ABSTRACT
Introduction: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) exhibits 25-30% mortality in hospitalized patients with heart failure (HF). Cardiovascular disease is the most significant comorbidity associated with increased mortality in COVID-19 patients with data suggesting local and systemic inflammation play a critical role in cardiac functional abnormalities. SARS-CoV-2 vaccination reportedly reduces severity of infection. We sought to characterize if vaccination had any protective effect on patients with HF hospitalized for acute COVID-19. Hypothesis: Baseline cardiac biomarkers including CRP, ferritin, high sensitivity cardiac troponin I (hs-cTnI), and pro-brain natriuretic peptide (pBNP) may be lower in vaccinated COVID-19 HF patients revealing the impact of vaccination on reducing inflammation by SARS-CoV-2 infection. Method(s): Electronic health records underwent IRB exempted extraction of demographics, anthropometrics, vital signs, laboratory tests, and ICD-10-CM-based Elixhauser comorbidity categories. Continuous data summarized with median [IQR] were compared using Kruskal-Wallis test and discrete data with chi-squared test. Result(s): Among HF patients with a recorded vaccine status admitted between July 3, 2021 and March 17, 2022, 206 underwent acute COVID-19 hospitalization. Vaccinated (n=91, 44%) and unvaccinated (115, 56%) patients exhibited statistically similar distribution of males (56%), aged 78[69-86] years with comorbidities 5[4-7] distributed across Whites (88%), Blacks (8%), and other races (4%). There were no intergroup differences with most prevalent comorbidities at admission including hypertension (99%), diabetes (41%), chronic pulmonary disease (37%), obesity (36%), deficiency anemia (31%), and renal failure (25%). There were no intergroup differences in initiation of COVID-19 directed treatments. Baseline biomarkers in vaccinated versus unvaccinated were CRP 6.0[1.3-9.5] vs. 6.9[2.7-11.3] mg/dL (p=.25), ferritin 171[76-552] vs. 432[79-876] ng/mL (p=.13), LDH 245[192-317] vs. 338[260-439] U/L (p=.003), D-dimer 0.89[0.53-1.73] vs. 1.36[0.95-2.80] mg/L FEU (p=.06), hs-cTnI 27[14-67] vs. 28[16-81] ng/L (p=.39), and pro-BNP 3487[1516-7162] vs. 3278[1549 vs. 9001] pg/mL (p=.90). Clinical visit criteria respectively were hospital LOS 4.9[2.9-10.3] vs. 5.4[3.4-10.3] days (p=.27), ICU admission 10% vs. 17% (p=.15), and discharge disposition expired or Hospice 15% vs. 16% (p=.48). Rehospitalization occurred similarly between groups and was not significant. Conclusion(s): Acute and chronic inflammation are pathogenic drivers of HF. Inflammatory biomarkers lower among vaccinated patients with HF included CRP, ferritin, D-dimer, and hs-cTnI, although not significant. LDH, however, was significantly lower suggesting improved host widespread tissue perfusion as one mechanism of reduced severity in patients with HF undergoing SARS-CoV-2 vaccine breakthrough infection. One study caveat is that despite inclusion of all patients, these preliminary findings are likely not sufficiently powered to validate our hypothesis.Copyright © 2022
ABSTRACT
Background: The impact of SARS-CoV-2 infection on intrinsic myocardial conduction continues to be an area of focus amongst the medical community. Our objective was to investigate if specific myocardial conduction abnormalities were independently associated with mortality in patients hospitalized with COVID 19. Method(s): Under IRB exemption, the electronic medical records of COVID-19 patients (N=3840) undergoing index hospitalization were reviewed to extract presentation ECG conduction data, demographics, and laboratory results (within 8h). This patient cohort was then separated into two groups based on mortality vs. no mortality (N=520). Logistical regression was used to test association of ECG conduction intervals with mortality. A subgroup analysis of 651 patients who underwent at least 1 ECG in the 12 months prior to their COVID hospitalization were analyzed to detect statistically significant differences in conduction intervals pre and post SARS-CoV-2 infection. Result(s): According to our nominal logistic fit for hospital mortality, Heart Rate (HR) >100 (p=0.0007;LW 4.14), QRS duration > 120 ms (p=0.0053;LW 