The use of social media and virtual opportunities by integrated vascular surgery residency programs during the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic has significantly affected the 2021 match application cycle as in person sub-internships and interviews have been halted. Given the abrupt change, we aimed to characterize the utilization of social media and virtual open house platforms by integrated vascular surgery residency programs for outreach and networking during the pandemic for the 2021 cycle. METHODS: A list of accredited integrated vascular surgery residency programs was compiled using the Electronic Residency Application Service (ERAS) website provided by the Academic Medical Colleges (AMC). The social media platforms Twitter, Instagram, and Facebook were queried for accounts associated with the training programs or their associated institutional vascular surgery divisions. Each discovered account was surveyed for date of creation as well as posts outlining virtual interactive events such as open houses, meet-and-greets, and virtual sub-internship opportunities. Slopes of the curves representing total account numbers and account numbers on each platform were compared from pre-COVID to current day using linear regression and t-statistics. RESULTS: There were 64 integrated vascular surgery residency programs participating in the 2021 match cycle. 70.3% (N = 45) of programs had a social media presence on at least one of the three platforms. 54.7% (N = 35) of programs had an associated Twitter account. 43.9% (N = 28) of programs had an associated Instagram account. Six (9.4%) programs were found on Facebook. The number of social media accounts significantly increased from March 2020 (37 vs 69, p < .001) to March 2021. CONCLUSIONS: Vascular surgery residency programs have significantly increased use of social media platforms over a 12-month period beginning in March 2020, indicating adaptation to the restrictions prompted by the pandemic.

Factors associated with having COVID-19 among unvaccinated pregnant and non-pregnant women in Metro Manila, Philippines: a multicentre longitudinal cohort study.

OBJECTIVE: To determine the potential risk factors associated with having COVID-19 among unvaccinated pregnant and non-pregnant women. DESIGN: A multicentre prospective cohort study among eligible women in Metro Manila, Philippines, from 2020 to 2022. SETTING: Five national and local hospital research sites altogether recruited and screened 500 consenting eligible individuals. PARTICIPANTS: Pregnant and non-pregnant participants meeting the eligibility criteria were admitted for a reverse-transcription PCR determination of SARS-CoV-2, pregnancy testing and ultrasound, and an interview with an administered questionnaire. EXPOSURES: Primary exposure was pregnancy; secondary exposures involve sociodemographic, lifestyle and obstetric-gynaecologic factors. OUTCOME MEASURE: Outcome being measured was COVID-19 status. RESULTS: The significant COVID-19 risk factors were: pregnancy (PR=1.184, 95% CI 1.096, 1.279), having a white-collar job (PR=1.123, 95% CI 1.02, 1.235), travelling abroad (PR=1.369, 95% CI 1.083, 1.173) and being infected by at least one vaccine-preventable disease (VPD) (PR=1.208, 95% CI 1.113, 1.310). Protective factors included having graduate-level education (PR=0.787, 95% CI 0.649, 0.954), immunisation against a VPD (PR=0.795, 95% CI 0.733, 0.862) and practising contraception (PR=0.889, 95% CI 0.824, 0.960). CONCLUSION: This study is the first in the country to determine the risks influencing COVID-19 infection among unvaccinated pregnant and non-pregnant women. Pregnancy is a significant risk for COVID-19 among women in Metro Manila. Educational attainment and positive health behaviours seem to confer protection. Occupations and activities that increase the frequency of interactions, as well as history of communicable diseases may predispose women to COVID-19. Further studies are needed to elucidate the development of the disease in pregnant women, including the maternal and neonatal effects of COVID-19 via potential vertical mechanisms of transmission.

