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The coronavirus disease 2019 (COVID-19) pandemic is a challenge for all health care providers (HCPs). Anesthesiologists are vulnerable to acquiring the disease during aerosol-generating procedures in operating theater and intensive care units. High index of suspicion, detailed history including travel history, strict hand hygiene, use of face masks, and appropriate personal protective equipment are some ways to minimize the risk of exposure to disease. Neurologic manifestations of COVID-19, modification of anesthesia regimen based on the procedure performed, and HCP safety are some implications relevant to a neuroanesthesiologist. National and international guidelines, recommendations, and position statements help in risk stratification, prioritization, and scheduling of neurosurgery and neurointervention procedures. Institutional protocols can be formulated based on the guidelines wherein each HCP has a definite role in this ever-changing scenario. Mental and physical well-being of HCPs is an integral part of successful management of patients. We present our experience in managing 143 patients during the lockdown period in India.Copyright © 2020 Wolters Kluwer Medknow Publications. All rights reserved.
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SESSION TITLE: COVID-19 Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: The SARS-CoV-2 pandemic quickly spread throughout the world after it was first identified in Wuhan, China in 2019. Severe cases of hypoxic respiratory failure have since filled hospitals over the past few years. We present a case of an immunosuppressed patient with persistent respiratory failure from SARS-CoV-2, with a failure to mount antibody response, treated with convalescent plasma. CASE PRESENTATION: We present a 54-year-old female with a past medical history significant for rheumatoid arthritis on immunosuppression with methotrexate, prednisone, sulfasalazine, and rituximab who presented with diarrhea, cough, and shortness of breath. She was unvaccinated and tested positive for COVID-19 pneumonia, which was treated with corticosteroids and Remdesevir. CT thorax revealed diffuse infiltrates (Figure-1). She had progressive hypoxia requiring ICU stay and her course was complicated by inferior wall STEMI, requiring Intra-aortic balloon pump and intubation given worsening hypoxia. She had progressive improvement and was discharged from the hospital on 4 L of supplemental oxygen after a 30-day hospital stay. She presented two days after discharge with cough, fevers and increasing oxygen requirements up to 100% high flow nasal cannula. She was septic and was treated with steroids and antibiotics. She was febrile despite broad spectrum antibiotics. CT thorax demonstrated diffuse infiltrates worsened from the previous and steroid dosing was increased (Figure-2). No obvious source of infection was found, and further evaluation revealed positive Covid-19 RT-PCR. Despite her initial infection occurring two months prior, COVID-19 anti-spike and anti-nucleocapsid antibodies were negative. She was treated with two doses of convalescent plasma and had improvement in her oxygenation, going from 80% high-flow nasal cannula to 6L of supplemental oxygen within two days of administration. DISCUSSION: It's unclear whether immunosuppressed patients with rheumatologic disease are at an increased risk of severe SARS-CoV-2 infection. However, the use of immunosuppressants places patients at risk of an improper immune response to infection. In immunocompetent patients, the typical time to negative SARS-CoV-2 RT-PCR is 3 weeks after positivity (1), and most patients develop antibodies within 2-3 weeks after viral exposure (2). Anti-CD20 monoclonal antibodies like rituximab, commonly used for rheumatologic diseases, can hinder humoral immunity, and impair vaccine response (3). Given our patient's immunosuppressive regimen, we suspect she failed to mount an immune response to COVID-19, resulting in 56 days of infection without an adequate antibody response, successfully treated with convalescent plasma. CONCLUSIONS: Patients with significant immunosuppression regimens may fail to produce antibody responses to SARS-CoV-2, resulting in prolonged infection. Reference #1: Rodríguez-Grande, C., Adán-Jiménez, J., Catalán, P., Alcalá, L., Estévez, A., Muñoz, P., Pérez-Lago, L., de