Lipase Elevation in Patients With COVID-19.

INTRODUCTION: Although coronavirus disease (COVID-19) has been associated with gastrointestinal manifestations, its effect on the pancreas remains unclear. We aimed to assess the frequency and characteristics of hyperlipasemia in patients with COVID-19. METHODS: A retrospective cohort study of hospitalized patients across 6 US centers with COVID-19. RESULTS: Of 71 patients, 9 (12.1%) developed hyperlipasemia, with 2 (2.8%) greater than 3 times upper limit of normal. No patient developed acute pancreatitis. Hyperlipasemia was not associated with poor outcomes or symptoms. DISCUSSION: Although a mild elevation in serum lipase was observed in some patients with COVID-19, clinical acute pancreatitis was not seen.

Strategies to meet blood demand for transfusions during the COVID-19 pandemic: lessons learnt from a large central hospital in Malawi

Background: The coronavirus disease-19 (COVID-19) pandemic affected blood banks globally. We sought to examine how COVID-19 affected blood supply and transfusion in our institution. Method(s): The study was conducted at the Queen Elizabeth Central Hospital (QECH) and the Malawi Blood Transfusion Service (MBTS) in Malawi. Data from April to November 2020, collected during the pandemic, were compared with data from the same time period in 2019 pre-COVID-19. Additionally, in-depth interviews with key personnel were conducted at both institutions. Statistical analysis was performed using Stata 15 and qualitative data were analyzed using Nvivo software. Result(s): There was a significant reduction in blood supplied to the QECH from 7,303 [2019] to 6,028 units [2020] (P<0.04). The highest reduction in blood supply was to the Adult Emergency & Trauma department (29%) while the lowest was in Obstetrics & Gynecology, and Pediatric departments (17% reduction each). This is despite that the transfusion services continued to conduct blood drives during the pandemic, and the hospital laboratory prioritized blood issuing for emergency indications. Conclusion(s): Blood supply has significantly reduced during COVID-19 pandemic in our centers. Developing plans for overcoming similar shortages in future pandemics is critical.Copyright © Annals of Blood. All rights reserved.

Structural Competence and Equity-Minded Interprofessional Education: A Common Reading Approach to Learning

As a result of the COVID-19 pandemic and the Black Lives Matter movement, leaders in the field of interprofessional (IP) education have encouraged faculty to explore online adaptations to curriculum and examine strategies that enhance students' structural competence. Structural competence is broadly defined as the ability to understand how oppression, governmental policies, and environmental inputs impact the health and well-being of an individual. With these changes in mind, a team of IP health science faculty developed two online curricular activities guided by the "common reading” book, Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital by Sheri Fink. This article describes the development and findings of a mixed-methods evaluation of the two IP learning activities: (a) The Interprofessional Common Reading Experience (IPCRE) and (b) The IPCRE follow-up. The activities engaged over 250 students across multiple health professions (i.e., social work, nursing, athletic training, speech-language pathology, nutrition, and public health) attending three different universities. Our findings contribute to a greater understanding of how to develop online IP activities and curricular innovations that help to train equity-minded and anti-racist practitioners. © 2023 by the authors.

Can Personality Traits Predict Students' Satisfaction with Blended Learning during the COVID-19 Pandemic?

The present study aimed to assess the impact of personality traits on student satisfaction with blended learning which many higher education institutions have adopted since the COVID-19 pandemic in the UK. Personality traits were assessed using the International Personality Item Pool and student satisfaction was recorded on a 7-point Likert scale. Data analysis of 72 undergraduate students revealed that low extraversion and high neuroticism predicted higher levels of student satisfaction. Implications are discussed considering the current pandemic with a view of increasing student satisfaction and in-turn improving National Student Survey results that impact on Teaching Excellence Framework scores and league tables. © 2022 The Author(s). Published with license by Taylor & Francis Group, LLC.

