ABSTRACT
Open science and preprints have invited a larger audience of readers, especially during the pandemic. Consequently, communicating the limitations and uncertainties of research to a broader public has become important over the entire information lifecycle. This paper brings together reports from the NISO Plus 2021 conference session “Misinformation and truth: from fake news to retractions to preprints”. We discuss the validation and verification of scientific information at the preprint stage in order to support sound and open science standards, at the publication stage in order to limit the spread of retracted research, and after publication, to fight fake news about health-related research by mining open access content. © 2021 - The authors. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC 4.0).
ABSTRACT
Background: Adherence is critical in chronic kidney disease (CKD) to delay progression to kidney failure. Treatment plans for CKD can include medications, diet, and exercise. Overall adherence to treatment is low in CKD, and also as few as 40% of new kidney failure patients have any documented CKD-related care. The purpose of this study was to explore CKD patients' experiences of adherence to treatment plans and what role their healthcare providers had in supporting adherence. Methods: As part of a larger mixed-methods study of Chronic Renal Insufficiency Cohort (CRIC) study participants, a subset was randomly selected for 1:1 interviews. All CRIC participants are >45 years with CKD stages 1-4, and this sample consisted of University of Pennsylvania participants interviewed in 2019-2020. Participants described their experiences with adherence and what they have done when experiencing difficulty. Interviews were recorded, transcribed, and coded using conventional content analysis. Results: The sample (n=32) had a mean age of 67 years, 53% women, 59% nonwhite. After analysis of factors relevant to treatment planning and adherence, four themes emerged: patient factors (multiple chronic conditions, motivation, outlook), provider factors (attentiveness, availability, communication), treatment planning factors (lack of plan, proactive patient research, provider-focused goals, and shared decision making), and patient responses to the treatment plan (disagreeing with treatment, frustration with their lack of adherence [I know what to do], lack of information, and positive feedback). Patients also described the impact of COVID on access to care and the positive impact of family, ancillary providers, and routines/habits. Conclusions: These themes align with behavioral learning theory, which includes: internal antecedents (patient factors), external antecedents (provider factors), behavior (treatment planning and attempts at adherence), and consequences (adherence and responses to the treatment plan). Our results provide many potential points of intervention to support treatment adherence in CKD, and a tailored approach is needed to address patients' specific adherence factors.
ABSTRACT
Rationale: The novel coronavirus disease-19 (COVID-19) has presented major challenges for global health systems. Given limited availability of diagnostic testing and delays in test results during the first wave of the pandemic, our hospital used computed tomography (CT) to risk stratify patients with suspected COVID-19. The aim of this study was to describe the various patterns of disease on chest CT and relate them to chest x-ray (CXR) findings. Methods: This is a retrospective review of 559 symptomatic patients infected with COVID-19 (diagnosed by real-time reverse transcription polymerase chain reaction) admitted from March 2020 to May 2020 at Temple University Hospital (Philadelphia, PA) who received admission CXR and chest CT scans that were performed within 24 hours of admission. Scans were independently reviewed by a group of radiologists. CXRs was interpreted as “consistent with COVID-19” if there were lower lobe peripheral opacities. Chest CTs were evaluated for the presence of ground glass opacities, consolidations, interlobular septal thickening, centrilobular nodules, and crazy paving pattern. Chest CT was also assessed for background lung disease (emphysema, interstitial lung disease). Results: Of the 559 patients, median age was 58 years old, 55.5% were female, and 56.7% were African American. Median BMI was 31.61. Median duration of symptoms at time of chest imaging was 5 days. 153 (27.4%) of patient's admission CXR was not consistent with COVID-19. Of those, 124 (81%) had abnormalities on chest CT. Median number of lobes involved with disease on CT was 3.8 and 317 patients (56.7%) had all 5 lobes with disease. The most common abnormalities found were ground glass opacities (n=507, 90.7%), consolidations (n=224, 40%) and centrilobular nodules (n=127, 22.7%). Less common findings included pleural effusion (n=62, 11.8%), lymphadenopathy (n=55, 9.8%), pericardial effusion (n=24, 4.2%), and pneumothorax (n=3, 0.53%). Of note, 82 (14.7%) patients were found to have emphysema, and 2 (0.35%) were found to have interstitial lung disease. Conclusion: We present one of the largest reviews of CT scans in patients admitted for COVID-19. The majority of our population had significant burden of disease on CT at time of presentation. Ground glass opacities and consolidations were the predominant findings. Most patients did not have background emphysema or interstitial lung disease. The fact that many patients with normal CXR had abnormalities on chest CT highlights the utility of chest CT in evaluating patients with COVID-19.
ABSTRACT
Rationale: The novel coronavirus disease-19 (COVID-19) has overwhelmed global healthcare systems. It would be beneficial to identify clinical signs that predict adverse outcomes to anticipate clinical deterioration and optimize management. COVID-19 has presented with a variety of patterns on computed tomography (CT) and these findings may assist in disease stratification. This study aims to identify potential CT characteristics that may portend adverse outcomes. Methods: This is a retrospective review of 559 symptomatic patients infected with COVID-19 admitted from March 2020 to May 2020 at Temple University Hospital (Philadelphia, PA) who received thorax CT scans on admission. These scans were independently reviewed by a chest radiologist and evaluated for the presence of ground glass opacities, consolidations, interlobular septal thickening, enlarged pulmonary artery (PA) diameter, centrilobular nodules, and crazy paving pattern. Common CT findings were then associated with a combined adverse inpatient outcome (requiring high-flow oxygen, mechanical ventilation, and/or death) through univariate and multivariate logistic regression. Results: Of the 559 patients, 182 (32.6%) required high-flow oxygen, mechanical ventilation, and/or died. The cohort with adverse outcomes were older (mean age 65.0 years vs 56.7 years, p<0.0001), but had statistically similar gender, BMI and duration of symptoms compared to the cohort without adverse outcomes. The adverse outcome cohort had more COPD (18.7% vs 8.2%) but had statistically similar proportions of hypertension, diabetes, asthma, coronary artery disease, and congestive heart failure. On multivariate logistic regression, a PA diameter greater than 30mm (OR 1.056 [95% CI 1.015-1.097], p=0.0064), segmental consolidations (OR 2.359 [95% CI 1.446-3.848], p=0.0009), and non-segmental consolidations (OR 2.441, [95% CI 1.440-4.140], p=0.0009) were found to be significant predictors of adverse inpatient outcomes of either requiring high-flow nasal cannula, mechanical ventilation, or death. Conclusion: In symptomatic COVID-19 patients, enlarged PA diameter and consolidations on chest CT were associated with worse outcomes. These findings are likely representative of advanced pulmonary involvement and may be predictors of patients who require more aggressive upfront therapy. Multicenter analysis would be beneficial to confirm these findings.
ABSTRACT
Most day-to-day decision making of paramedics is made in an environment where resources are not truly scarce, or not soon likely to be. Paramedics are therefore able to apply an ethical approach to their work that upholds their duty to provide patient-centred care that is in the best interests of the patient. Paramedics can and do apply a broader community-minded approach to triage at mass casualty events. However, what may be new and associated with the unprecedented public health emergency that is COVID-19 is that paramedics will now be required to make such rationing decisions across a much longer period of time for a far larger number of people. This short commentary aims to begin the discussion about the legal and ethical changes to paramedic practice that are likely to occur over the next 6 to 12 months in response to the COVID-19 crisis.