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1.
Simul Healthc ; 2022 Feb 10.
Article in English | MEDLINE | ID: covidwho-1684924

ABSTRACT

INTRODUCTION: Routine workflows were redesigned during the first surge of the COVID-19 pandemic to standardize perioperative management of patients and minimize the risk of viral exposure and transmission to staff members. Just-in-time (JIT), in situ simulation training was adopted to implement urgent change, the value of which in a public health crisis has not previously been explored. METHODS: Implementation of workflow changes in the setting of the COVID-19 pandemic was accomplished through JIT, in situ simulation training, delivered over a period of 3 weeks to participants from anesthesia, nursing, and surgery, within our healthcare network. The perceived value of this training method was assessed using a postsimulation training survey, composed of Likert scale assessments and free-text responses. The impact on change in practice was assessed by measuring compliance with new COVID-19 workflows for cases of confirmed or suspected COVID-19 managed in the operating room, between March and August 2020. RESULTS: Postsimulation survey responses collected from 110 of 428 participants (25.7%) demonstrated significant positive shifts along the Likert scale on perceived knowledge of new workflow processes, comfort in adopting them in practice and probability that training would have an impact on future practice (all Ps < 0.001). Free-text responses reflected appreciation for the training being timely, hands-on, and interprofessional. Compliance with new COVID workflows protocols in practice was 95% (121 of 127 cases) and was associated with lower than expected healthcare worker test positive rates (<1%) within the network during this same period. CONCLUSIONS: These findings support JIT, in situ simulation training as a preparedness measure for the perioperative care of COVID-19 patients and demonstrate the value of this approach during public health crises.

2.
Journal of Allergy and Clinical Immunology ; 149(2, Supplement):AB320, 2022.
Article in English | ScienceDirect | ID: covidwho-1665046
3.
Allergy Asthma Proc ; 42(6): 515-521, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1607107

ABSTRACT

Background: Acute allergic reactions to messenger RNA (mRNA) vaccines are rare but may limit public health immunization efforts. Objectives: To characterize suspected allergic reactions to the first dose of coronavirus disease 2019 (COVID-19) mRNA vaccine and to assess the safety and utility of a two-step graded-dose protocol for the second dose of the Pfizer-BioNTech vaccine in patients with a history of low suspicion of anaphylaxis to their first dose. Methods: This was a retrospective evaluation of referrals to the allergy and immunology clinic for a presumed allergic reaction to the first dose of the COVID-19 mRNA vaccine (Pfizer-BioNTech or Moderna) between December 17, 2020, and February 28, 2021. Recommendations for the second dose and outcomes were evaluated by trained board-certified allergists. Results: Seventy-seven patients presented with a Pfizer-BioNTech reaction (56 [72.7%]) or with a Moderna reaction (21 [27.3%]). Most patients (69.7%) had symptom onset within 4 hours. Most commonly reported symptoms were cutaneous (51.9%), cardiovascular (48.1%), and respiratory (33.8%) symptoms. Recommendations included to proceed with the single dose (70.1%), two-step graded dose (19.5%), or deferral (10.4%). Twelve of 15 patients completed the second dose with a graded-dose protocol. Of these patients, five reported at least one or more similar symptoms as experienced with their first dose. Conclusion: Of the patients with presumed allergic reactions to their first dose of COVID-19 mRNA vaccine, most were able to safely receive the second dose. For those with a low suspicion of anaphylaxis, the two-step graded protocol with the Pfizer-BioNTech vaccine was well tolerated. A graded-dose protocol could be an effective strategy for second-dose vaccination in those who may otherwise defer the second dose.


Subject(s)
Anaphylaxis/chemically induced , COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Hypersensitivity , Vaccines, Synthetic/adverse effects , Adult , Aged , COVID-19/epidemiology , COVID-19 Vaccines/administration & dosage , Female , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , Vaccines, Synthetic/administration & dosage
4.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-292965