Adaptive leadership practices: High school leadership in Maine during the COVID-19 crisis

This research focuses on leadership decisions by high school administrators in Maine in response to school closures and subsequent reopening plans due the Covid-19 pandemic. The purpose of this study was to learn the degree to which adaptive leadership was used as a leadership approach in response to a unique, complex and dynamic set of challenges, and to discover how the theories of constructive development influenced administrators' comfort with adaptive work. Adaptive leadership is identified as the focus for this study based on the unprecedented magnitude of adaptive challenges caused by the Covid-19 pandemic for school systems throughout the state of Maine. High schools were intentionally chosen as the environment for inquiry due to organizational dynamics this study identifies as a barrier to adaptive leadership (Bowles & Gintis, 1978). To understand how high school administrators led during the Covid-19 crisis, the researcher interviewed fourteen principals throughout Maine using a two-part interview protocol. The first part focused on the administrator's professional history and development as a school leader, while the second part was conducted to better understand how administrators implemented collaborative and adaptive leadership strategies from the months of March 2020 to the reopening of schools. Interviews were transcribed and coded for emerging themes related to adaptive leadership and cognitive development theory. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Cohort Profile: A longitudinal Victorian COVID-19 cohort (COVID PROFILE) (preprint)

Purpose: The COVID PROFILE cohort is a longitudinal clinical study based in Victoria Australia, which was established to understand immunity to SARS-CoV-2 in a low transmission population setting and to identify immunological markers of long-term immunity and immune-dysregulation after both infection and vaccination. Additionally, this cohort was established as a biobank resource for researchers to address other health-related immunological questions. Participants: We enrolled 178 adult community members, including household contacts, who had either recovered from a SARS-CoV-2 infection or were SARS-CoV-2 naive. Only participants 18 years of age or older and, in the case of female participants, non-pregnant women at the time of enrollment were included in the study. Detailed COVID-19 clinical data, vaccination status, medical history and demographics was collected. Findings to date: At enrollment, we found that 87.8% of COVID-19 recovered individuals were seropositive with detectable levels of anti-SARS-CoV-2 IgG antibodies. Seronegative COVID-19 recovered individuals included asymptomatic individuals or participants that were enrolled more than 12 months after their COVID-19 diagnosis. Except for one individual who was seropositive at baseline despite a previous SARS-CoV-2 PCR negative diagnosis, all household contacts and other community members enrolled as SARS-CoV-2 PCR negative, were seronegative for all SARS-CoV-2-specific antibodies tested. The infection rate (re-infection or new infection) during 24 months of the study was 42.7%, as determined by either rapid antigen tests, PCRs or serology screens. Of the SARS-CoV-2 recovered participants, 32.6% reported ongoing symptoms at enrollment of which 47% had already experienced ongoing symptoms for more than 12 weeks. Future Plans: COVID PROFILE will be used to comprehensively understand temporal immunity to SARS-CoV-2 and COVID-19 vaccines and to understand the impact of host immunological composition on such immunity and symptom severity. Additionally, studies focusing on understanding immunity following breakthrough infections and immunological risk factors that contribute towards development of long COVID are planned.

Impact of Infections in Patients Receiving Pembrolizumab-Based Therapies for Non-Small Cell Lung Cancer.

Background: Immune checkpoint inhibitor (ICI) therapy has significantly improved outcomes across a range of malignancies. While infections are a well-known contributor to morbidity and mortality amongst patients receiving systemic chemotherapy regimens, little is known about the impact of infections on patients receiving ICI therapy. This study aims to assess incidence, risk factors, and outcomes in patients who develop infections while on pembrolizumab-based therapies for non-small cell lung cancer (NSCLC). Methods: Patients receiving pembrolizumab for stage III/IV NSCLC from 1/1/2017-8/1/2021 across seven hospitals were identified. Incidence and type of infection were characterized. Covariates including baseline demographics, treatment information, treatment toxicities, and immunosuppressive use were collected and compared between infected and non-infected patients. Outcomes included the rate of infections, all-cause hospital admissions, median number of treatment cycles, overall survival (OS), and progression free survival (PFS). Univariable and multivariable analysis with reported odds ratio (OR) and 95% confidence intervals (CI) were utilized to evaluate infection risks. OS and PFS were analyzed by Kaplan−Meier analysis and tested by log-rank test. p-value < 0.05 was considered statistically significant. Results: There were 243 NSCLC patients that met the inclusion criteria. Of these, 111 (45.7%) had one documented infection, and 36 (14.8%) had two or more. Compared to non-infected patients, infected patients had significantly more all-cause Emergency Department (ED) [37 (33.3%) vs. 26 (19.7%), p = 0.016], hospital [87 (78.4%) vs. 53 (40.1%), p < 0.001], and ICU visits [26 (23.4%) vs. 5 (3.8%), p < 0.001], and had poorer median OS (11.53 [95% CI 6.4−16.7] vs. 21.03 [95% CI: 14.7−24.2] months, p = 0.033). On multivariable analysis, anti-infective therapy (OR 3.32, [95% CI: 1.26−8.76], p = 0.015) and ECOG of >1 (OR 5.79, [95% CI 1.72−19.47], p = 0.005) at ICI initiation conferred an increased risk for infections. At last evaluation, 74 (66.7%) infected and 70 (53.0%) non-infected patients died (p = 0.041). Conclusion: Infections occurred in nearly half of patients receiving pembrolizumab-based therapies for NSCLC. Infected patients had frequent hospitalizations, treatment delays, and poorer survival. ECOG status and anti-infective use at ICI initiation conferred a higher infection risk. Infection prevention and control strategies are needed to ameliorate the risk for infections in patients receiving ICIs.