Health experiences of the multiple sclerosis community during the second year of the COVID-19 pandemic, plans for future crises

Objectives & Aims: To investigate the health and healthcare experiences of persons with multiple sclerosis (MS) in the second year of the COVID-19 pandemic, including gathering community opinions to inform future crisis planning. Method(s): Second year data collection of a longitudinal consumer directed mixed-methods study. An online survey followed by semi structured interviews took place August-October 2021. Participants were Australian persons with MS, carers, MS-healthcare providers and MS advocates, most interviewed participants were returnees from the original 2020 interviews. The survey and interviews established health-related experiences in the second year of the pandemic and opinions on the needs of persons with MS for future crises. Qualitative data were analysed using a general inductive approach. Result(s): The study was completed by 34 persons (persons with MS:18, Carers:5, healthcare professionals:6, MS advocacy employees:5) from across Australia. Themes of healthy lifestyle, accessing healthcare and medication, accessing information, and plans of action were identified. Participants discussed and suggested helpful management strategies for the MS community during future crises including mental health services, increased accessibility to preventative measures, and healthcare and rehabilitation consistency through the crisis. Conclusion(s): The health and health-management implications of the COVID-19 pandemic are ongoing and represent one community crisis affecting Australians with MS. Consumer informed preparation models, such as those which include access to mental health services and consistency in healthcare and rehabilitation services are wanted by the MS community.

Renal Pathology of Fatal Cases of COVID-19: A Study of 94 Autopsies

Background: Acute kidney injury (AKI) is a serious complication of infection with SARS-CoV-2 and it associated with high mortality. Post-mortem examination of kidney & lung of these patients allows a logistical assessment of the glomerular & vascular events. This is one of the largest North American autopsy series with details on renal lesions correlated with lung microthrombi. Method(s): From April 2020 to July 2021, a total of 94 autopsy cases were examined: 82 COVID-19 cases examined prospectively, & 12 control cases with similar comorbidities, retrospectively from the pre-COVID-19 era. Demographics, clinical presentation, cause of death, laboratory results were collected & pathologic findings, focusing on the following pathological lesions were studied: 1- collapsing glomerulopathy (CG), 2- evidence of thrombotic microangiopathy (TMA), i.e., presence of any glomerular microthrombi +/- thrombi in arteries/arterioles & acute tubular injury & necrosis (ATI-ATN);3- topography of the lesions in cortex;4- presence of pulmonary microthrombi. Beside routine stains used in renal pathology, Martius-scarlet-blue (MSB) stain and immunohistochemistry for fibrin were performed on 54 cases to detect microthrombi. Result(s): In the COVID-19 group composed of 82 cases, CG was observed in 40 (49%) cases, of whom only 14 (35%) were of African descent;TMA in 32 (39%);combined CG + TMA in 16 (19%) & ATI-ATN in 29 (35%). In the control group composed of 12 cases, TMA was observed in 3 (25%), ATI-ATN in 6 (50%) and no CG was found. Lung microthrombi examined in 35 cases were found in 19 cases (54%), 14 (40%) cases having TMA in the kidney. Statistical analysis of Variance showed a p-value of 0.0847, reflecting trending correlation between presence of TMA and CG. Conclusion(s): TMA, CG, and ATI-ATN were the main renal pathologic findings in our study. Wedge-shaped areas of cortical scarring suggesting a vascular pattern were observed. Co-incidence of TMA & CG was observed in half of the cases, suggesting an association between TMA & CG. Only a percentage of cases with CG were of African descent suggesting a second pathogenesis (other than podocyte injury related to APOL-1) for CG: In patients of non-African descent, TMA may be the pathogenesis behind the development of CG.

Impact of Telemedicine on Prenatal Counseling at a Tertiary Fetal Center: A Mixed Methods Study.