2.27), and QTc prolongation (defined as QTc > 450ms in males;QTc > 460ms in females) (p=0.0089;LW 2.04) were independently associated with higher risk of mortality. LogWorth (LW) calculations were included in an effort to estimate the proportional effect each variable has on overall mortality. LW > 2 were shown to be statistically significant with p< 0.05 with HR > 100 (LW 4.14) having the highest proportional effect on mortality followed by QRSd (LW 2.27) then QTc prolongation (LW 2.04). PR interval> 200ms (p=0.30) and QRS axis (p=0.15) were not associated with higher risk of mortality. Our subgroup analysis of the 651 patients mentioned above yielded no statistically significant differences in conduction intervals pre & post SARS-CoV-2 infection. Conclusion(s): : Amongst our patient cohort, HR > 100, QRSd > 120ms, and QTc prolongation (QTc > 450 in males;QTc > 460 in females) were each independently associated with higher risk of mortality in patients hospitalized with COVID 19. Subgroup analysis of 651 patients showed no statistically significant differences in conduction intervals pre and post SARS-CoV-2 infection. These findings support the use of objective ECG data in risk stratifying patients hospitalized with COVID 19.Copyright © 2022
ABSTRACT
Objective: The aim of this study was to use bibliometric analysis to provide an overview of the empirical and theoretical research that has been carried out with regard to COVID-19 focusing on scientific publications on the topic of farmers. Design/methodology/approach: The global literature on COVID-19 and agricultural producers (farmers) published between 2019 and 2022 (August 8), was obtained from the SCOPUS database, comprising a total of 665 documents. VOSviewer was used to perform a bibliometric analysis of these papers. Results: The two countries that published the most research related to the terms studied were the United States and India. Research conducted in these countries was found in the most cited studies. The studies focused on five major topics: agriculture, epidemiology, psychology, economic impact, as well as rural areas and risk determination. The evolution of the topics over time showed that the research originally began with health-oriented studies, and that once the protocols for the return to normal were generated, studies were carried out to visibilize the producers and their challenges during the pandemic in addition to the support strategies that were generated and the impact that the pandemic had on them, as well as on the local, regional, national, and global economy. Limitations on study/implications: The documents analyzed are exclusive to the SCOPUS database, so literature was excluded from other sources such as Google Scholar or Web of Science, which could contain important information on the subject in relation to other disciplines. Findings/conclusions: This type of study makes it possible to better understand the current state of the art regarding the effect of COVID-19 on the agri-food sector, thus allowing researchers to visualize the relevance of, and guide, their research on the topic.
ABSTRACT
During the COVID-19 pandemic, applied behavior analysis services for many autistic individuals were transitioned to telehealth. The current study assessed caregiver-reported quality of life (QoL) and social validity for families of autistic children receiving only telehealth services (n = 96) or a combination of telehealth and in-person services (n = 173). Barriers to the telehealth experience were analyzed via an ANOVA, and the impact of funding source was analyzed using an independent samples t-test. Caregivers reported benefit across QoL and social validity items, with scores ranging from 3.31 to 4.44 (1 = least benefit, 5 = most benefit). While many caregivers reported no barriers regarding technology (44.61%), childcare (69.52%), and employment (64.68%), the presence of those barriers significantly impacted QoL and social validity scores. Funding source was not found to have a significant impact. Overall, caregivers found value in their child's telehealth services. Clinicians have an obligation to mitigate barriers to ensure the success of the intervention. © 2023 John Wiley & Sons Ltd.