The Choice between Plasma-Based Common Coagulation Tests and Cell-Based Viscoelastic Tests in Monitoring Hemostatic Competence: Not an either-or Proposition.

There has been a significant interest in the last decade in the use of viscoelastic tests (VETs) to determine the hemostatic competence of bleeding patients. Previously, common coagulation tests (CCTs) such as the prothrombin time (PT) and partial thromboplastin time (PTT) were used to assist in the guidance of blood component and hemostatic adjunctive therapy for these patients. However, the experience of decades of VET use in liver failure with transplantation, cardiac surgery, and trauma has now spread to obstetrical hemorrhage and congenital and acquired coagulopathies. Since CCTs measure only 5 to 10% of the lifespan of a clot, these assays have been found to be of limited use for acute surgical and medical conditions, whereby rapid results are required. However, there are medical indications for the PT/PTT that cannot be supplanted by VETs. Therefore, the choice of whether to use a CCT or a VET to guide blood component therapy or hemostatic adjunctive therapy may often require consideration of both methodologies. In this review, we provide examples of the relative indications for CCTs and VETs in monitoring hemostatic competence of bleeding patients.

Laparoscopic Cholecystectomy in the Time of Coronavirus: A Level-1 Trauma Center's Experience.

INTRODUCTION: Laparoscopic cholecystectomy (LC), one of the most common surgical procedures performed in the U.S., offers a window into the effects of the COVID-19 pandemic on routine surgical care. The purpose of our study was to analyze the effects of the COVID-19 pandemic at a Level-1 trauma center on the performance rate of non-elective LC over time. METHODS: A retrospective chart review from July 2019 to December 2020 identified all non-elective LC cases performed at a level-1 trauma center. Patients were categorized into 4 temporal phases along the course of the pandemic based on statewide incidence data on COVID-19: pre-pandemic, peak 1, recovery, and peak 2. We compared the phases based on demographic information and outcomes. RESULTS: In total, 176 patients were reviewed. The performance rate in cases/day varied as follows: pre-pandemic .61, 1st peak .34, recovery .44, and 2nd peak .53. The complication rate was highest in the 2nd peak (16%) (P < .05). Compared to the pre-pandemic period, the intra-pandemic period had a higher incidence of complicated gallbladder disease (P < .05). In the non-elderly subgroup, complicated gallbladder disease was significantly more prevalent in the intra-pandemic period compared to the pre-pandemic period (25% vs 10%, P < .05). CONCLUSIONS: Our data suggests a learning curve throughout the course of the pandemic, reflecting a stepwise increase in the performance rate of LC. The higher incidence of complicated gallbladder disease in the intra-pandemic period may imply patient hesitancy to seek routine surgical care, especially among younger patients.