ABSTRACT

Background: Favipiravir is an oral, RNA–dependent RNA polymerase inhibitor with in vitro activity against SARS–CoV2. Despite limited data, favipiravir is administered to patients with COVID-19 in several countries. Methods: We conducted a phase 2 double–blind randomized controlled outpatient trial of favipiravir in asymptomatic or mildly symptomatic adults with a positive SARS–CoV2 RT–PCR within 72 hours of enrollment. Participants were randomized 1:1 to receive placebo or favipiravir (1800 mg BID Day 1, 800mg BID Days 2–10). The primary outcome was SARS–CoV2 shedding cessation in a modified intention-to-treat (mITT) cohort of participants with positive enrollment RT–PCRs. Using SARS–CoV2 deep sequencing, we assessed the impact of favipiravir on mutagenesis. Results: From July 8, 2020 to March 23, 2021, we randomized 149 participants with 116 included in the mITT cohort. The mean age was 43 years (SD 12.5) and 57 (49%) were women. We found no difference in time to shedding cessation by treatment arm overall (HR 0.76 favoring placebo, 95% confidence interval [CI] 0.48 – 1.20) or in sub-group analyses (age, sex, high-risk comorbidities, seropositivity or symptom duration at enrollment). We observed no difference in time to symptom resolution (initial: HR 0.84, 95% CI 0.54 – 1.29;sustained: HR 0.87, 95% CI 0.52 – 1.45). We detected no difference in accumulation of transition mutations in the viral genome during treatment. Conclusions: Our data do not support favipiravir use at commonly used doses in outpatients with uncomplicated COVID-19. Further research is needed to ascertain if higher doses of favipiravir are effective and safe for patients with COVID-19.

5.
Cureus ; 13(7): e16507, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1350520

ABSTRACT

To evaluate the use of an aerosol box during video laryngoscopy intubation, we conducted a two-phase simulation-based study to assess if there were significant differences in time needed to safely intubate a patient with an aerosol box in place, as well as assess changes in laryngoscopists' hand motions as determined by changes in accelerometry. 20 anesthesiology providers from our institution participated in the first phase assessing the time to intubation. Use of the aerosol box led to statistically significant increases in intubation times (Wilcoxon-Signed Rank test p < 0.001, z-score = 3.921), with the calculated Pearson's correlation coefficient (r = 0.877) indicating a large effect size. An 8.5 - 11.5 second difference in median intubation times was maintained between corresponding attempts with versus without the aerosol box. 15 participants completed an optional post-assessment survey, with 10 of 15 respondents firmly stating they would not use the box in clinical practice. The hand accelerometry assessment included five anesthesiology providers from our institution. This revealed a statistically significant increase in trials with aerosol boxes for the left hand's general accelerometry with a medium effect size (p = 0.031; z = -1.873; r = -0.484), as well as for the right hand's general accelerometry with a large effect size (p < 0.001; z = -3.351; r = -0.865). Although the aerosol box is an interesting concept, its use is associated with increased time to intubation and a change in ergonomics, which may increase risk during airway management and represents a concern for patient safety.

6.
Electronics ; 10(14):1626, 2021.
Article in English | MDPI | ID: covidwho-1302183

ABSTRACT

Research on SARS-CoV-2 and its social implications have become a major focus to interdisciplinary teams worldwide. As interest in more direct solutions, such as mass testing and vaccination grows, several studies appear to be dedicated to the operationalization of those solutions, leveraging both traditional and new methodologies, and, increasingly, the combination of both. This research examines the challenges anticipated for preventative testing of SARS-CoV-2 in schools and proposes an artificial intelligence (AI)-powered agent-based model crafted specifically for school scenarios. This research shows that in the absence of real data, simulation-based data can be used to develop an artificial intelligence model for the application of rapid assessment of school testing policies.

7.
Clin Imaging ; 75: 75-82, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1030861

ABSTRACT

PURPOSE: Our purpose was to conduct a comprehensive systematic review of all existing literature regarding imaging findings on chest CT and associated clinical features in pregnant patients diagnosed with COVID-19. MATERIALS & METHODS: A literature search was conducted on April 21, 2020 and updated on July 24, 2020 using PubMed, Embase, World Health Organization, and Google Scholar databases. Only studies which described chest CT findings of COVID-19 in pregnant patients were included for analysis. RESULTS: A total of 67 articles and 427 pregnant patients diagnosed with COVID-19 were analyzed. The most frequently encountered pulmonary findings on chest CT were ground-glass opacities (77.2%, 250/324), posterior lung involvement (72.5%, 50/69), multilobar involvement (71.8%, 239/333), bilateral lung involvement (69.4%, 231/333), peripheral distribution (68.1%, 98/144), and consolidation (40.9%, 94/230). Pregnant patients were also found to present more frequently with consolidation (40.9% vs. 21.0-31.8%) and pleural effusion (30.0% vs. 5.0%) in comparison to the general population. Associated clinical features included antepartum fever (198 cases), lymphopenia (128 cases), and neutrophilia (97 cases). Of the 251 neonates delivered, 96.8% had negative RT-PCR and/or IgG antibody testing for COVID-19. In the eight cases (3.2%) of reported neonatal infection, tests were either conducted on samples collected up to 72 h after birth or were found negative on all subsequent RT-PCR tests. CONCLUSION: Pregnant patients appear to present more commonly with more advanced COVID-19 CT findings compared to the general adult population. Furthermore, characteristic laboratory abnormalities found in pregnant patients tended to mirror those found in the general patient population. Lastly, results from neonatal testing suggest a low risk of vertical transmission.