ABSTRACT
This research seeks to analyze the experiences of psychosocial coping in the context of Obligatory Social Isolation, brough about by COVID-19, in heads of families of Metropolitan Lima, Peru. In order to do this, we developed a qualitative research with a phenomenological design;semi-structured interviews were carried out with 17 participants, heads of their families, from districts with high and low income. The results show that, on the one hand, participants experience styles focused on the problem, which encompass active coping, planning, restructuring their activities and routines, as well as displacement and change of priorities. On the other hand, we have the styles centered on emotions, such as acceptance and agency, search for emotional support, positive reinterpretation and the release of emotions. Likewise, there are differences in the ways in which people cope, both regarding their belonging to districts with higher or lower income, or in relation to whether they are men, women or non-binary people. We conclude that the coping experiences vary according to the different socioeconomic and gender characteristics of the participants, requiring an intersectional perspective in the analysis. © 2022 Universidad de Alicante. All rights reserved.
ABSTRACT
Objectives: Suicide is a global epidemic that claims up to 800,000 lives each year and is the second leading cause of death in young people aged 15-29 years. With the COVID-19 pandemic came increased rates of stress, helplessness, and suicide among adolescents. The increasing popularity of telemedicine opens new doors for identifying patients in distress, decreasing suicide rates, and increasing access to mental health services. Youth and adolescents grew up with electronics and will likely be open to the use of telemedicine in the future. However, it is unknown how prepared learners are for the unique challenges of these new modes of patient interaction. Method(s): We designed a telemedicine simulation for medical and physician assistant students to identify, assess, and appropriately escalate care for a standardized patient (SP) with suicidal ideation. We incorporated didactics on telepsychiatry, a motivational interviewing exercise, and a simulated telemedicine objective structured clinical exam (OSCE). Students completed a participant survey and were evaluated by SPs on their medical knowledge, interpersonal/communication skills, and 8 key telemedicine competencies. Result(s): Forty-four students completed the workshop, and 30 students completed the participant survey. Students were strongest in interpersonal/communication skills and weakest in telemedicine competencies. SPs evaluated telemedicine performance by deeming students "not yet entrustable," "approaching entrustment," or "entrustable" based on their ability to perform a described behavior or task unsupervised. Only 20% of students were entrustable to describe when patient safety was at risk, including when and how to escalate care. Fifty percent correctly interpreted the Patient Health Questionnaire, 59% completed the Columbia Suicide Risk Assessment, and 41% completed a suicide safety plan. Ninety-seven percent of students said that they expect to use telemedicine in their future practice. Conclusion(s): The telepsychiatry OSCE revealed gaps in students' telepsychiatry knowledge, particularly in telemedicine-specific competencies. Future studies are needed to assess the generalizability of our findings, including incorporating adolescent SPs to prepare students for the mental health needs of all ages given increasing rates of suicide in adolescent populations. TVM, S, AC Copyright © 2022
ABSTRACT
COVID-19 has affected education worldwide, in Mexico. In this study, the impact of the extraordinary online modality because of the pandemic on the accreditation of courses for engineering students was evaluated, of the 64 students officially registered in three courses of microbiology, only 90% registered on the Moodle platform to take the online course, 71% of the dynamics were delivered, 67% of the final project and 80% of the delivery of the team’s activities were not reached, there was an approval of 54%. Some problems were that videoconferences were not attended and assignments were not turned in. IEEE
ABSTRACT