INTRODUCTION: COVID-19 spurred an unprecedented transition from in-person to telemedicine visits in March 2020 at our institution for all prenatal counseling sessions. This study aims to explore differences in demographics of expectant mothers evaluated pre- and post-telemedicine implementation and to explore the patient experience with telemedicine. METHODS: A mixed methods study was completed for mothers with a pregnancy complicated by a fetal surgical anomaly who visited a large tertiary fetal center. Using medical records as quantitative data, patient information was collected for all prenatal visits from 3/2019 to 3/2021. The sample was grouped into pre- and post-telemedicine implementation (based on transition date of 3/2020). Univariate analysis was used to compare demographics between the study groups. Statistical significance was defined as P < 0.05. Eighteen semi-structured interviews were conducted from 8/2021 to 12/2021 to explore patients' experiences. Line-by-line coding and thematic analysis was performed to develop emerging themes. RESULTS: 292 pregnancies were evaluated from 3/2019 to 3/2021 (pre-telemedicine 123, post-telemedicine 169). There was no significant difference in self-reported race (P = 0.28), ethnicity (P = 0.46), or primary language (P = 0.98). In qualitative interviews, patients reported advantages to telemedicine, including the convenience of the modality with the option to conduct their session in familiar settings (e.g., home) and avoid stressors (e.g., travel to the medical center and finding childcare). Some women reported difficulties establishing a physician-patient connection and a preference for in-person consultations. CONCLUSIONS: There was no difference in patient demographics at our fetal center in the year leading up to, and the time following, a significant transition to telemedicine. However, patients had unique perspectives on the advantages and disadvantages of the telemedicine experience. To ensure patient centered care, these findings suggest patient preference should be considered when scheduling outpatient surgical counseling and visits.

Improving Voluntary Engagement for PTSD Treatment Among Soldiers

Year 2 focused on completing pre-trial activities, including finalizing the clinical and control PTSD interventions, corresponding counselor manuals, research protocols, recruitment advertisements, and recruitment plan. Year 2-4 have primarily focused on randomized controlled trial (RCT) activities (Phase 2), including recruitment, enrollment and data collection that began in January 2018. We obtained necessary approvals for Phase 2 from University of Washington IRB, Madigan IRB, and HRPO.

How Do Presenting Symptoms and Outcomes Differ by Race/Ethnicity Among Hospitalized Patients With Coronavirus Disease 2019 Infection? Experience in Massachusetts.

BACKGROUND: Population-based literature suggests severe acute respiratory syndrome coronavirus 2 infection may disproportionately affect racial/ethnic minorities; however, patient-level observations of hospitalization outcomes by race/ethnicity are limited. Our aim in this study was to characterize coronavirus disease 2019 (COVID-19)-associated morbidity and in-hospital mortality by race/ethnicity. METHODS: This was a retrospective analysis of 9 Massachusetts hospitals including all consecutive adult patients hospitalized with laboratory-confirmed COVID-19. Measured outcomes were assessed and compared by patient-reported race/ethnicity, classified as white, black, Latinx, Asian, or other. Student t test, Fischer exact test, and multivariable regression analyses were performed. RESULTS: A total of 379 patients (aged 62.9 ± 16.5 years; 55.7% men) with confirmed COVID-19 were included (49.9% white, 13.7% black, 29.8% Latinx, 3.7% Asian), of which 376 (99.2%) were insured (34.3% private, 41.2% public, 23.8% public with supplement). Latinx patients were younger, had fewer cardiopulmonary disorders, were more likely to be obese, more frequently reported fever and myalgia, and had lower D-dimer levels compared with white patients (P < .05). On multivariable analysis controlling for age, gender, obesity, cardiopulmonary comorbidities, hypertension, and diabetes, no significant differences in in-hospital mortality, intensive care unit admission, or mechanical ventilation by race/ethnicity were found. Diabetes was a significant predictor for mechanical ventilation (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.11-3.23), while older age was a predictor of in-hospital mortality (OR, 4.18; 95% CI, 1.94-9.04). CONCLUSIONS: In this multicenter cohort of hospitalized COVID-19 patients in the largest health system in Massachusetts, there was no association between race/ethnicity and clinically relevant hospitalization outcomes, including in-hospital mortality, after controlling for key demographic/clinical characteristics. These findings serve to refute suggestions that certain races/ethnicities may be biologically predisposed to poorer COVID-19 outcomes.

