Relationship between Covid 19 Vaccination and Psa Level

INTRODUCTION AND OBJECTIVE: Some reports have indicated that the COVID vaccine could affect parameters used for some cancer screenings. The effect of COVID vaccination on breast cancer screening mammograms has been hotly debated and anecdotal reports of a rise in prostate-specific antigen (PSA) after COVID vaccination have appeared in the media. We explored the relationship between PSA levels and COVID vaccination. METHOD(S): With IRB approval, we queried the electronic medical record for men who received at least two mRNA COVID vaccine injections (Pfizer or Moderna), at least one PSA test within two years prior to the first vaccine injection and at least one PSA within one year of their second injection and before any third injection. PSA results were grouped according to the timing of the post vaccination PSA. The pre-vaccine PSA closest to the first injection was used. Both within and between subject analyses were conducted. Wilcoxon signed rank tests were performed to compare PSAs pre- and post- vaccine for each time defined group. McNemar tests were used to assess the percentage of patients crossing a 4.0 ng/dl threshold when compared with their prevaccine PSA. Difference in relative PSA change across the groups was compared using a Kruskal Wallis test. RESULT(S): 5713 men met inclusion criteria. Median prevaccine PSA was 1.2 ng/dl (IQR 0.6-2.7 ng/dl). The median time difference between vaccine injection 1 and 2 was 22 days (IQR 21- 28 days). Within each time group, a significant increase in PSA was observed pre to post and a higher proportion of men went above 4.0 relative to those going below. However, no significant differences were observed across groups (Table 1). CONCLUSION(S): Due to the lack of intergroup differences, PSA increases most likely reflect natural progression rather than any temporal effect of vaccination.

NURSING HOME ADMINISTRATOR EXPERIENCES DURING COVID-19: AN EXPLORATORY STUDY

Nursing homes have been the epicenter for the COVID-19 pandemic;149,107 residents and over 2,200 staff have died of COVID-19. In addition to the loss of lives, 99% of nursing homes report staffing shortages. Various exploratory studies have emerged gathering the experiences of frontline nursing home staff during COVID-19, however less is known about the experiences of Nursing Home Administrators (NHA) responsible for overseeing personnel and operating a facility in line with shifting state and federal mandates. Thus, this study explores the experiences of NHA during the pandemic. A cross-sectional online survey was conducted. In addition to demographic and facility-level questions, open-ended questions explored prior training on infection prevention, day-to-day operational challenges, needs, and considerations of leaving their role as administrator. The total sample (N=60) included 47 NHA of record and 13 assistant administrators/other;53% worked in corporate NHs and 23% were part of continuing care retirement communities. Respondents report prior infection prevention training, but indicate it was not adequate preparation for COVID-19. Moreover, administrators describe challenges in recruiting and retaining staff, and in supporting staff mental health needs (e.g., burnout, PTSD). The majority of NHAs endorse a desire to step away from their role, but indicate a commitment to residents keeps them from resigning. Findings indicate that NHAs, like other members of the NH team, have experienced the effects of COVID-19, and point to specific training and support needs to equip NHAs for work in the context of this pandemic and future emergencies.

The vagus nerve: current concepts in anaesthesia and ICU management

The vagus nerve (XN) is a major component of the autonomic nervous system. It plays an important role both in the regulation of metabolic homeostasis and in inflammatory modulation. XN tone is dampened in stress conditions (either of inflammatory and/ or infectious origin) and the preservation of parasympathetic function may serve as a biomarker of general health, longevity and vitality. COVID-19 remains a major healthcare issue worldwide. Excessive inflammation and its end organ consequences are key elements in the pathogenesis of COVID-19-induced multiple organ dysfunction, as well as post-COVID-19 syndrome (long COVID). XN stimulation has been hypothesised to control both the SARS-CoV-2 replication and the ensuing inflammation, and could improve the clinical outcomes as an adjunct treatment. Electrical stimulation of the auricular XN (AXNS) is an emerging technology, with few side effects and anaesthetic implications, and is showing promise with respect to the management of gastroparesis, epilepsy, migraine, autoimmune diseases, anxiety and major depressive disorders, obesity, SARS-CoV-2 infection in the intensive care unit (ICU), and long COVID. Continuous vagal tone monitoring in patients with COVID-19 may potentially also be used as a predictive marker of the COVID-19 illness course, and an evaluation of future therapies. Copyright © 2022 The Author(s).