Excess risk for mortality in hospitalized adults with COVID-19 has been linked to extant chronic conditions, especially obesity (Obes), diabetes (DM) or combination (ObesDM). We investigated dose-response interactions between Elixhauser Comorbidity Index (ECI) and comorbidity ensembles including Obes, DM, ObesDM or Control. Presentation demographics, putative COVID-19 severity markers, and administrative data including ICD-10 codes to measure ECI (AHRQ, v2022.1, 0-38 categories) were extracted under IRB exemption from electronic medical records. Youden's J statistic identified ECI35 prognostic of mortality. Bootstrap Forest (BF) estimated explained variance (EV%) in mortality provided by ECI and comorbidity ensembles including Obes, DM, or ObesDM. Continuous data summarized with median [IQR] were compared using Kruskal-Wallis ANOVA. Discrete data summarized as proportions were compared with chi-squared test. Confounders statistically balanced included age, sex, race, COVID-19 directed treatment and 4-surges of local pandemic. Significant p-value (.013) was Bonferroni corrected. Among 4,275 consecutive COVID-19 patients discharged between March 14, 2020 and September 30, 2021, there were 834 (Obes), 730 (DM), 610 (ObesDM) and 2,101 (Control). Intergroup results are reported using same sequence. Pooled age 69[56-79] years, among 45% females was distributed across Whites (78%), Blacks (10%) and other (12%) races. Additional chronic conditions exhibiting intergroup differences (p<.013) included pooled hypertension (47%, 65%, 58%, 55%), pooled kidney disease (10%, 38%, 25%, 17%), deficiency anemias (19%, 27%, 29%, 23%), chronic pulmonary disease (20%, 19%, 25%, 24%), pooled neurological disorders (14%, 22%, 23%, 23%), heart failure (12%, 21%, 26%, 14%), pooled thyroid disease (16%, 18%, 16%, 17%), coagulopathy (14%, 15%, 14%, 18%) and depression (17%, 16%, 17%, 19%). ECI was 3[2-5], 4[3-6], 5[4-7], vs 3[2-5] (p<.013). ECI accounted for 81% of EV in mortality versus comorbidity ensembles including Obes (11%), ObesDM (4%) or DM (4%). Obes, DM, ObesDM or Control patients with ECI35 vs not exhibited mortality of 25 vs 9% (p<.001), 13 vs 7% (p=.01), 22 vs 7% (p<.001) or 15 vs 6% (p=.01). Statistically equivalent inflammatory markers included CRP (8.2[4.2-13.5], 7.0[2.8-12.5], 9.6[4.8-15.2], 6.3[2.3-11.8] mg/dL, LDH (366[273-488], 322[246-429], 352[264-477], 295[222-392] U/L), ferritin (565[236-1150], 563[255-1166], 549[245-990], 435[200-931] ng/mL) and D-dimer (0.84 [0.53-1.67], 1.04[0.60-1.97], 0.89[0.50-1.78], 1.01[0.56-2.05] mg/mL. Metabolic markers exhibited intergroup differences (p<.013) including cholesterol 151[104-173], 137[104-164], 142[113-179], 143[113-178] mg/dL, triglycerides (161[109-258], 146[100-217], 179[122-252], 120[85-182] mg/dL) and serum glucose 113[101-128], 156[119-229], 158[119-229], 172[126-239] mg/dL. ICU admission was 24%, 19%, 31%, 16% with ObesDM and Obes p<.013 vs DM and control. In conclusion, we found dose of comorbidities in hospitalized COVID-19 patients was more strongly associated with mortality than confounder balanced Obes, DM, or ObesDM. Further investigation is warranted to characterize subgroups with varied response to increasing polymorbidity. Interpretation caveats include monocenter retrospective study with potential unmeasured confounders.Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
ABSTRACT
Introduction: To obtain control of the COVID-19 epidemic in Cuba, the decision was made by the highest management of the government and the Ministry of Public Health to carry out a health intervention with Abdala vaccine in Matanzas province, due to its high incidence and mortality. Objective: To estimate the impact and effectiveness of Abdala vaccine in the face of symptomatic disease of reported cases and death in hospitals in Matanzas province. Methods: A retrospective cohort study was conducted, with a cohort of vaccinated people consisting of 252,557 people who met the three-dose schedule, and another of unvaccinated or who had not complied with the complete vaccination schedule of 325,462 people. Age and personal pathological history were explored. As a source of information, the registry of confirmed cases and deaths issued by the Ministry of Public Health and the automated vaccination base Andariego Higia were used. It was calculated the effectiveness (VE=1-RR) and by confidence intervals and analyzed epidemiological indicators with the Bayesian structural time series method. Results: The effectiveness against symptomatic disease and death was 75.5 % and 95.7 %, respectively. In the analysis of the causal impact, values of reduction of 90.0% of the reported incidence and 86.0% of mortality were evidenced with respect to the expected figures. Conclusions: Abdala vaccine showed high effectiveness and impact in the prevention of symptomatic disease and death in real-world conditions. © 2022, Editorial Ciencias Medicas. All rights reserved.
