Patient-reported outcome measures 3 and 6 months after pulmonary rehabilitation following COVID-19

Recent studies have suggested that pulmonary rehabilitation (PR) improves patient-reported outcome measures (PROMs) in patients recovering from COVID-19. Yet, there are hardly any studies that report the further course of recovery after PR. Therefore, we assessed PROMs regarding exertional dyspnea, fatigue, depression, anxiety, and quality of life (QoL) of 224 patients (Oage: 54.3+/-10.4;42% female) who were admitted to a three-week inpatient PR between 4/2020 and 4/2021 due to COVID-19. Data were assessed at the beginning (T1) and at the end (T2) of PR as well as 3 months (T3) and 6 months (T4) afterwards. Repeated measures ANOVAs were calculated to reveal significant changes. In line with previous results, we found significant reductions in symptom severity regarding all PROMs over the course of PR (dT1-T2 =0.910 to dT1-T2=1.538) and a significant increase in QoL (dT1-T2=-1.238). While the improvements in exertional dyspnea and QoL persisted after PR (PT2-T3 =0.321 and pT2-T3=0.358), each other variable significantly deteriorated again at T3 (dT2-T3=-0.386 to dT2-T3=-0.933). However, significant improvements between T1 and T4 could be detected in each variable (dT1-T4=0.567 to dT1-T4=0.696) except for anxiety (pT1-T4=0.708). The improvements were associated with an increase in QoL (dT1-T4=-1.010). Our results suggest that PR leads to significant improvements in clinically relevant PROMs. In most variables, the improvements may also persist after PR. Since we found no improvements in the further course, we conclude that the improvements were predominantly due to PR rather than to the natural course of recovery after COVID-19.

Negative association between fatigue and signs of sleep apnoea in patients after COVID-19

Both during and after the acute phase, COVID-19 is associated with a variety of clinical symptoms, many of which may persist even several months after the infection [1, 2]. One of the most common symptoms that is likely to persist is fatigue [1, 3]. Despite intensive research, little is known about the factors that contribute to the development and persistence of fatigue during and after COVID-19 [3]. Since sleep apnoea and particularly more severe forms are commonly associated with tiredness and exertion, an increased rate of sleep apnoea may explain at least in part the commonly mentioned fatigue symptoms.

B-CELL RECONSTITUTION IS STRONGLY ASSOCIATED with A POSITIVE SEROLOGIC RESPONSE to the COVID-19 BOOSTER VACCINE in PREVIOUSLY SEROLOGICALLY UNRESPONSIVE RITUXIMAB TREATED RHEUMATIC DISEASE PATIENTS

Background: Booster doses of SARS-CoV-2 vaccines have emerged as an important strategy for containing the pandemic and may be especially important to rituximab treated patients. B-cell depletion has been associated with worse outcomes from COVID-19 infection, and many rituximab treated patients demonstrate an inadequate serologic response to the initial vaccine series (1). Strategies to optimize serologic response to COVID-19 vaccine boosters in previously serologically unresponsive patients is, therefore, of particular relevance. Objectives: To assess factors associated with serologic response to COVID-19 booster vaccines in rituximab treated patients previously serologically unresponsive to the initial vaccine series. Methods: A retrospective chart review of rituximab treated patients who failed to demonstrate a serologic response to the frst SARS-CoV-2 vaccination series and subsequently received an mRNA vaccine booster was performed. Serologic response four weeks or more after the booster was the primary outcome. T-tests, Fisher's exact tests, and Wilcoxon rank sum tests were used for comparisons. Box and whisker plots were constructed to visualize differences between serologic response. Results: In 31 rituximab treated patients who were seronegative following the initial vaccine series, demographic characteristics, concurrent therapies, rheuma-tologic diagnosis, and vaccine type were not associated with serologic positivity to the booster vaccine (Table 1). B-cell reconstitution was signifcantly different between those with positive (median, IQR 1.785 (0.65, 3)) and negative (median, IQR 0 (0,0)) serologic responses to the booster (p-value<0.001) as was time from last rituximab exposure (p-value = 0.030) (Figure 1). Positive predictive value of B-cell presence was 90.9% (95% CI: 70.8%, 98.9%) and negative predictive value was 100% (95% CI: 59%, 100%) for serologic response to the mRNA booster. Positive predictive value of time >6 months from last rituximab to the booster was 78.3% (95% CI 56.3%, 92.5%) and the negative predictive value was 62.5% (95% CI 24.5%, 91.5%). Conclusion: Presence of detectable B-cells and longer time from last rituximab were associated with the development of SARS-CoV-2 spike protein antibodies following the booster vaccine. These factors should be considered in timing of administration of booster vaccine doses in previously unresponsive rituximab treated patients.

Expansion of a Pathology Resident Wellness Initiative Amidst the COVID-19 Pandemic