Firm Survival and Gender of Firm Owner in Times of COVID-19: Evidence from 10 European Countries

This paper uses firm level data from World Bank Enterprise surveys conducted in 2019, and COVID-19 follow-up surveys conducted in 2020, in ten European countries to investigate the link between the gender of the firm’s owner and the firm’s survival until 2020. The empirical investigation uses econometric models that control for the firm’s characteristics that are known to be related to firm survival. The estimated effect of female ownership is positive ceteris paribus. Furthermore, the size of this estimated effect can be considered to be large on average. Having a female owner helped firms to survive. © 2022 by the author. Licensee MDPI, Basel, Switzerland.

Interplay Between Risk Perception, Behavior, and COVID-19 Spread

Pharmaceutical and non-pharmaceutical interventions (NPIs) have been crucial for controlling COVID-19. They are complemented by voluntary health-protective behavior, building a complex interplay between risk perception, behavior, and disease spread. We studied how voluntary health-protective behavior and vaccination willingness impact the long-term dynamics. We analyzed how different levels of mandatory NPIs determine how individuals use their leeway for voluntary actions. If mandatory NPIs are too weak, COVID-19 incidence will surge, implying high morbidity and mortality before individuals react;if they are too strong, one expects a rebound wave once restrictions are lifted, challenging the transition to endemicity. Conversely, moderate mandatory NPIs give individuals time and room to adapt their level of caution, mitigating disease spread effectively. When complemented with high vaccination rates, this also offers a robust way to limit the impacts of the Omicron variant of concern. Altogether, our work highlights the importance of appropriate mandatory NPIs to maximise the impact of individual voluntary actions in pandemic control. Copyright © 2022 Dönges, Wagner, Contreras, Iftekhar, Bauer, Mohr, Dehning, Calero Valdez, Kretzschmar, Mäs, Nagel and Priesemann.

DEGREE AND PATTERN OF ELEVATED HEPATOBILIARY ENZYMES ARE PROGNOSTIC OF SEVERE CLINICAL OUTCOMES IN HOSPITALIZED COVID-19 PATIENTS

Elevated transaminases are common in hospitalized patients with Covid-19 and may be related to disease severity. However, few studies have examined the degree of transaminase elevation and their relation to outcomes of disease severity. In this retrospective cohort review study of 135 patients admitted to a single academic community hospital between March 1st, 2020-July 1st, 2020, we used multivariate logistic regression to determine if patients with higher peak transaminases, defined as the highest laboratory value obtained during admission, categorized into 1-2 times (X) the upper limit of normal (ULN), 2-5X ULN or >5X ULN, had different clinical outcomes, relative to those with normal transaminases. Relative to patients with normal transaminases during hospitalization, patients with peak Aspartate Aminotransferase (AST) >2X ULN were found to have multiple clinical outcomes of disease severity (Figure 1A), including need for intubation by an adjusted odds ratio (aOR) of 11.58 (95% CI: 3.61, 42.86), vasopressors by an aOR 7.70 (95% CI: 2.09, 33.31), ICU admission by an aOR of 9.81 (95% CI: 3.07, 34.72) and ICU stay > 7days by an aOR of 6.30 (95% CI: 1.71, 27.06). Interestingly, patients with peak Alanine Aminotransferase (ALT) > 1X ULN were found to have similar outcomes (Figure 1B), including need for intubation by an aOR of 3.84 (95% CI: 1.16, 14.09), vasopressors by an aOR of 4.75 (95% CI: 1.23, 21.44), ICU admission by an aOR of 6.17 (95% CI: 2.16, 20.18) and ICU stay > 7 days by an aOR of 5.19 (95% CI: 1.57, 19.63). Patients with peak AST and ALT >5X the ULN had a similar profile, but also had increased odds of in-hospital mortality by adjusted odds ratios of 10.79 (95% CI: 1.28, 103.51) and 7.60 (95% CI: 1.03, 57.96), respectively (Figure 1A and B). We additionally found that when categorizing patients by hepatobiliary laboratory abnormality (Figure 2), patients with a predominantly mixed pattern (elevated peak AST or ALT and peak Alkaline Phosphatase) had more clinical outcomes than those with isolated hepatocellular phenotype (isolated peak AST and/or ALT elevation) relative to those with normal labs. Thus, we find that patients with peak AST and ALT above the upper limit of normal, particularly those with >5X ULN, and those with a mixed hepatobiliary laboratory abnormality phenotype have higher odds of multiple clinical events consistent with a severe disease phenotype in Covid-19. Hospitalized patients with these lab findings should be watched closely for clinical deterioration. $Φgure