THE EFFECTS OF THE COVID-19 PANDEMIC ON PRESENTATIONS AND DIAGNOSIS OF UPPER GI AND HEPATOPANCREATICOBILIARY MALIGNANCIES

Introduction: In March 2020, Coronavirus Disease 2019 (COVID-19) was declared a pandemic. Elective healthcare services were reorganised worldwide. This study addresses the impact of measures taken in the early stages of the pandemic on diagnosing Upper Gastrointestinal (UGI) and Hepatopancreaticobiliary (HPB) malignancies in a university teaching hospital. Aims: To ascertain whether fewer cases of UGI/HPB cancers were detected, the differences in inpatient and outpatient diagnosis and whether there was an increased detection of later stage disease during the pandemic than in the preceding year. Methods: This was a retrospective cohort study conducted in Tallaght University Hospital in Ireland. All new diagnoses of UGI/HPB cancers, excluding hepatocellular carcinomas, are managed at a weekly Multidisciplinary Team (MDT) meeting. Data was retrieved from the MDT database and medical records and analysed using IBM SPSS Statistics V20. Results: 111 cases were detected. There was no significant difference in the proportion of cases detected in the overall post-COVID period (n=53, 47.7%) compared to the Pre-COVID period (n=58, 52.3%) (p=0.7884). When COVID-19 cases were at their highest levels in Ireland, we observed a significant drop in new UGI/HPB cases detected compared to the pre-COVID period. This was mitigated in the third quarter of 2020, when transmission was depressed and a sharp increase in detection of UGI/HPB cases was observed. The variance of distribution of cases per quarter in the two periods was statistically significant with a P-value of 0.0001. There was a non-significant trend towards fewer diagnoses of early cancer (stage ≤2) in the Post- COVID period (21% v 26%) (p=0.6416). The proportion of patients diagnosed as an inpatient did not differ between the two periods, p=.739. Discussion: As fears about aerosolization abated, endoscopy services quickly increased the number of scopes performed after the initial reduction at the start of the pandemic. There are several limitations to this study, however it does lead us to conclude that our fears regarding cancer diagnosis in the postpandemic period did not materialise. It also offers solace that when transmission of COVID- 19 is depressed, as it was in Ireland in Q3 2020 before the peak of the second wave in Q4 2020, that outpatient services can quickly escalate their level of activity and detect cancers that were missed with no significant change in stage. A further observation is that when lockdown measures in Ireland were reintroduced in winter 2020/2021 but outpatient services were kept open, a similar reduction in detections was observed compared to when they were closed. Therefore, the question may be posed if the primary driver of reduced detection of UGI/HPB cancers is primary care services being overwhelmed with pandemic work rather than a reduction in outpatient services . (Table Presented) (Figure Presented)

Outcomes of B-Cell-Depleted Patients With Coronavirus Disease 2019 Treated With Antispike Monoclonal Antibodies.

Antispike monoclonal antibody treatment of 180 B-cell-depleted patients with mild-to-moderate coronavirus disease 2019 (COVID-19) resulted in good outcomes overall, with only 12.2% progressing to severe disease, 9.4% requiring hospitalization, 0.6% requiring mechanical ventilation, no deaths within 30 days, and 1.8% developing persistent COVID-19. Antispike monoclonal antibodies appear effective in this immunocompromised population.

Critical Periods, Critical Time Points and Day-of-the-Week Effects in COVID-19 Surveillance Data: An Example in Middlesex County, Massachusetts, USA.

Critical temporal changes such as weekly fluctuations in surveillance systems often reflect changes in laboratory testing capacity, access to testing or healthcare facilities, or testing preferences. Many studies have noted but few have described day-of-the-week (DoW) effects in SARS-CoV-2 surveillance over the major waves of the novel coronavirus 2019 pandemic (COVID-19). We examined DoW effects by non-pharmaceutical intervention phases adjusting for wave-specific signatures using the John Hopkins University's (JHU's) Center for Systems Science and Engineering (CSSE) COVID-19 data repository from 2 March 2020 through 7 November 2021 in Middlesex County, Massachusetts, USA. We cross-referenced JHU's data with Massachusetts Department of Public Health (MDPH) COVID-19 records to reconcile inconsistent reporting. We created a calendar of statewide non-pharmaceutical intervention phases and defined the critical periods and timepoints of outbreak signatures for reported tests, cases, and deaths using Kolmogorov-Zurbenko adaptive filters. We determined that daily death counts had no DoW effects; tests were twice as likely to be reported on weekdays than weekends with decreasing effect sizes across intervention phases. Cases were also twice as likely to be reported on Tuesdays-Fridays (RR = 1.90-2.69 [95%CI: 1.38-4.08]) in the most stringent phases and half as likely to be reported on Mondays and Tuesdays (RR = 0.51-0.93 [0.44, 0.97]) in less stringent phases compared to Sundays; indicating temporal changes in laboratory testing practices and use of healthcare facilities. Understanding the DoW effects in daily surveillance records is valuable to better anticipate fluctuations in SARS-CoV-2 testing and manage appropriate workflow. We encourage health authorities to establish standardized reporting protocols.