Background: The focus on physician wellness and burnout continues to build in the era of the COVID-19 pandemic. The pre- COVID rate of burnout among pathology residents was reported to be approximately 46-52%, but there is little data on this group during the period of COVID-19. Amongst residents as a whole, the burnout rate during the COVID-19 pandemic is about 50%, with 69% of young healthcare workers (ages 18-29) reporting burnout. In addition to the limitations on direct social interaction, uncertainty pertaining to redeployment, risk of exposure to COVID-19, and future job security has added to the challenge of maintaining resident well-being during the pandemic. Design: An established Pathology Resident Wellness Initiative program at a large academic institution was expanded to address the well-being needs of pathology residents during the COVID-19 pandemic. With oversight from senior residents and department leaders, the Pathology Wellness Committee (PWC) planned both virtual and socially distanced in-person events to foster resident wellness while complying with safety guidelines. An annual Wellness Survey was modified in 2020 to assess resident well-being during the pandemic. Results: In compliance with COVID-19 safety guidelines, the PWC creatively designed social events including virtual yoga classes, an outdoor photo scavenger hunt, wellness hikes, holiday events, and periodically provided individually packaged meals and baked goods for residents. The Wellness Survey distributed during the pandemic revealed that 76% of residents felt satisfied or very satisfied with their relationships with coworkers, friends, and family despite social distancing guidelines. There was no significant change in the amount of residents who reported feeling cheerful (p=0.38), fulfilled (p=1.00), or appreciated (p=0.38) more than half of the time compared to pre-COVID results. Conclusions: The COVID-19 pandemic created many unique challenges for maintaining wellness during residency, including for pathology trainees. With expansion of an existing pathology resident Wellness Initiative, our Wellness Committee was able to creatively and safely continue to promote wellness objectives and adapt to the challenge of social distancing during the COVID-19 pandemic.

Osteoporosis Care in Hospital during Covid - An Overview

Covid 19 has led to a change in the usual structures and processes in many areas. Osteoporosis Care is also affected - from diagnosis to treatment. In this article, we focused on stationary care for osteoporosis and its changings. © 2022 Georg Thieme Verlag. All rights reserved.

The aquaculture supply chain in the time of covid-19 pandemic: Vulnerability, resilience, solutions and priorities at the global scale.

The COVID-19 global pandemic has had severe, unpredictable and synchronous impacts on all levels of perishable food supply chains (PFSC), across multiple sectors and spatial scales. Aquaculture plays a vital and rapidly expanding role in food security, in some cases overtaking wild caught fisheries in the production of high-quality animal protein in this PFSC. We performed a rapid global assessment to evaluate the effects of the COVID-19 pandemic and related emerging control measures on the aquaculture supply chain. Socio-economic effects of the pandemic were analysed by surveying the perceptions of stakeholders, who were asked to describe potential supply-side disruption, vulnerabilities and resilience patterns along the production pipeline with four main supply chain components: a) hatchery, b) production/processing, c) distribution/logistics and d) market. We also assessed different farming strategies, comparing land- vs. sea-based systems; extensive vs. intensive methods; and with and without integrated multi-trophic aquaculture, IMTA. In addition to evaluating levels and sources of economic distress, interviewees were asked to identify mitigation solutions adopted at local / internal (i.e., farm-site) scales, and to express their preference on national / external scale mitigation measures among a set of a priori options. Survey responses identified the potential causes of disruption, ripple effects, sources of food insecurity, and socio-economic conflicts. They also pointed to various levels of mitigation strategies. The collated evidence represents a first baseline useful to address future disaster-driven responses, to reinforce the resilience of the sector and to facilitate the design reconstruction plans and mitigation measures, such as financial aid strategies.

[Group Training of Patients with Chronic Lung Diseases under Outpatient Conditions - Recommendations of the Working Group Lung Sports in Germany and the German Airways League]. / Ambulanter Lungensport und körperliches Training bei Patienten mit Atemwegs- und Lungenkrankheiten.

To improve acceptance and use of physical training by patients with chronic lung diseases, recommendations for performing lung exercises on an outpatient basis in a group setting are given by experts in physical training, sports therapists and pulmonologists. The evidence-based positive effects of physical training were analyzed for asthma , COPD, interstitial lung diseases, cystic fibrosis, lung carcinoma, and pulmonary hypertension. The requirements for lung exercises in outpatient groups as well as compensation by care providers were given on the basis of legal regulations. Furthermore, the main items of the training units as well as supervision by specially trained group leaders in relation to the severity of the underlying lung disease are described. Finally, aspects of safety of the participating patients are discussed, including the prevention of infection with corona-2-virus.

[Recommendations from the German Respiratory Society for Pulmonary Rehabilitation in Patients with COVID-19]. / DGP-Empfehlungen zur pneumologischen Rehabilitation bei COVID-19.

The German Respiratory Society (DGP) has commissioned Assembly 12 "Rehabilitation, Prevention and Tobacco Control" to develop recommendations for the implementation of pulmonary rehabilitation in COVID-19 patients. This position paper is based on the current state of knowledge, which develops daily. This position paper describes the health consequences in COVID-19 as well as the indications for pulmonary rehabilitation. Rehabilitative therapies in COVID-19 are already indicated on the ward or intensive care unit, continue as early pulmonary rehabilitation in the acute hospital and as pulmonary rehabilitation in pulmonary rehabilitation centers. The main focus of this position paper is to propose recommendations for the content-related implementation of a multimodal, interdisciplinary pulmonary rehabilitation in COVID-19 patients.

DGP-Empfehlungen zur pneumologischen Rehabilitation bei COVID-19

The German Respiratory Society (DGP) has commissioned Assembly 12 "Rehabilitation, Prevention and Tobacco Control"to develop recommendations for the implementation of pulmonary rehabilitation in COVID-19 patients. This position paper is based on the current state of knowledge, which develops daily. This position paper describes the health consequences in COVID-19 as well as the indications for pulmonary rehabilitation. Rehabilitative therapies in COVID-19 are already indicated on the ward or intensive care unit, continue as early pulmonary rehabilitation in the acute hospital and as pulmonary rehabilitation in pulmonary rehabilitation centers. The main focus of this position paper is to propose recommendations for the content-related implementation of a multimodal, interdisciplinary pulmonary rehabilitation in COVID-19 patients.