ABSTRACT
Background: NASPGHAN guidelines for fellowship training in pediatric gastroenterology (GI) highlight the importance of multidisciplinary treatment across GI conditions. Specific required medical knowledge for pediatric GI fellows includes (1) understanding of the biopsychosocial model and brain-gut axis involvement in functional GI disorders (FGIDs) and (2) familiarity with the role of psychological evaluation and interventions within the multidisciplinary management of FGIDs. Pediatric psychologists are well-suited to provide this training as education of interdisciplinary professionals is a defining competency in pediatric psychology. While pediatric GI psychologists may be informally involved in the training of GI fellows through shared multidisciplinary patient care, we sought to develop a didactic series to formalize a GI Psychology curriculum consistent with clinical training guidelines and the expressed interests of fellows at our institution. Method(s): GI psychologists and GI chief fellows at Children's Hospital of Philadelphia (CHOP) developed an 8-lecture didactic series to be incorporated into an existing weekly didactic meeting for all GI fellows. GI psychologists presented a topic quarterly over the course of 2 training years (FY20-FY21). Topics for the inaugural 2-year series were: Introduction to GI Psychology, Giving the Positive Functional Diagnosis, Cognitive Behavioral Therapy for Functional Abdominal Pain Disorders, Behavioral Interventions for Constipation and Encopresis, Psychosocial Adjustment in Inflammatory Bowel Disease, Behavioral Treatment of Rumination Syndrome, Somatic Symptom Disorders, and Treatment Adherence. In summer 2020, GI psychologists also presented an unplanned didactic session related to coping with secondary traumatic stress during the COVID-19 pandemic. For the next iteration of the 2-year series (FY22-FY23), GI psychologists selected a new topic of Feeding and Eating Difficulties: Role of GI Psychology to replace Introduction to GI Psychology. Introduction to GI Psychology was moved to a fellow orientation session. Fellows participated in the first three years of the program which spanned the inaugural 2-year series and 1 year of a second series (n = 12, 11, 11). Attendance at specific didactic sessions was not recorded. At the end of each training year, fellows completed an anonymous program evaluation survey via REDCap for ongoing quality improvement. Fellows rated 5 items assessing the impact of the didactics on their knowledge of the biopsychosocial approach, delivery of clinical impressions and recommendations, confidence with description of psychological goals and strategies, and recommendations for continuation of the GI Psychology didactics. Items were scored on a 5-point Likert scale ranging from Strongly Agree to Strongly Disagree. During the inaugural 2-year series, the survey also included items rating the value of each didactic topic. Each year the survey allowed for open-ended suggestions for additional topics. Result(s): The GI Psychology didactic series for GI fellows has been implemented successfully at CHOP for an inaugural 2-year series (FY20-FY21) with a second series currently in progress (FY22-FY23). Although survey response rate was low (33% FY20;9% FY21;45% FY22), 100% of the fellows completing the survey Agree/Strongly Agree the didactic series increased their knowledge of the biopsychosocial approach to managing GI conditions, informed how they deliver clinical impressions and treatment recommendations for patients/families, recommended continued GI Psychology involvement in GI fellow didactics and recommended other institutions consider Psychology involvement in GI fellow didactic education. Additionally, 80% of the fellows Agree/Strongly Agree the didactic series increased their confidence to describe common goals and strategies within psychological treatment for patients with GI conditions. Conclusion(s): We describe development of a novel GI Psychology curriculum for GI fellows at CHOP focused on core topics to enhance competency in the biopsychosocial approach across GI conditions, which was favorably evaluated by GI fellows. Fellowship training programs in pediatric GI may wish to consider a similar approach to incorporating didactic training from pediatric psychologists. Doing so may increase relevant medical knowledge and facilitate experience with and use of a multidisciplinary approach to evaluation and management across GI conditions, consistent with NASPGHAN clinical training guidelines and calls for best practice to incorporate integrated psychological care across GI conditions.