The patient experience and clinical efficacy of a novel virtual c13ubt service at an irish tertiary referral center during the covid 19 pandemic

Introduction: UBT is the most accurate non-invasive test for H.pylori infection. The orally given urea, labelled with C13, is hydrolysed by the enzyme urease of H.pylori and C13O2 is measured expired in breath. UBT was our gold standard diagnostic test for H.pylori. This practice changed abruptly in March 2020, when our first wave of coronavirus -2 (SARS-CoV-2) started. UBT carries the risk of contamination by SARS-CoV-2 in the aerosol droplets generated by exhaled air. The British Society of Gastroenterology guideline at that time graded UBT as Aerosol Generating Procedure and therefore at high risk for transmission. Only emergency gastroenterology high risk procedures were recommended during restrictions which effectively terminated our standard UBT service. To maintain a non-invasive diagnostic option we developed a novel virtual test. C13 UBT At Home, is performed by patients at home with step by step instructions involving live video conference interaction between the patients and technicians. Aims & Methods: To determine the acceptability and the accuracy of the novel C13 UBT At Home service. Patients on a UBT waiting list were contacted and invited to undergo the alternative virtual breath test. Willing participants were pre assessed over phone to explain the process. Technical aspects (internet, smart phone or laptop requirements), navigation through the video call system attendanywhere and routine clinical parameters including PPI and antibiotic use were discussed. Suitable patients collected a Home UBT kit (Patient information sheet, test documentation, pre and post collection tubes, collection straw, urea tablet and feedback questionnaire) from a drop off point up to a week prior to their scheduled appointment. The test was performed as standard by the patient at home with live interaction for all active steps. The 20 minute rest between samples 1 and 2 collection was offline which allowed technicians to do concurrent cases. Patients were requested to fill in a feedback questionnaire after the test and to return it with the samples to the drop off point within 48 hours for analysis. The questionnaire included 6 questions covering pre procedure, procedure and post procedure domains. In addition to patient satisfaction, positivity rate, sample error rate and activity numbers were compared between UBT at home and a standard UBT cohort which was reinstated in 2021. Results: 300 patients were enrolled, mean age 41 years (range 7-85), 177 female (59%). Overall response rate was 96% (288), 96% (285) rated the entire UBT at home process as either excellent or good. All other parameters except connection to the hospital video call system, which was subject to external factors were also rated excellent/good by >90%. Accuracy between UBT tests was similar: positivity rate 23% (69/299) versus 22% (74/326), sample error rate 0.33% (1/300) versus 0.6% (2/326) for the UBT at home and standard tests respectively. Currently 3 of every 4 UBT's is now virtual despite reduced restrictions. Conclusion: UBT at home is possible and acceptable to patients with equivalent accuracy to standard UBT and should be continued to improve patient choice and satisfaction.