Viedma, D. G., Adán-Jiménez, J., Alcalá, L., Aldámiz, T., Alonso, R., Álvarez, B., Álvarez-Uría, A., Arias, A., Arroyo, L. A., Berenguer, J., Bermúdez, E., Bouza, E., … de la Villa, S. (2021). Inference of active viral replication in cases with sustained positive reverse transcription-PCR results for SARS-CoV-2. Journal of Clinical Microbiology, 59(2). https://doi.org/10.1128/JCM.02277-20 Reference #2: Boechat, J. L., Chora, I., Morais, A., & Delgado, L. (2021). The immune response to SARS-CoV-2 and COVID-19 immunopathology – Current perspectives. In Pulmonology (Vol. 27, Issue 5). https://doi.org/10.1016/j.pulmoe.2021.03.008 Reference #3: Eisenberg, R. A., Jawad, A. F., Boyer, J., Maurer, K., McDonald, K., Prak, E. T. L., & Sullivan, K. E. (2013). Rituximab-treated patients have a poor response to influenza vaccination. Journal of Clinical Immunology, 33(2). https://doi.org/10.1007/s10875-012-9813-x DISCLOSURES No relevant relationships by Issa Makki No relevant relationships by John Parent No relevant relationships by Jay Patel No relevant relationships by Ruchira Sengupta
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Background: Axial spondyloarthritis (axSpA) is an important cause of infam-matory back pain (IBP). It is under-recognized, leading to signifcant delays in diagnosis. Early recognition and diagnosis are crucial to achieve the best outcomes for patients and in Malaysia, signifcant gaps in the clinical management of axSpA remain. Therefore, we sought to implement a strategy to improve the time to diagnosis and management of axSpA in Malaysia by collaborating and adopting guidance from an international axSpA expert. Objectives: The objectives were to improve disease recognition among healthcare practitioners (HCPs), reducing time to specialist referral and diagnosis whilst improving disease management by developing and implementing a new patient care model called the Spondyloarthritis Accelerated Management (SAM) and measure its effectiveness in 3 Rheumatology centers in Malaysia. Methods: The SAM initiative was developed by the Malaysian SpA Consortium Working Group involving 8 Malaysian rheumatologists from 3 local centers and 1 international axSpA expert from the UK as part of the steering committee. Selections were based on clinical expertise. The frst local alignment meeting on model structure was held in July 2020 with subsequent meetings held to address key barriers to early axSpA diagnosis and timely access to quality care. A care model with feasible key performance indicators (KPIs) was established, adapted and tracked monthly in the 3 rheumatology centers (Figure 1). Referral tools were developed to facilitate early referrals to rheumatologists. These included a QR-coded '3-R' referral guide1 and a patient self-screening tool with a patient self-referral letter all hosted on the Malaysian Society of Rheumatology (MSR) website, educational talks to HCPs and public awareness forums on IBP and axSpA. Data were collected on referral source, duration of referrals, knowledge on IBP in HCPs by surveys and imaging accessibility at baseline and at 1 year after the initiative was launched. Baseline data collected were from August to October 2020 and 1 year data were from November 2020 to November 2021. Results: At 1 year, the SAM initiative showed a 44.4% (Median: 1.33 [IQR 1-1.7] vs 1.92 [IQR 1.6-2.1]) increase in IBP referrals, a reducing trend from 9.5 (IQR 8-11.1) to 5.9 (IQR 5.1-6.8) weeks of waiting time to a frst Rheumatology visit and an increase of 37.2% (34% vs 71%) in IBP patients who were seen at the rheumatology clinic within 6 weeks. All patients with IBP had X-rays (sacroiliac joints or pelvis). MRI requests in X-ray negative patients suspected of axSpA was increased by 13.9% (77.8% vs 91.7%) and waiting time for MRI was reduced by 3.1 weeks (12 vs 8.9 weeks). The IBP knowledge among 224 HCPs improved by 40.6% (45.7% vs 86.3%). The number of patients newly diagnosed with axSpA increased by 40% (Median: 5 [IQR 4-9.5] vs 7 [IQR 6.5-7]) despite the COVID-19 pandemic. Conclusion: The SAM initiative has shown promising initial results in improving referrals of patients with IBP, promoting earlier diagnosis and establishing the importance of having timely access to optimal care. A nationwide implementation is being planned to improve the recognition of the axSpA in Malaysia.