ABSTRACT
The purpose of this work is to assess the impact that COVID-19 has had on the quality of the training process in the FCA of the UG. To achieve this, a small-scale study was carried out from a qualitative approach. The determination of the instruments and indicators was made based on those used in the reports "Global Survey of the International Association of Universities on the impact of COVID-19 on Higher Education in the world" and "Survey of the Higher Education Section of the Program for Twinning and Interconnection of Universities to COVID-19";those that were analyzed and appropriate, in a pertinent way, to the objectives of this study. In the same way, the instruments of these surveys were taken as references, which were also conveniently adequate in correspondence with the interests of this work, after socialization with experts from the University of Guayaquil. In general, the results confirm the commitment and responsibility of the FCA of the UG, towards its students and the will to give continuity to its substantive processes and the need for the educational institution to create the conditions to reduce the digital divide among its students.
ABSTRACT
Background: Latinx children have the highest childhood overweight and obesity rates out of any United States racial and ethnic group. The United States Preventative Task Force recommends pediatric obesity screening and referral to comprehensive, intensive behavioral interventions. However, there is a lack of data for obesity treatment programs for newly developing (emerging) Latinx communities that often have fewer social supports in place compared to more established Latinx communities. Qualitative evaluations of obesity treatment programs for Latinx youth are also limited. Methods: Forty Latinx children aged 5-12 years old who were overweight or obese were recruited into a community-based, family-oriented obesity treatment program in an emerging Latinx community. The program was based on the Active and Healthy Families (AHF) intervention initially implemented in California. Our program, which ran from September 2017 to September 2019, consisted of eight in-person group sessions over sixteen weeks led by a nutritionist, pediatrician, and promotora. All the parents who participated with their children in the intervention were invited to be interviewed. For those parents who consented, interviews were conducted from December 2020 to February 2021 to explore their experience during and post intervention as well as the impact of the COVID-19 pandemic on family behaviors. Transcripts were recorded, transcribed, and analyzed for thematic content. Transcripts were coded independently using Dedoose and subsequently reconciled with a second coder. The coding team reviewed the codes and selected the themes through group consensus. This project was approved by our institutional IRB (IRB00136080). Results: We interviewed 14 mothers. Four major themes emerged: 1) mothers' felt a sense of responsibility and desire to learn how to improve the health of their child, 2) families acquired new knowledge that they applied to change household habits, 3) parents felt solidarity with other parents in the program by sharing struggles and common experiences, and 4) the COVID-19 pandemic made it difficult to maintain dietary changes and active lifestyles. Further, parents were open to a virtual format for the intervention. Conclusion: The family intervention was well received and created a supportive environment for parents. Based on the knowledge they gained through the intervention, parents endorsed behavior change at both the child and parent level following the program. However, social distancing measures as part of the COVID-19 pandemic response often reversed many of these behavior changes. These findings support the use of community-based, family-oriented pediatric obesity treatment programs in emerging Latinx communities. Additional quantitative analysis of this project to review intervention effectiveness is underway. Booster sessions may be needed to support families and provide strategies when new stressors and barriers arise such as such as those that occurred during the COVID-19 pandemic. Future studies could also investigate the acceptability and effectiveness of a virtual format for the intervention. Associations of Childhood Obesity Google Trends Scores with the USA's 2011-2018 Annual Prevalence of Childhood Obesity & Pediatric Type 2 Diabetes Mellitus Red: Childhood Obesity Blue: Pediatric Type II Diabetes Mellitus.