Vaccination in the COVID-19 era: Attitudes amongst oncology patients

Background: Early data suggested a higher risk of COVID-19 in oncology patients, in particular those with co-morbidities or on systemic anticancer therapy (SACT). Immunisation strategies are likely to be critical in risk-reduction patient management. We examined patients' attitudes towards COVID-19 vaccines, studying factors affecting uptake such as demographics, socioeconomics, cancer diagnoses and treatments, and previous influenza vaccination. Methods: An anonymised questionnaire was distributed among oncology patients attending for SACT from November to December 2020. Statistical analyses were performed using SPSS v23 (IBM, Armonk, NY, USA). Results: In total 115 patients completed the survey. Of these, 30 (26%) were aged > 65, 65 (56%) were female and 54 (47%) were treated for metastatic disease. Overall 68 (59%) were receiving cytotoxic chemotherapy, and 15 (13%) were receiving immunotherapy. The most common cancer was breast (29%), followed by colorectal (18%) and lung (10%). Most patients (72%) had received or were intending to receive the influenza vaccine. Of patients surveyed 19 (17%) had friends or family who had been diagnosed with COVID-19, while only 3 (2.6%) had had COVID-19. The majority (81%) were in favour of receiving a COVID-19 vaccine if it was recommended for them. A small number however (5.2%) were against receiving a vaccine. Similar numbers of patients worried (30%) and did not worry (33%) that a COVID-19 vaccine could be unsafe. Interestingly 42% stated they if a COVID-19 vaccine were to be made available they would prefer to wait rather than to get it immediately. Patients who had received or intended to receive the influenza vaccine were less likely to want to delay receiving a COVID-19 vaccine (p=0.018). Age group, education level and palliative treatment was not associated with a significant difference in vaccine acceptance. Conclusions: The majority of patients surveyed were agreeable to COVID-19 vaccination, particularly those with prior influenza vaccination. An interesting finding was that though 42% of patients would prefer not to be first to receive the vaccine the majority welcomed vaccination. This finding, especially within a cohort regarded as being "highly vulnerable” to COVID, may have implications for the vaccine program in the general population. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Maintaining intravenous anti-cancer systemic therapy during COVID: Pharmacy and nursing factors

Background: The COVID-19 pandemic has impacted many aspects of the practice of oncology around the world. COVID was first detected in Ireland on 29/2/20. Many oncology units saw dramatic changes in activity in the face of rising infection rates. We aim to assess compare pharmacy activity, day unit systemic therapy adminstration and nursing staffing levels during the pre- and COVID periods. Methods: Hospital information systems were used to retrieve numbers of patients attending, numbers and types of items dispensed by pharmacy, and available nurses to deliver the systemic therapies from March 2019 to Feb. 2021. The data was analysed to identify trends in prescribing and dispensing practices for this period. Supportive medications such as anti-emetics, bisphosphosphonates were not included. Subgroup analysis on numbers of chemotherapy, immunotherapy, monoclonal antibody drugs dispensed per month was performed. A paired t-test was used to compare means. Results: 9410 non-clinical trials and 411 clinical trials items were dispensed from March 2019 until February 2020 (pre-COVID) for 11,606 patient attendances. From March 2020 until February 2021 (COVID period), 8931 non-clinical trials and 826 clinical trials items were dispensed for 10818 patient attendances. The mean number of non-clinical trials items dispensed per month were 784 and 744 respectively, with no statistical difference being found (p=0.11). There was a doubling in the number of clinical trials agents dispensed. The mean number of nurses available to administer therapies per day was 5.7 (SD=0.78) compared to the projected 7.8 WTE (whole time equivalents) ideally required. [Formula presented] Conclusions: Despite COVID restrictions it was possible to administer comparable numbers of cancer treatments throughout the COVID period, when compared to the previous year despite modest nursing staff numbers due to the dedication and selflessness of nursing, oncologists and oncology pharmacy staff. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

OUTCOMES IN PATIENTS RESUMING INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOLLOWING TREATMENT DELAY DURING THE CORONAVIRUS-19 PANDEMIC.

