ABSTRACT
Background: Acute stroke care is constantly evolving and often necessitates rapid change. When COVID-19 struck our community, our team determined that we needed to change our approach to emergent stroke cases without sacrificing efficiency and safety. Our goals with the changes in our hyperacute stroke response pathway (called Code Brain) in our ED was to minimize COVID-19 exposure to our team, reduce PPE usage, and maintain an environment of safety and readiness, all while providing the same high-quality stroke care. Purpose: The purpose of this study was to determine if the changes we made to our Code Brain pathway in the ED effected our door-to-needle time for tissue plasminogen activator (t-PA) administration our door-to-groin puncture (DTG) times, or our CT scan turn-around times (CT TAT) under 45 minutes percentage. Implementation: It was decided that the stroke team RNs would respond to the bedside and a neurology resident or fellow would respond via telemedicine robot at bedside. The stroke team nurse is the safety monitor who ensures proper PPE use. The patient is moved through the Code Brain pathway with the telemedicine robot in tow, assuring constant contact with the patient by the stroke physician and stroke nurse. We implemented our revised Code Brain pathway on March 17, 2020. We retrospectively collected data from November 2019 to July 2020 and extracted our DTN, DTG and CT TAT times for a 4 1/2 month comparison. Results: From November 2019 through March 17, 2020, our DTN median time was 39 minutes, DTG median time was 101 minutes, and CT TAT under 45 minutes was 97%. From March 18, 2020 to July 2020, our DTN median time was 54 minutes, DTG median time was 101 minutes, and CT TAT under 45 minutes was 95%. Variables to consider are the length of time it takes to apply the appropriate PPE for the stroke nurse, obtaining the telemedicine robot from our ED storage area and connectivity issues. Conclusion: Although we radically changed the way we approach our Code Brain patients, our response and treatment times changed only slightly. We will continue to streamline this process for optimal outcomes.
ABSTRACT
Objective: To evaluate the effect of the COVID-19 pandemic state on early, 1st trimester pregnancies, in light of a link described between war-induced stress and adverse pregnancy outcomes. Design: Retrospective cohort study conducted in a University fertility center. Materials and Methods: All 1ST trimester viability scans done since the COVID-19 shut down, March13-May 6, 2020 (Study group), and between March 1-May 17, 2019 (pre-pandemic Control), were reviewed. Early 1st trimester pregnancy outcomes (Viable pregnancy, Arrested pregnancy including biochemical pregnancy loss and miscarriage, and ectopic pregnancy (EP)) were measured. A multivariate analysis was performed to control for significant confounders. Power analysis revealed that a sample size of 58 patients per group has a 90% power with a 15% difference in outcomes and α=5%. The study group denied symptoms of COVID-19. Results: 113 women were scanned in the study, and 172 in the control periods (5-11 weeks gestational age). The groups had similar demographics, gestational history, fertility diagnosis and treatment characteristics (Table). No significant differences were noted in the rate of recurrent pregnancy loss (RPL). Viable clinical pregnancy rates were not different between the groups (76.1% vs. 80.2% in the pandemic and pre-pandemic groups p= 0.41). No significant difference was seen in number of 1st trimester miscarriage (14.2% vs 12.8% p=0.76), biochemical pregnancies (3.5% vs 1.7% p=0.34), or in total miscarriage rate (22.1% vs 16.9% p=0.32), nor in EP rates (0.9% vs 2.3% p=0.36) Mean serum TSH levels were higher in the control but fell in the normal range for both groups. Use of donor sperm was higher in the control and may have favored lower miscarriage rates in that group. Conclusions: The COVID-19 pandemic environment does not seem to affect early first-trimester miscarriage rates in asymptomatic patients. [Formula presented]