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We propose a tested, sensitive, and prompt COVID-19 breath screening method that takes less than 1 min. The method is nonbiological and is based on the detection of a shift in the resonance frequency of a nanoengineered inductor-capacitor (LC) resonant metamaterial chip, caused by viruses and mainly related exhaled particles, when performing terahertz spectroscopy. The chip consists of thousands of microantennas arranged in an array and enclosed in a plastic breathalyzer-like disposable capsule kit. After an appreciable agreement between numerical simulations (COMSOL and CST) and experimental results was reached using our metamaterial design, low-scale clinical trials were conducted with asymptomatic and symptomatic coronavirus patients and healthy individuals. It is shown that coronavirus-positive individuals are effectively screened upon observation of a shift in the transmission resonance frequency of about 1.5-9 GHz, which is diagnostically different from the resonance shift of healthy individuals who display a 0-1.5 GHz shift. The initial results of screening coronavirus patients yielded 88% agreement with the realtime quantitative polymerase chain reaction (RT-qPCR) results (performed concurrently with the breath test) with an outcome of a positive predicted value of 87% and a negative predicted value of 88%.
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Background/Aims For some time, there has been an importance placed in rheumatology on promoting and supporting patient self-management. Self-management aims to improve patients' independence and quality of life by empowering individuals to be proactive decision makers while managing their illness. Self-management support (SMS) as detailed in the Practical RevIews in Self-Management Support (PRISMS) taxonomy can include education, monitoring, adherence, training, and support with healthcare practitioner (HCP) interaction. In rheumatic and musculoskeletal diseases (RMDs), interventions for SMS are complex, and have been described by the European League Against Rheumatism (EULAR) as a current unmet need. In response to the COVID-19 pandemic, telerehabilitation has been successfully used at the Royal National Hospital for Rheumatic Diseases in Bath to provide continued SMS to axial spondyloarthritis (axial SpA) patients. Although some research into SMS of inflammatory arthritis has been conducted, there appears to be a scarcity of research on SMS interventions provided through telerehabilitation for axial SpA. The present scoping review aims to systematically identify and describe existing SMS interventions delivered via telehealth for RMDs, and how effectiveness is evaluated within these interventions. Methods The method for a scoping review protocol will be outlined using the JBI manual for evidence synthesis guidance. It is anticipated that there will be a lack of interventions for axial SpA, therefore the broader population of RMDs will be included. Three electronic databases will be searched (Embase, Scopus and Web of Science Core Collection), as well as the reference lists of included full-text studies. A study team of three researchers will apply a priori eligibility criteria, based on the Population (RMDs), Concept (rehabilitation) and Context (telehealth) components of the research focus, to the screening and fulltext screening. Results Data will be extracted into a charting table for relevant full-text articles to allow a narrative synthesis of identified SMS telerehabilitation interventions. We will explore SMS definitions used, aspects of rehabilitation targeted (e.g. education, disease management, psychological support, physical activity, physiotherapy, occupational health input, behaviour change techniques), details on the SMS intervention (e.g. autonomous/group-based, mode of telerehabilitation delivery, length of intervention, synchronous/asynchronous interaction), components of SMS included (PRISMS taxonomy), HCP interaction details, and measures of effectiveness. Conclusion Telehealth, and specifically telerehabilitation, have become a critical feature of healthcare over the last 18 months and may provide an effective long-term solution to broaden provision of SMS for RMDs and improve symptoms, while relieving pressure on healthcare systems. Through this scoping review, existing telehealth delivered SMS interventions for RMDs will be identified, which will help to understand how interventions are currently delivered and effectiveness evaluated in rheumatology. A greater understanding of existing interventions will be critical as we move into the new post-COVID-19 age of blended in-person/ virtual service provision.