PURPOSE: To evaluate the outcomes of delay in care secondary to the coronavirus pandemic in patients requiring intravitreal anti-vascular endothelial growth factor therapy. METHODS: A retrospective review was performed, and subjects were divided into two groups: 1) a study group of patients who experienced a treatment delay of ≥6 weeks from the intended follow-up during the coronavirus pandemic and resumed treatment with ≥2 anti-vascular endothelial growth factor injections over 6 months following treatment delay, and 2) a control group of patients who received regular care throughout the coronavirus pandemic. RESULTS: Totally, 234 subjects were analyzed. The mean treatment delay from the intended follow-up in the study group was 11.8 (±4.0) weeks. Visual acuity and central macular thickness worsened from baseline to 6 months after resuming anti-vascular endothelial growth factor therapy in the study group (P < 0.0001 and P = 0.001, respectively). Visual acuity and central macular thickness were better in the control group compared with the study group at the end of the 6-month study period (P < 0.0001 for both). CONCLUSION: Treatment delay in subjects undergoing anti-vascular endothelial growth factor therapy for retina disease during the coronavirus pandemic had worse visual and anatomical outcomes despite reinitiating treatment over 6 months compared with a control group, suggesting irreversibility and permanence of outcomes.

Providing Food and Nutrition Services during the COVID-19 Surge at the Javits New York Medical Station.

Military field hospitals typically provide essential medical care in combat zones. In recent years, the United States (US) Army has deployed these facilities to assist domestic humanitarian emergency and natural disaster response efforts. As part of the nation's whole-of-government approach to the coronavirus disease (COVID-19) pandemic, directed by the Federal Emergency Management Agency and the Department of Health and Human Services, during New York City's (NYC) initial surge of COVID-19, from 26 March to 1 May 2020, the US Army erected the Javits New York Medical Station (JNYMS) field hospital to support the city's overwhelmed healthcare system. The JNYMS tasked a nutrition operations team (NuOp) to provide patient meals and clinical nutrition evaluations to convalescent COVID-19 patients. However, few guidelines were available for conducting emergency nutrition and dietary response efforts prior to the field hospital's opening. In this case study, we summarize the experiences of the NuOp at the JNYMS field hospital, to disseminate the best practices for future field hospital deployments. We then explain the challenges in service performance, due to information, personnel, supply, and equipment shortages. We conclude by describing the nutrition service protocols that have been implemented to overcome these challenges, including creating a standardized recordkeeping system for patient nutrition information, developing a meal tracking system to forecast meal requirements with food service contractors, and establishing a training and staffing model for military-to-civilian command transition. We highlight the need for a standardized humanitarian emergency nutrition service response framework and propose a Nutrition Response Toolkit for Humanitarian Crises, which offers low-cost, easily adaptable operational protocols for implementation in future field hospital deployments.

Polyp excision rates post-COVID-19: Personal protective equipment does not impairperformance

Aims The UK JAG on GI Endoscopy's minimum standard for polyp detection rates (PDR) in colonoscopy is 15 %. TheCOVID-19 pandemic precipitated the use of restrictive personal protective equipment (PPE) which might reduce dexterityand decrease PDRs. We audited our polyp excision rates both prior to and post the COVID-19 pandemic in order to assesswhether restrictive PPE led to a diminution therein. Methods Our endoscopy database was queried for all colonoscopies performed between 01/01/2014 and 29/02/2020 (Pre-COVID-19, n = 18,231) and between 01/03/2020 and 02/09/2020 (Post-COVID-19, n = 825) and subsequently irrevocablyanonymised. A polyp excision rate (PER) was calculated for each period as a proxy for PDR. A comparative odds ratio was calculated. An ordinary least squares (OLS) regression, using number of polyps excised as the dependent variable and procedure in thepost-COVID-19 period as a primary explanatory variable, was performed. The regression was controlled for age, malegender and procedure coded as therapeutic (as opposed to diagnostic). Results 4,346 and 209 patients had at least one polyp excised in the pre-COVID-19 (PER 23.8 %) and post-COVID-19 (PER25.3 %) periods respectively. Odds ratio 1.08 (95 %CIs: 0.92, 1.27). OLS regression established positive relationships between number of polyps excised and age (0.004, 95 %CIs: 0.003,0.005), male gender (0.10, 95 %CIs: 0.07, 0.13) and procedure coded as therapeutic (1.75, 95 %CIs: 1.71, 1.78). Itdemonstrated no significant relationship between procedure in the post-COVID-19 period (-0.003, 95 %CIs:-0.07, 0.07)and number of polyps excised. Conclusions Odds ratios comparing PERs and an OLS regression analysing number of polyps excised failed to demonstrateany significant difference between the pre-COVID-19 and post-COVID-19 eras.