Loss of an Immunodominant HLA-Α *01:01 Restricted Epitope for CD8+ Cytotoxic T Lymphocytes (CTLs) in the Delta Variant of COVID-19: An Example of Immunologic Escape and Implications for Immunologic Treatment

SARS-COV-2 (COVID-19) has resulted in over 4 million deaths worldwide. While vaccination has decreased mortality, there remains a need for curative therapies for active infections. Uncertainties regarding the duration of post-vaccination immunity and the rapidity of mutational evolution by this virus suggest that it is unwise to rely on preventative measures alone. Humoral and cellular immunity provide selective pressure for the emergence of variant strains which have eliminated target epitopes. Elimination of immunodominant epitopes provides the strongest advantage to newly emerging strains and, consequently, immunodominant epitopes would be expected to be preferentially eliminated compared to subdominant epitopes in emerging variants. Immunologic treatments for SARS-COV-2 need to be continuously reassessed as new sequence information becomes available. TVGN-489 is a clinical grade product consisting of highly enriched, highly potent CD8+ CTLs recognizing peptides derived from COVID-19 gene/ORF products in an HLA restricted manner. CTLs are generated from apheresis products from individuals who have recovered from COVID-19 infections. Lymphocytes are serially primed and selected using APCs from these donors pulsed with small numbers of peptides encoded by the COVID-19 genome predicted or demonstrated to bind to specific HLA class I alleles. The resulting products are typically >95% CD3+/CD8+, >60% positive by tetramer staining and demonstrate strong cytolytic activity with >60% lysis of peptide pulsed targets typically at an effector to target ratio of 3:1 (See Figure). Given the immunologic pressure to lose dominant target epitopes, we assessed whether the peptides derived from genomic sequences from early SARS-COV-2 strains (and successfully used to generate CTLs from donors infected with these early strains) were still present in the more recently evolved Delta variant. Seven peptides were used to generate CTL products restricted by HLA-A*02:01, the most common allele worldwide. These peptides are derived from the spike (S) and nucleocapsid (N) proteins as well as ORF3a and ORF1ab. The contributions of these peptides to the overall cytotoxicity and tetramer staining range from 2% to 18% without clear immunodominance by one of these peptides. Though identified in early viral strains, these sequences persist in 97.5%-100% of the more than 120 Delta variant sequences present in the NIH database. For HLA-A*01:01, eight peptides derived from the matrix (M) protein as well as ORF1ab and ORF3a were utilized to generate CTLs. Seven of the eight peptides showed binding similar to what was seen with the HLA-A*02:01 peptides (1% to 18%). However, in contrast to HLA-A*02:01, an immunodominant peptide (TTDPSFLGRY, ORF1ab 1637-1646) was noted which was responsible for over half of the observed tetramer binding. This region of ORF1ab was mutated in the Delta variant resulting in loss of this immunodominant epitope from nearly 93% of the Delta genomic sequences in the NIH database. The remaining subdominant peptides were all preserved in 100% of the sequences. Given the growing number of Delta cases, it will be essential to remove this peptide from the HLA-A*01:01 peptide pool used to stimulate SARS-COV-2-specific CD8+ CTLs to avoid encouraging the expansion of cells which would recognize early strains of the virus, but not Delta variants. The remaining CTLs, generated in the absence of TTDPSFLGRY, should be capable of eradicating Delta as well as the earlier prototypic strains of COVID-19. The loss of immunodominant epitopes is not surprising in a virus such as SARS-COV-2, with a high frequency of mutation. This provides an example of immunologic escape similar to what has been described for the Delta variant in the case of HLA-A24. These data are consistent with the hypothesis that immunodominant epitopes will be preferentially eliminated as the virus continues to evolve. They further illustrate the need to monitor viral sequences and to tune the production of CTLs in order to ensure that they can continue to recognize and e fectively treat newly emerging variants of COVID-19. [Formula presented] Disclosures: No relevant conflicts of interest to declare. OffLabel Disclosure: The drug is Cytotoxic T lymphocytes that are specific to COVID-19. Preclinical data.