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Education in the United States (US) has come a long way over the past few decades. Now, learning institutions are combining traditional educational tools with newer technology such as virtual reality (VR) as well as augmented learning spaces. In light of the recent COVID-19 global pandemic, internet-assisted virtual classrooms are often preferred over traditional teaching - this reduces in-person contact while delivering lessons on time in a safe space. The construction industry has adopted virtual reality (VR) in safety training, design, and field management, and to coordinate installations as it helps in visualizing decisions. Despite the benefits, it has found limited application in construction management (CM) education. This study introduces CM undergraduates to a virtual jobsite and investigates the efficacy of VR as a knowledge transfer pedagogy. Using data and construction documents from an ongoing project, we deploy state of the art technology to convert them into a virtual space using TwinMotion, which in turn is viewed by students with the help of Oculus Rift headsets in a controlled environment. This research propels the learner into an immersive environment to learn about building systems through VR instead of using two-dimensional construction drawings. The subjects' understanding of the materials is gauged using an online pre- post quiz. With a design-based research approach, we assess the impact of VR tools on construction student knowledge, how students respond to this hybrid model of instruction, and whether it holds any value compared to other traditional methods of instruction. Incorporating such educational tools and practices can increase the prevalence of more focused educational knowledge transfer while protecting the students' health by reducing personal contact at the same time. We plan to further investigate VR across several course iterations and are optimistic that these immersive tools will help to better train young construction professionals before they join the industry. © American Society for Engineering Education, 2021
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Corona virus infection is caused by a virus of COVID-19 strain. this infection is spread by close contact with infected person and mainly due to droplets, this virus may remain alive on surfaces which was touched by an infected person .so to stop its spread it was necessary to reduce human contact, for that all countries around the world including India declared complete of all places where mass people gatherings were happens. WHO announced Covid-19 infection as a global pandemic and this was a global emergency required complete lockdown. This necessary lockdown was for stoppage of infection spread but it also impacted very badly on every individual's lifestyle. Conclusion: PHC are the easily assessable and cost friendly for rural peoples but during this pandemic situation these PHC are not prepared for facing COVID-19 pandemic. Due to less accessibility to media and less media coverage exact situation in rural areas was not stated properly also less knowledge in rural peoples about COVID-19 infection was reason of high risk of spread of infection amongst them. Children in rural areas who are economically not that much well can't get access to internet and cannot afford the mobile or laptops for online education this made the chances of drop outs in these children. During lockdown due to pandemic all the farmers and small shop holders faced huge loss ,this was the period of great earnings from various rabi crops but due to shortage of labor and non-availability of various machineries delay harvest and this lead to huge loss for farmers.
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Background/AimsThe Rheumatology nurse advice line (NAL) at the Royal NationalHospital for Rheumatic Diseases (RNHRD, Bath) provides a vitalservice for direct patient access to specialist advice via a designatedvoicemail system. Increasing numbers and difficulty connecting callreturns have increased staff workload, reduced efficiency andimpacted on staff satisfaction. An audit was therefore undertaken toevaluate service use and efficiency, paired with formal assessment ofstaff satisfaction in order to identify areas for improvement.MethodsThe total number of monthly calls through the NAL during 2020 werecounted. A subset of consecutive calls were audited in detail, documenting temporal parameters in relation to the call beinglogged, returned and concluded. The number of clinicians andattempts required to contact the patient was noted. An anonymisedstaff satisfaction questionnaire was completed by NAL nurses andadministrators. Data was analysed using Excel.ResultsAn average 653 calls per month (range 340-894) came through theNAL between January and September 2020. 97 consecutive patientcontacts were audited from August 2020. Multiple attempts wererequired to successfully return the call in 19.6% of cases (n = 19/97).Of those, 68.4% (n = 13/19) of calls needed 2 nurses to contact thepatient. In general, the first attempt to return the call was prompt(average 7.6 hours, range 0.1-27.7). However, the time to conclude thecall from the patient's first call log ranged from 0.1 - 142.6 hours(average 12.7 hours) with increased time associated with difficultiescontacting the patient or when further advice was required from aRheumatology doctor (18.5%, n = 18/97).Staff surveys revealed 67% of staff felt that the NAL is a good serviceto offer patients. However, 67% of staff did not feel the NAL in itscurrent format was easy to manage. Specific comments included thatthe lack of rota'd responsibility, unpredictable workload and timeinefficiencies were barriers to managing the service.ConclusionFrom this data, we conclude that patient calls are returned promptly, but utilising a system of voicemail and unscheduled call returns isinefficient and contributes to staff dissatisfaction. This data has drivenchange for service improvement. To improve efficiency, calls will beanswered live by an administrator during working hours and patientsgiven a call-back time. A doctor will be named as a single point ofcontact for the nurses to seek additional advice and a nurse rota willdesignate responsibility for NAL calls to reduce work-load uncertainty.Follow up service evaluation will include staff and patient satisfactionquestionnaires, and repeat audit, with consideration of ways tosupport frequent service users.