A multi-centre service evaluation of the impact of the COVID-19 pandemic on presentation of newly diagnosed cancers and type 1 diabetes in children in the UK

Background The COVID-19 pandemic led to changes in patterns of presentation to Emergency Departments. Child health professionals were concerned that this could contribute to the delayed diagnosis of life-threatening conditions, including childhood cancer (CC) and type 1 diabetes (T1DM). Objectives Our multicentre, UK-based service evaluation assessed diagnostic intervals and disease severity for these conditions. Methods We collected presentation route, timing and disease severity for children with newly diagnosed CC in three principal treatment centres between January-June 2020 and T1DM in four centres between January-July 2020. We compared these to the corresponding period in 2019. The impact of lockdown on total diagnostic interval (TDI), patient interval (PI), system interval (SI) and disease severity were evaluated. Results Children with new diagnosis of CC (n=253) and T1DM (n=187) were included in the analysis. Overall there was a 17% reduction (138 vs 115) in number of incident CC cases and 9% reduction (98 vs 89) in T1DM cases between 2019 and 2020, with some regional variation. No significant differences in gender, ethnic background or age at diagnosis between study periods were observed. The route to diagnosis and severity of illness at presentation were unchanged across all time periods. Median diagnostic interval for CCs during lockdown was comparable to that in 2019 (TDI 4.6, PI 1.1 and SI 2.1 weeks), except for an increased PI during pre-lockdown period Jan-Mar 2020 (2.7 weeks) (table 1). Median diagnostic interval for T1DM during lockdown was similar to that in 2019 (TDI 16 vs 15 and PI 14 vs 14 days), except for an increased PI in pre-lockdown period Jan-Mar 2020 (21 days) (table 2). Conclusions There is no evidence of diagnostic delay or increased illness severity for CC or T1DM during the first lockdown in the participating centres. This provides reassuring data for children and families with these life-changing conditions. Data collection at a more comprehensive national level would provide greater clarity on diagnostic intervals.

Cytomegalovirus Reactivation after Bendamustine-Based Chemotherapy: A Case Report

Cytomegalovirus (CMV) is a DNA hepadnavirus, commonly implicated in reactivation disease after immunosuppression, especially in solid-organ and stem cell transplant patients. Bendamustine is an alkylating chemotherapeutic agent introduced into the management of hematological malignancies within the last decade. Few reports have raised potential concern for CMV reactivation disease after bendamustine therapy involving, but not limited to, the gastrointestinal tract, lungs, retina, and viremia. Cytomegalovirus reactivation in such instances should be added to the differential diagnoses for febrile nonneutropenic immunocompromised patients. Here, we report a case of an elderly gentleman recently diagnosed with mantle cell lymphoma who was started on chemotherapy with rituximab, bendamustine, and dexamethasone and developed CMV colitis and viremia after just 2 cycles of chemotherapy.

Improving post-operative care during COVID-19 pandemic: Wearable sensors identify clinical deterioration in patients monitored at home following radical cystectomy

Introduction: Radical cystectomy (RC) has 30-day and 90-day re-admission rates of 15% and 20% respectively. Majority of complications such as infective and bowel-related are frequently associated with changes in vital signs. The primary aim was to compliance and feasibility of using remote monitoring in patients discharged following RC. Secondary endpoints included monitoring for adverse events. Materials & Methods: Patients consented to a 30-day monitoring period commencing on discharge (Day 1). A wearable sensor was worn continuously, intermittent monitoring and a PROM (quality-of-recovery-15 questionnaire (QoR15) was also completed using a bespoke app. Data was collected in real-time to a secure server (Ethera.health) was assessed in the DREAMPath study (ISRCTN62293620). Readmission and complications (CD grades I-V) were recorded. Results: Compliance with the wearable device and interaction with the app and PROM was high. In 16% of cases a significant adverse event necessitating readmission was recorded. On average 5,687 data points were collected for each case over 30 days. A measure of physiological performance status derived from the wearable device alone was applied across the study cohort and identified clinical deterioration in 75% of cases at least 48 hrs before readmission. A combination of performance measurement and the QoR15 identified clinical deterioration in all cases prior to admission. Conclusions: Remote monitoring is feasible, and patients can engage with it with minimal effort. In the COVID era, this is invaluable as this data can be used to triage patients remotely and treat complications early.

The effect of the Australian bushfires and the COVID-19 pandemic on health behaviours in people with multiple sclerosis.