Nanoscale Bioreceptor Layers Comprising Carboxylated Polythiophene for Organic Electrochemical Transistor-Based Biosensors

We investigated the carboxylated conjugated polymer poly 3-(3-carboxypropyl)thiophene-2,5-diyl as a nanosized (200-350 nm) biomolecule receptor layer on the channel of organic electrochemical transistor (OECT) devices. Myelin basic protein, SARS-CoV-2 spike glycoprotein S1, and their antibodies (10 nm size scale) were alternately used in the attached molecule form as receptors and analytes. Sub-ng detection in buffer was observed, and response to S1 was also obtained in clinical serum. Changes in threshold voltage and current output from OECT transfer curves and measurements of open circuit potential between receptor layers and a reference electrode provided complementary responses and insight into the response mechanisms, guiding further development of electrochemical field-effect and voltammetric protein sensors based on polymeric active layers with nanoscale functionality. ©

Novel SARS-CoV-2 variants induce higher toxicity in cardiovascular cells

Objective: SARS-CoV-2 causes the coronavirus disease 2019 (COVID-19) and has spawned a global health crisis. Virus infection can lead to elevated markers of cardiac injury and inflammation associated with a higher risk of mortality. However, it is so far unclear whether cardiovascular damage is caused by direct virus infection or is mainly secondary due to inflammation. Recently, additional novel SARS-CoV-2 variants have emerged accounting for more than 70% of all cases in Germany. To what extend these variants differ from the original strain in their pathology remains to be elucidated. Here, we investigated the effect of the novel SARS-CoV-2 variants on cardiovascular cells. Results: To study whether cardiovascular cells are permissive for SARSCoV-2, we inoculated human iPS-derived cardiomyocytes and endothelial cells from five different origins, including umbilical vein endothelial cells, coronary artery endothelial cells (HCAEC), cardiac and lung microvascular endothelial cells, or pulmonary arterial cells, in vitro with SARS-CoV-2 isolates (G614 (original strain), B.1.1.7 (British variant), B.1.351 (South African variant) and P.1 (Brazilian variant)). While the original virus strain infected iPS-cardiomyocytes and induced cell toxicity 96h post infection (290±10 cells vs. 130±10 cells;p=0.00045), preliminary data suggest a more severe infection by the novel variants. To what extend the response to the novel variants differ from the original strain is currently investigated by phosphoproteom analysis. Of the five endothelial cells studied, only human coronary artery EC took up the original virus strain, without showing viral replication and cell toxicity. Spike protein was only detected in the perinuclear region and was co-localized with calnexin-positive endosomes, which was accompanied by elevated ER-stress marker genes, such as EDEM1 (1.5±0.2-fold change;p=0.04). Infection with the novel SARS-CoV-2 variants resulted in significant higher levels of viral spike compared to the current strain. Surprisingly, viral up-take was also seen in other endothelial cell types (e.g. HUVEC). Although no viral replication was observed (850±158 viral RNA copies at day 0 vs. 197±43 viral RNA copies at day 3;p=0.01), the British SARS-CoV-2 variant B.1.1.7 reduced endothelial cell numbers (0.63±0.03-fold change;p=0.0001). Conclusion: Endothelial cells and cardiomyocytes showed a distinct response to SARS-CoV-2. Whereas cardiomyocytes were permissively infected, endothelial cells took up the virus, but were resistant to viral replication. However, both cell types showed signs of increased toxicity induced by the British SARS-CoV-2 variant. These data suggest that cardiac complications observed in COVID-19 patients might at least in part be based on direct infection of cardiovascular cells. The more severe cytotoxic effects of the novel variants implicate that patients infected with the new variants should be even more closely monitored.

Incidence of gastrointestinal hemorrhage in hospitalized covid-19 patients and subsequent clinical outcomes

Introduction: SARS-CoV-2 infection (COVID-19) is known for its pathologic effects on microvasculature and is proposed to afflict the gastrointestinal tract via the ACE2 receptors. We hypothesize that there is a higher incidence and an increased risk of mortality among Covid-19 patients with gastrointestinal bleeding (GIB). Methods: This retrospective study included 2,711 patients ages 18 years or older who tested positive for Covid-19 between March 2020 through March 2021 at a public hospital in New York City. GIB was documented based on clinical criteria and a decrease in hemoglobin level. Patients were divided into two groups, GIB and non-GIB. We examined baseline characteristics of sex and age, as well as comorbidities including diabetes mellitus type 2, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), hypertension (HTN), heart failure (HF), and proton pump inhibitor (PPI) use. We used T-test for statistical analysis of age and Pearson's chisquared test for the primary outcome of all-cause mortality and the secondary outcomes of acute kidney injury, vasopressor use, and mechanical ventilation. Results: Of 2,711 patients, 205 (incidence of 8.18%) developed GIB. Overall sample characteristics included mean age of 71.15 (SD=16.36) and 63.36 (SD=19.26) for GIB and non-GIB groups, respectively. Males comprised 54.6% of the GIB group and 54.1% of the non-GIB group. Baseline clinical characteristics except for sex significantly differed between groups (p<0.05). The odds of all-cause mortality (OR: 2.604, 95% CI: 1.947, 3.482, p <0.001) were significantly higher in the GIB group. For secondary outcomes, patients with GIB had increased unadjusted odds for acute kidney injury (OR: 3.238, 95% CI: 2.387, 4.392, p <0.001), vasopressor use (OR: 3.004, 95% CI: 2.242, 4.023, p<0.001), and mechanical ventilation (OR: 2.806, 95% CI: 2.079, 3.787, p<0.001). Conclusion: GIB is associated with increased odds for all-cause mortality, mechanical ventilation, vasopressor use, and acute kidney injury compared to patients without GIB. Despite having largely differing baseline characteristics, these findings support studies that suggest a correlation between GI symptoms and Covid-19 disease severity. Future research with a larger sample size is needed. Subsequently, supportive care is key to decreasing morbidity and mortality amongst these patients.