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The coronavirus disease 2019 (COVID-19) pandemic is a challenge for all health care providers (HCPs). Anesthesiologists are vulnerable to acquiring the disease during aerosol-generating procedures in operating theater and intensive care units. High index of suspicion, detailed history including travel history, strict hand hygiene, use of face masks, and appropriate personal protective equipment are some ways to minimize the risk of exposure to disease. Neurologic manifestations of COVID-19, modification of anesthesia regimen based on the procedure performed, and HCP safety are some implications relevant to a neuroanesthesiologist. National and international guidelines, recommendations, and position statements help in risk stratification, prioritization, and scheduling of neurosurgery and neurointervention procedures. Institutional protocols can be formulated based on the guidelines wherein each HCP has a definite role in this ever-changing scenario. Mental and physical well-being of HCPs is an integral part of successful management of patients. We present our experience in managing 143 patients during the lockdown period in India.
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Background: End stage renal disease (ESRD) shows higher prevalence in poor urban communities, areas with high SARS-CoV-2 exposure risk. This ecological analysis examined the correlation of SARS-CoV-2 positive tests per capita with number of dialysis stations, demographics and income data of the residents within ZIP codes (n=163) in Cook County, Illinois. Methods: Data on SARS-CoV-2 positive tests per capita within a ZIP code were merged with ZIP code data on number of dialysis stations (sum of dialysis stations per dialysis center), demographics and household income, during a period from January 21-May 16, 2020 in Cook County (5,231,852 residents). Spearman's rank correlation coefficients were calculated to examine the linear correlation of SARS-CoV-2 positive tests per capita with dialysis stations, demographics and household poverty. We mapped SARS-CoV-2 positive tests per capita and total dialysis stations by ZIP code in Cook County. Results: Positive tests per capita correlated significantly with number of dialysis stations (r = 0.23;95% CI 0.18, 0.28;P < 0.005), number of households living in poverty (r= 0.58;95% CI 0.54, 0.61;P < 0.005) and percentage of residents reporting Black race (r = 0.34 p < 0.005, CI = 0.30, 0.39) or Hispanic ethnicity (r = 0.60 p < 0.001, CI: 0.57- 0.63). Figure 1 show several areas within Cook County with both high number of SARSCoV- 2 tests per capita and number of dialysis stations. Conclusions: SARS-CoV-2 tests per capita correlates positively with number of dialysis stations, and poverty status of that ZIP code. These findings highlight the high risk of SARS-CoV-2 exposure for patients with ESRD living in poor urban areas.
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BACKGROUND: Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse coronavirus disease 2019 (COVID-19) outcomes compared with patients receiving no systemic treatments. OBJECTIVES: We used international patient survey data to explore the hypothesis that greater risk-mitigating behaviour in those receiving targeted therapies may account, at least in part, for this observation. METHODS: Online surveys were completed by individuals with psoriasis (globally) or rheumatic and musculoskeletal diseases (RMDs) (UK only) between 4 May and 7 September 2020. We used multiple logistic regression to assess the association between treatment type and risk-mitigating behaviour, adjusting for clinical and demographic characteristics. We characterized international variation in a mixed-effects model. RESULTS: Of 3720 participants (2869 psoriasis, 851 RMDs) from 74 countries, 2262 (60·8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term 'shielding'). A greater proportion of those receiving targeted therapies (biologics and Janus Kinase inhibitors) reported shielding compared with those receiving no systemic therapy [adjusted odds ratio (OR) 1·63, 95% confidence interval (CI) 1·35-1·97]. The association between targeted therapy and shielding was preserved when standard systemic therapy was used as the reference group (OR 1·39, 95% CI 1·23-1·56). Shielding was associated with established risk factors for severe COVID-19 [male sex (OR 1·14, 95% CI 1·05-1·24), obesity (OR 1·37, 95% CI 1·23-1·54), comorbidity burden (OR 1·43, 95% CI 1·15-1·78)], a primary indication of RMDs (OR 1·37, 95% CI 1·27-1·48) and a positive anxiety or depression screen (OR 1·57, 95% CI 1·36-1·80). Modest differences in the proportion shielding were observed across nations. CONCLUSIONS: Greater risk-mitigating behaviour among people with IMIDs receiving targeted therapies may contribute to the reported lower risk of adverse COVID-19 outcomes. The behaviour variation across treatment groups, IMIDs and nations reinforces the need for clear evidence-based patient communication on risk-mitigation strategies and may help inform updated public health guidelines as the pandemic continues.