ABSTRACT
Background: the COVID-19 pandemic has had a considerable impact in terms of infections, deaths, economic and social changes in the world. Objective: to characterize the suspected and confirmed cases of COVID19 in the MICONS Isolation Center in Cienfuegos. Methods: Observational, descriptive cross-sectional study that included the total number of suspected (836) and confirmed (193) cases reported with COVID-19 in the study period. Clinical and epidemiological records of the cases were reviewed. The variables analyzed were age, sex, municipality of origin, occupation, source of infection, comorbidity, symptoms presented, positive and negative rapid tests, positive and negative PCR, type of case and statistical week. Results: the age group between 45 and 59 years old prevailed with 33.8%;48.4% of patients admitted to the center were hypertensive;23.4% of the total cases were positive for the SARS-CoV-2 virus;the predominant symptoms were fever with 39.2%;cough with 37.7% and headache with 30.1%. Conclusions: the work responds to a scientifically based vision of the characteristics of the COVID-19 pandemic in the province in terms of the form of control, where it is necessary to continue carrying out new studies to evaluate the impact of this disease in public health.
ABSTRACT
Purpose/Background: Quality improvement (QI) and enhanced recovery after surgery (ERAS) protocols are effective in reducing length of stay and complications after colorectal surgery. The COVID-19 pandemic's strain on hospital personnel and resources called into question the feasibility of implementation of QI studies. Hypothesis/Aim: We aimed to successfully implement of a novel, structured postoperative ambulation protocol in colorectal surgery patients and determine its effect on patient outcomes in a time of strained personnel. Methods/Interventions: This prospective non-randomized study included all patient who underwent elective inpatient abdominal colorectal procedures at a single quaternary care center. All patients were already undergoing a standard ERAS protocol at baseline. A structured, aggressive postoperative ambulation protocol was developed. An erasable poster (Figure) was placed in patient rooms which allowed the nursing staff and patient to track progress towards specific ambulation goals. The protocol measured specific metrics such as out-of-bed to chair and the number and extent of daily ambulation relative to postoperative day. The protocol was initiated on post-operative day 0, and increased in duration and distance daily. Nursing staff was educated on the protocol prior to initiation and a standard process was created to outline the documentation requirements. The primary outcome measured was hospital length of stay. Secondary outcomes were return of bowel function, 30-day postoperative DVT/PE rate, and 30-day readmission rate. A change in these outcomes metrics over time compared to historical controls was noted. Results/Outcome(s): The protocol was implemented in February 2020, with improvements in outcomes beginning in July 2020 following extensive re-education for nursing staff. Adherence to the post-operative ambulation regimen increased from 36% at baseline to 75%. This was associated with an improvement in postoperative return of bowel function (2.13 days vs 1.44 days), post-operative length of stay (6.36 days vs 3.33 days), postop VTE/PE rates (1.64% vs 0%) and readmission rate (6.56% vs 0%) over a period of 12 months. Limitations: The outcomes of this study may have been influenced by other uncontrolled measures during the COVID crisis but most if not all led to decreased personnel and resources making success of such a project difficult. A standard ERAS protocol was in place with good compliance (>95%) for over 2 years prior to the initiation of this study. Conclusions/Discussion: A novel, structured, aggressive early postoperative ambulation protocol is feasible during times of strained personnel resources such as the COVID-19 pandemic, and leads to improvement in postoperative outcomes such as postoperative length of hospital stay, return of bowel function, VTE/PE rates, and postoperative ambulation without an increase in the readmission rate.
ABSTRACT
This report presents the results of a descriptive case study associated with tweets published under the hashtags #vaccunacoronavirus and #coronavirusvaccine. A fundamental contribution of the research is the proposal of a methodology of discourse analysis assisted by data mining in a scenario associated with multi-supported messages. The present paper with a mixed approach was applied on a sample of 1 million tweets randomly extracted by Stela and Brand24 applications. We show the necessary methodological interrelation of the use of software and quantitative tools, as well as the qualitative perspective to determine the interpretation of the symbolic representation that was issued on anti-covid 19 vaccination. The results present the framing, polarity, and perceptions adopted by users regarding internationally marketed vaccines.