The unusual COVID-19 symptom: Diarrhea in hospitalized patients

Introduction: The Covid-19 virus has been postulated to interact with Angiotensin-converting enzyme 2 (ACE2) receptors in the gut and possibly cause malabsorption. Our study aimed to determine the incidence of diarrhea in patients hospitalized with Covid-19 and determine if there is any association in clinical outcomes. Methods: This retrospective study included 2711 patients ages 18 years or older that were hospitalized and tested positive for SARS-COV2 from 3/1/2020 through 4/1/2021 at a public hospital in New York City. We examined baseline characteristics and comorbidities. T-test for age and Pearson's Chi squared test for statistical analysis were used for the primary outcome of mortality and secondary outcomes of mechanical ventilation, vasopressor use and acute kidney injury. Results: Clinical outcomes of 279 Covid-19 hospitalized patients with diarrhea was compared to 2432 patients without diarrhea. 279/2711 Covid-19 patients were positive for diarrhea (incidence of 10.3%). Overall sample characteristics included mean age inyears (62.81, SD 18.40) and 64.09 (SD 19.25) (p< 0.293) for diarrhea and non-diarrhea groups, respectively. Males comprised 143 (51.3%) in the diarrhea group and 1324 (54.4%) in the non-diarrhea group (p< 0.312). Baseline characteristics and multiple comorbidities (Diabetes, Chronic Kidney Disease, Chronic Obstructive Pulmonary Disease, Heart Failure, Hypertension, and Coronary Artery Disease) were not statistically different (p >0.063) between groups. Overall mortality in the diarrhea group was 71(25.4%) and in the nondiarrhea group was 608 (25%) with odds ratio of 1.024 (0.770-1.36, p< 0.870). For secondary outcomes, we found acute kidney injury odds ratio of 1.131 (0.882 - 1.452, p< 0.332), shock requiring vasopressors odds ratio of 1.010 (0.751-1.358, p< 0.948), and mechanical ventilation odds ratio of 1.150 (0.849 - 1.556, (p< 0.366). Conclusion: Baseline characteristics and comorbidities were not different in patients with and without diarrhea. Even though diarrhea is prevalent in Covid-19 patients, our data suggests that there is no statistically significant difference in primary outcome ofmortality and secondary outcomes of AKI, Vasopressor use, and Mechanical ventilation. These findings could be due to small sample size and future research with a larger population is needed. However, patients should still be treated with supportive care for symptomatic relief.

With a little help from my website. Firm survival and web presence in times of COVID-19 - Evidence from 10 European countries

This paper uses firm level data from the World Bank Enterprise surveys conducted in 2019 and from the COVID-19 follow-up surveys conducted in 2020 in ten European countries to investigate the link between having a website before the pandemic and firm survival until 2020. The estimated effect of web presence is statistically highly significant ceteris paribus after controlling for various firm characteristics that are known to be related to survival. Furthermore, the size of this estimated effect can be considered to be large on average. © 2021. All Rights Reserved.