Development and Evaluation of an Automated Manual Resuscitator-Based Emergency Ventilator-Alternative.

Mass casualty incidents such as those that are being experienced during the novel coronavirus disease (COVID-19) pandemic can overwhelm local healthcare systems, where the number of casualties exceeds local resources and capabilities in a short period of time. The influx of patients with lung function deterioration as a result of COVID-19 has strained traditional ventilator supplies. To bridge the gap during ventilator shortages and to help clinicians triage patients, manual resuscitator devices can be used to deliver respirations to a patient requiring breathing support. Bag-valve mask (BVM) devices are ubiquitous in ambulances and healthcare environments, however require a medical professional to be present and constantly applying compression to provide the patient with respirations. We developed an automated manual resuscitator-based emergency ventilator-alternative (AMREV) that provides automated compressions of a BVM in a repetitive manner and is broadly compatible with commercially-available BVM devices approximately 5 inches (128 mm) in diameter. The AMREV device relieves the medical professional from providing manual breathing support and allows for hands-free operation of the BVM. The AMREV supports the following treatment parameters: 1) adjustable tidal volume (V T ), 2) positive end-expiratory pressure (PEEP) (intrinsic and/or external), 3) 1:1 inspiratory: expiratory ratio, and 4) a controllable respiratory rate between 10-30 breaths per minute. The relationship between the inherent resistance and compliance of the lung and the delivered breaths was assessed for the AMREV device. Adjustable V T of 110-700 ml was achieved within the range of simulated lung states. A linear increase in mean airway pressure (P aw ), from 10-40 cmH2O was observed, as the resistance and compliance on the lung model moved from normal to severe simulated disease states. The AMREV functioned continuously for seven days with less than 3.2% variation in delivered V T and P aw . Additionally, the AMREV device was compatible with seven commercially-available BVM setups and delivered consistent V T and P aw within 10% between models. This automated BVM-based emergency-use resuscitator can provide consistent positive pressure, volume-controlled ventilation over an extended duration when a traditional ventilator is not available. True ventilator shortages may lead to manual resuscitators devices such as the AMREV being the only option for some healthcare systems during the COVID-19 pandemic.

The performance of point-of-care antibody test for COVID-19 diagnosis in a tertiary hospital in Bandung, Indonesia.

INTRODUCTION: We aim to describe the performance of combined IgM and IgG point-of-care antibody test (POC-Ab) (Wondfo®) compared to real-time reverse transcriptase (rRT-PCR) (Allplex™ 2019-nCoV Assay) in detecting coronavirus disease 2019 (COVID-19). METHODOLOGY: We compared POC-Ab with rRT-PCR results among patients in a tertiary hospital from January to March 2020 in Bandung, Indonesia. We selected presumptive COVID-19 patients with positive rRT-PCR consecutively and 20 patients with negative rRT-PCR results were selected randomly from the same group of patients as controls. We described the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) with corresponding 95% confidence interval using serum and capillary blood samples. We also tested POC-Ab using non-COVID-19 (confirmed dengue and typhoid) patients' sera. RESULTS: Twenty-seven patients with positive rRT-PCR result and 20 negative controls were included (68.1% males, mean age 46 (SD: 15.4)). Using the serum, the sensitivity of the POC-Ab was 63.0% (42.4-80.6), specificity was 95.0% (75.1-99.9), PPV was 94.4% (72.7-99.8), NPV was 65.5% (45.7-82.1). A subset of 20 patients was tested using a capillary blood sample. The accuracy of the capillary blood sample is lower compared to serum (50.0% vs. 78.7%). None of the non-COVID-19 sera tested were reactive. CONCLUSIONS: POC-Ab for COVID-19 has a high specificity with no false-positive result in non-COVID-19 sera. Therefore, it can be used to guide diagnostic among symptomatic patients in resource limited settings. Given its low sensitivity, patients with high suspicion of COVID-19 but non-reactive result should be prioritized for rRT-PCR testing.