BACKGROUND: Crises and disasters disproportionally impact people with chronic health conditions such as multiple sclerosis (MS). OBJECTIVE: To assess the impact of the COVID-19 pandemic and the Australian Black Summer Bushfires on health behaviours in people with MS. METHODS: People with MS, carers, healthcare and advocacy professionals were recruited online between May-July 2020 for an online survey and telephone interviews. RESULTS: Survey items relating to health behaviours were completed by 113 people with MS, and 18 people with MS, 4 MS advocates, 5 healthcare professionals, and 2 carers were interviewed. The bushfires affected 34.5% and the pandemic affected 74.3% of survey participants with MS. The pandemic and bushfires caused a decrease in physical activity in 53.8% and 55.3% of participants respectively, as well as increases in unhealthy eating (43.6% and 24.3% respectively) and alcohol consumption (35.4% and 10.5% respectively), and a decrease in typical sleeping patterns (40.5% and 39.5% respectively). Conversely, 27.5% of participants reported an increase in physical activity during the pandemic. Interview data detailed the circumstances and motivations for changes in health behaviours, as well as consequences, including reduced mobility, fitness, mood disturbances, and weight gain. CONCLUSION: There is a need to increase support and health promotion for people with MS to maintain or initiate positive health behaviours, especially in times of adversity.

Strategies for efficient adaptation in a pandemic: A decision-making flowchart from an integrative oncology wellness center

Objective: To support implementation at other integrative health institutions, this poster describes the processes and tools necessary to rapidly establish virtual and distance healthcare options for a variety of integrative treatment modalities to serve as a template for other healthcare facilities. Methods: The Wellness and Integrative Health Center (WIHC) at Huntsman Cancer Institute (HCI) provides primarily in-person and hands-on patient visits for supportive oncology services. With the COVID-19 pandemic dramatically changing the landscape of in-person healthcare, The WIHC worked to quickly roll-out virtual and telemedicine appointments for most of its offerings over the course of only two weeks in March and April 2020. This poster visually showcases key decision-making processes and workflows to prepare and implement necessary technologies, documents, staff trainings, and other key components for a successful and swift transition to telehealth and virtual wellness services. The poster will also display ideas and strategies for utilizing and retaining staff and funding for hands-on modalities that cannot translate to a virtual alternative. Results: The WIHC successfully transitioned physician physical assessments, supervised exercise prescriptions, nutrition, music therapy, art therapy, and group fitness classes to virtual and online alternatives with a high rate of patient retention and satisfaction. Full-time acupuncturists and massage therapists were reassigned to work-fromhome tasks or other administrative and COVID-safety related tasks within the HCI building. Conclusion: The COVID-19 pandemic prompted many healthcare facilities to quickly adapt healthcare treatments and day-to-day operations into online and telehealth offerings. The in-person and hands-on modalities found at Huntsman Cancer Institute's WIHC forced our team to utilize creative and unprecedented measures to ensure continuity of care for our patients. The WIHC team and its leadership hope that by sharing its rapid and adaptable response to clinical and supportive services it can help other wellness programs and healthcare facilities adapt to future emergency and disaster situations. Education Research.

Study of presentation of new cases of childhood diabetes mellitus during the COVID pandemic at a tertiary University UK hospital

Introduction & objectives: The COVID pandemic has stimulated profound change in health care with societal restraint to control the spread of the virus through reduced human contact balanced with encouragement to seek appropriate advice in case of medical emergency. Delayed diagnosis of Type 1 diabetes can lead to Diabetic Ketoacidosis (DKA) with significant morbidity and mortality. We obtained base line referral and disease grading data for new presentations of diabetes for the first half of 2019 and 2020 to compare changes in referral pathways if any. Methods: Information regarding demographics, COVID-19 selfisolation status, and time to diagnosis were extracted from medical notes. Descriptive analyses, t test, ANOVA, χ2 test, Mann-Whitney U or Kruskal-Wallis tests were used to describe patterns of service utilization, and compare the differences of key measures. Result: 26 new cases of T1DM in the first half of 2019 versus 27 cases in 2020. ∗ Total diagnostic interval: time from symptom onset to diagnosis Patient interval: interval between symptom onset to first presentation to healthcare. System interval: interval between first presentation to health care and diagnosis. Route to diagnosis was through primary care in the majority of cases. In the last quarter (covering the period of lockdown), 2/16 of families were shielding and 4/16 parents reported that they would have sought advice sooner in normal times on direct questioning. Conclusion: While the COVID pandemic has created a unique situation with ED and GP attendances reduced by over half across the UK, locally at our Children's hospital, this has not led to delays in seeking treatment or an increased incidence of DKA in children presenting with newly diagnosed diabetes.