Comparison of rates of AKI between two COVID-19 surges in hospitalized patients in the bronx

Background: The incidence of AKI in COVID 19 is very variable across the world. In New York City it was as high as 36% in a large series in early 2020. However, the incidence of AKI during the second surge between Oct of 2020 to early 2021 is unknown. In this study, we compared these two COVID-19 periods for the incidence of AKI amongst hospitalized patients. Methods: This was a multi-center, retrospective cohort study of patients hospitalized with COVID-19 between March 1st and July 16th 2020 (n=1,719), and between October 15th 2020 and February 28th 2021(n=997) in two NYC public hospitals, (total n= 2,716). Patients < 18 years, with End Stage Kidney Disease or a kidney transplant were excluded. Chi-squared test and Fisher's exact test were used to compare the clinical characteristics of the patients. A p-value less than 0.05 was considered statistically significant. Results: The baseline clinical characteristics and demographics of the two surges were similar. The incidence of AKI as defined by KDIGO criteria, during admission decreased from 28.7% in the first surge to 18.6% in the second surge (p<0.0001). This trend was seen both at encounter level too as shown below. For laboratory characteristics, more patients with hypernatremia and with peak CRP > 50 (Ref range: <50) presented in the first surge than the second surge (p<0.0001). No differences in the peak potassium and peak D-Dimer, or ICU admission rates were seen between two surges. However, significantly more AKI patients in the first surge were on mechanical ventilation as compared to the second surge (p=0.0196). Conclusions: To our knowledge this is the first comparison reported between rates of AKI in hospitalized patients with COVID-19 during two different surge periods. The difference may be related to less severe disease during the second surge, though ICU admission rate was the same. Better care established by the time of the second surge and improved therapeutics such as early use of anti-viral agents, corticosteroids, and anticoagulation may have contributed to better outcomes. Improvement in care of COVID-19 in the second surge may have contributed to a decline in the incidence of AKI. Future studies are needed to see if this trend towards lower AKI incidence continues.

Coerced application of e-learning in the management accounting course - Critical reflection

The COVID-19 pandemic disabled the traditional classroom learning at Czech Universities in the summer semester of the academic year 2019/2020 and coerced the application of the e-learning approach which lasts until now (spring 2021). This paper reflects both teachers' and students' experience with this change in the management accounting course for undergraduate students at the Prague University of Economics and Business. © 2021 IDIMT 2021 - Pandemics: Impacts, Strategies and Responses, 29th Interdisciplinary Information Management Talks All rights reserved.

Effects of state mandated stay-at-home orders on timely presentation of ischemic stroke patients during the COVID-19 pandemic

Introduction: The ability to treat an acute ischemic stroke depends on the patient's timely presentation to the hospital from their last known well time. During the coronavirus disease 2019 (COVID-19) pandemic, individual state governments enacted stay-at-home orders to slow the transmission of the disease. We collected data from hospitals across four state-based networks where we provide stroke telemedicine coverage to ascertain the effects of these mandates. Objectives: We sought to evaluate the effects of stay-at-home orders on the number of patients evaluated and treated for ischemic stroke during the COVID-19 pandemic, and to evaluate the difference in treatment rate while states were under state-at-home orders versus while they were not. Methods: We retrospectively examined stroke alerts from March 1 to May 30 , 2020. We tabulated total number of stroke alerts, number of IV alteplase and intra-arterial (IA) treatment recommendations, number of less severe strokes (NIHSS 0-6) and more severe strokes (NIHSS 7- 41). Treatment rates were calculated and compared by state-based network before, during, and after the stay-at-home orders. Results: We found that the total number of alerts per week fell by 27.33% during the stay-at-home orders across all state networks. The total number of patients treated with alteplase and total number of patients treated with IA therapy per week also dropped by 29.31% and 13.69%, respectively. The alteplase and IA treatment rate increased by 10.57% and 13.85%, respectively, during the stay-at- home orders. The percentage of total strokes considered more severe slightly increased during these orders, by 5.54%. Conclusion: During the government mandated stay-at-home orders, the total number of patientsevaluated for stroke alerts decreased, as did the total number of patients treated either withalteplase or IA therapy. However, with the decrease in number treated, the rate at which patientswere treated with alteplase, IA, or both, increased. The percentage of total strokes that wereconsidered more severe slightly increased. In conclusion, while stay-at-home orders kept manystroke patients home, the most severe stroke patients continued to present to the hospital and weretreated in a timely manner via telemedicine.

The Evidence Base for Telehealth: Reassurance in the Face of Rapid Expansion During the COVID-19 Pandemic [Internet]

With funding from the AHRQ Effective Health Care Program, the Pacific Northwest Evidence-based Practice Center produced two reports on telehealth: (1) in 2016 an evidence mapon the impact of telehealth on patient outcomes7 and (2) in 2019 a systematic review of the evidence about telehealth for acute- and chronic-care consultations. In this commentary, we summarize evidence on selected topics from these reports that may be relevant in the context of the response to the COVID-19 pandemic.