ABSTRACT
Background: The two FDA approved mRNA-based SARS-CoV2 vaccines have shown >90% efficacy at preventing COVID and eliciting protective immunity in nearly all healthy individuals. However, the extent of vaccine induced antibody and T cell immunity in immunocompromised patients is not well known. Our study objective is to determine if patients with hematologic malignancies treated with B-cell targeting chimeric antigen receptor (CAR) T cell therapies can mount antibody and T cell immune responses to SARS-CoV2 vaccines. A prospective single-center study to evaluate the SARS-CoV2 immune responses in immunocompromised individuals (COVAX Study) was initiated at University of Pennsylvania following the IRB guidelines. The study enrolled 8 healthy adults,12 patients are in remission after treatment (average of 40.6 months) with CART cells targeting either CD19 or CD19+CD22 and received both doses of SARS-CoV2 vaccine. Methods and Results: Serology to SARS-CoV2 spike-receptor binding domain (RBD) IgG, RBD-IgA, RBD-IgM and spike-specific T cell responses were measured prior to vaccination and serially up to 28 days after booster vaccination. RBD-IgG and RBD-IgA were detected in 8/8 and 7/8 healthy subjects compared to 5/12 and 2/12 CART patients, respectively (Figure A). In the CART cohort, several patients who demonstrated an induction of RBD-IgG (57.2/uL +/- 20.2) compared to those who were RBD-IgG-negative (9/uL +/- 10.1, ANOVA with multiple comparisons test p=0.017) have higher level of circulating B cells. No association was found with time since CART infusion, age, disease type, or vaccine manufacturer. All 8 healthy subjects demonstrated induction of SARS-Cov2 spike-specific CD4 + T cell immunity compared to 7 out of 11 CART patients (Figure B). RBD-IgG responses were not correlated with CD4 + T cell activation (Pearson correlation, R=0.21, p=0.53). Indeed, 3 CART patients demonstrated robust CD4 + T cell activation despite absence of antibody induction. Overall, 8/12 CART patients demonstrated induction of either or both humoral and T cell immune responses. Conclusions: We show that immune responses to SARS-CoV2 mRNA vaccines are induced in majority of patients who have been treated with CART therapies targeting B-cell lineage antigens. Induction of vaccine-specific antibody was strongly associated with the level of circulating B cells. However, in CART cohort patients despite severe humoral immune deficiency, strong CD4 + T cell responses were observed suggestive of a sufficient protective immunity. [Formula presented] Disclosures: Frey: Novartis: Research Funding;Sana Biotechnology: Consultancy;Kite Pharma: Consultancy;Syndax Pharmaceuticals: Consultancy. Garfall: Amgen: Honoraria;CRISPR Therapeutics: Research Funding;GlaxoSmithKline: Honoraria;Janssen: Honoraria, Research Funding;Novartis: Research Funding;Tmunity: Research Funding. Porter: American Society for Transplantation and Cellular Therapy: Honoraria;Genentech: Current equity holder in publicly-traded company, Ended employment in the past 24 months;ASH: Membership on an entity's Board of Directors or advisory committees;DeCart: Membership on an entity's Board of Directors or advisory committees;Incyte: Membership on an entity's Board of Directors or advisory committees;Janssen: Membership on an entity's Board of Directors or advisory committees;Kite/Gilead: Membership on an entity's Board of Directors or advisory committees;National Marrow Donor Program: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees, Patents & Royalties, Research Funding;Tmunity: Patents & Royalties;Wiley and Sons Publishing: Honoraria. June: AC Immune, DeCART, BluesphereBio, Carisma, Cellares, Celldex, Cabaletta, Poseida, Verismo, Ziopharm: Consultancy;Tmunity, DeCART, BluesphereBio, Carisma, Cellares, Celldex, Cabaletta, Poseida, Verismo, Ziopharm: Current equity holder in publicly-traded company;Novartis: Patents & Royalties.