virtual patient care can also limit the patient-provider relationship, quality of examination, efficiency of health care delivery, and overall quality of care. As we witness the most rapidly adopted medical trend in modern history, clinicians are beginning to comprehend the many possibilities of telehealth, but its limitations also need to be understood. As outcomes are studied and federal regulations reconsidered, it is important to be precise in the virtual patient encounter approach. Herein, we offer some simple guidelines that could assist health care providers and clinic schedulers in determining the appropriateness of a telehealth visit by considering visit types, patient characteristics, and chief complaint or disease states.

Bringing student health and Well-Being onto a health system EHR: the benefits of integration in the COVID-19 era.

ObjectiveTo detail the implementation, benefits and challenges of onboarding campus-based health services onto a health system's electronic health record.ParticipantsUC San Diego Student Health and Well-Being offers medical services to over 39,000 students. UC San Diego Health is an academic medical center.Methods20 workstreams and 9 electronic modules, systems, or interfaces were converted to new electronic systems.Results36,023 student-patient medical records were created. EHR-integration increased security while creating visibility to 19,700 shared patient visits and records from 236 health systems across the country over 6 months. Benefits for the COVID-19 response included access to screening tools, decision support, telehealth, patient alerting system, reporting and analytics, COVID-19 dashboard, and increased testing capabilities.ConclusionIntegration of an interoperable EHR between neighboring campus-based health services and an affiliated academic medical center can streamline case management, improve quality and safety, and increase access to valuable health resources in times of need. Pertinent examples during the COVID-19 pandemic included uninterrupted and safe provision of clinical services through access to existing telehealth platforms and increased testing capacity.

Rapid response to COVID-19: health informatics support for outbreak management in an academic health system.

OBJECTIVE: To describe the implementation of technological support important for optimizing clinical management of the COVID-19 pandemic. MATERIALS AND METHODS: Our health system has confirmed prior and current cases of COVID-19. An Incident Command Center was established early in the crisis and helped identify electronic health record (EHR)-based tools to support clinical care. RESULTS: We outline the design and implementation of EHR-based rapid screening processes, laboratory testing, clinical decision support, reporting tools, and patient-facing technology related to COVID-19. DISCUSSION: The EHR is a useful tool to enable rapid deployment of standardized processes. UC San Diego Health built multiple COVID-19-specific tools to support outbreak management, including scripted triaging, electronic check-in, standard ordering and documentation, secure messaging, real-time data analytics, and telemedicine capabilities. Challenges included the need to frequently adjust build to meet rapidly evolving requirements, communication, and adoption, and to coordinate the needs of multiple stakeholders while maintaining high-quality, prepandemic medical care. CONCLUSION: The EHR is an essential tool in supporting the clinical needs of a health system managing the COVID-19 pandemic.