High Prevalence of Gastrointestinal Manifestations of COVID-19 Infection in Hospitalized Patients With Cancer.

BACKGROUND AND AIM: Gastrointestinal (GI) symptoms have been reported with SARS-CoV-2 infection, but data on the prevalence and severity of GI symptoms in patients with cancer are limited. We sought to characterize the GI manifestations of coronavirus disease-19 (COVID-19) in oncology patients. MATERIALS AND METHODS: We performed a multicenter cohort study of adult patients hospitalized with COVID-19 in 9 Massachusetts medical centers and identified those with an active malignancy. We evaluated the prevalence and severity of GI symptoms among hospitalized COVID-19 patients with cancer. RESULTS: Of 395 hospitalized patients with COVID-19, 36 (9%) had an active malignancy. Of the 36 cancer patients, 23 (63%) reported ≥1 new GI symptom. The most prevalent symptoms were anorexia (12, 52%), diarrhea (9, 39%), and vomiting (8, 35%). GI symptoms were the initial symptom in 4/36 (11%) patients, were the predominant symptom in 5/36 (14%) patients, and were severe in 4/23 (17%) patients. Four of 5 patients with GI symptoms at presentation reported concurrent fever; notably 1 patient had no fever or respiratory symptoms. Twelve (33%) patients had elevations in liver transaminases at presentation; patients with elevated transaminases were more likely to have associated GI symptoms (83% vs. 54%, P=0.04). CONCLUSIONS: Acute GI symptoms associated with COVID-19 are highly prevalent in hospitalized cancer patients and can occur as a presenting symptom without respiratory symptoms. Symptoms are severe in a small subset of patients.

Development and external validation of a prediction risk model for short-term mortality among hospitalized U.S. COVID-19 patients: A proposal for the COVID-AID risk tool.

BACKGROUND: The 2019 novel coronavirus disease (COVID-19) has created unprecedented medical challenges. There remains a need for validated risk prediction models to assess short-term mortality risk among hospitalized patients with COVID-19. The objective of this study was to develop and validate a 7-day and 14-day mortality risk prediction model for patients hospitalized with COVID-19. METHODS: We performed a multicenter retrospective cohort study with a separate multicenter cohort for external validation using two hospitals in New York, NY, and 9 hospitals in Massachusetts, respectively. A total of 664 patients in NY and 265 patients with COVID-19 in Massachusetts, hospitalized from March to April 2020. RESULTS: We developed a risk model consisting of patient age, hypoxia severity, mean arterial pressure and presence of kidney dysfunction at hospital presentation. Multivariable regression model was based on risk factors selected from univariable and Chi-squared automatic interaction detection analyses. Validation was by receiver operating characteristic curve (discrimination) and Hosmer-Lemeshow goodness of fit (GOF) test (calibration). In internal cross-validation, prediction of 7-day mortality had an AUC of 0.86 (95%CI 0.74-0.98; GOF p = 0.744); while 14-day had an AUC of 0.83 (95%CI 0.69-0.97; GOF p = 0.588). External validation was achieved using 265 patients from an outside cohort and confirmed 7- and 14-day mortality prediction performance with an AUC of 0.85 (95%CI 0.78-0.92; GOF p = 0.340) and 0.83 (95%CI 0.76-0.89; GOF p = 0.471) respectively, along with excellent calibration. Retrospective data collection, short follow-up time, and development in COVID-19 epicenter may limit model generalizability. CONCLUSIONS: The COVID-AID risk tool is a well-calibrated model that demonstrates accuracy in the prediction of both 7-day and 14-day mortality risk among patients hospitalized with COVID-19. This prediction score could assist with resource utilization, patient and caregiver education, and provide a risk stratification instrument for future research trials.