Subject(s)
COVID-19 , Lung Diseases , Adult , COVID-19 Testing , Female , Humans , Infant, Newborn , Lung , Pregnancy , SARS-CoV-2 , Tomography, X-Ray Computed
8.
J Pediatr Pharmacol Ther ; 26(1): 21-25, 2021.
Article in English | MEDLINE | ID: covidwho-1022184

ABSTRACT

Drug shortages have significantly affected the ability to provide care at pediatric institutions, particularly in the inpatient and critical care settings. The coronavirus disease 2019 (COVID-19) pandemic highlighted additional challenges with drug supply chains. A working group consisting of pharmacy management, clinical pharmacists, and pharmacy buyers met regularly at the beginning of the COVID-19 pandemic. In collaboration with medical staff leadership and the Pharmacy and Therapeutics Committee, we developed a pediatric critical drug list to track essential medications for targeted monitoring. We created an inventory model with easily modifiable input variables related to patient and hospital data. This model was aligned across affiliate health care systems to increase transparency of our hospital's surge capacity for managing patients with COVID-19. Here, we share our framework for modeling drug inventory management at a freestanding children's hospital during a global pandemic.

9.
Int J Environ Res Public Health ; 18(1)2020 12 31.
Article in English | MEDLINE | ID: covidwho-1006956

ABSTRACT

Planning for mass vaccination against SARS-Cov-2 is ongoing in many countries considering that vaccine will be available for the general public in the near future. Rapid mass vaccination while a pandemic is ongoing requires the use of traditional and new temporary vaccination clinics. Use of drive-through has been suggested as one of the possible effective temporary mass vaccinations among other methods. In this study, we present a machine learning model that has been developed based on a big dataset derived from 125K runs of a drive-through mass vaccination simulation tool. The results show that the model is able to reasonably well predict the key outputs of the simulation tool. Therefore, the model has been turned to an online application that can help mass vaccination planners to assess the outcomes of different types of drive-through mass vaccination facilities much faster.


Subject(s)
Artificial Intelligence , Mass Vaccination/organization & administration , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Humans , Pandemics
10.
J Allergy Clin Immunol ; 146(2): 307-314.e4, 2020 08.
Article in English | MEDLINE | ID: covidwho-701780

ABSTRACT

BACKGROUND: The Centers for Disease Control and Prevention advises that patients with moderate to severe asthma belong to a high-risk group that is susceptible to severe coronavirus disease 2019 (COVID-19). However, the association between asthma and COVID-19 has not been well-established. OBJECTIVE: The primary objective was to determine the prevalence of asthma among patients with COVID-19 in a major US health system. We assessed the clinical characteristics and comorbidities in asthmatic and nonasthmatic patients with COVID-19. We also determined the risk of hospitalization associated with asthma and/or inhaled corticosteroid use. METHODS: Medical records of patients with COVID-19 were searched by a computer algorithm (March 1 to April 15, 2020), and chart review was used to validate the diagnosis of asthma and medications prescribed for asthma. All patients had PCR-confirmed COVID-19. Demographic and clinical features were characterized. Regression models were used to assess the associations between asthma and corticosteroid use and the risk of COVID-19-related hospitalization. RESULTS: Of 1526 patients identified with COVID-19, 220 (14%) were classified as having asthma. Asthma was not associated with an increased risk of hospitalization (relative risk, 0.96; 95% CI, 0.77-1.19) after adjusting for age, sex, and comorbidities. The ongoing use of inhaled corticosteroids did not increase the risk of hospitalization in a similar adjusted model (relative risk, 1.39; 95% CI, 0.90-2.15). CONCLUSIONS: Despite a substantial prevalence of asthma in our COVID-19 cohort, asthma was not associated with an increased risk of hospitalization. Similarly, the use of inhaled corticosteroids with or without systemic corticosteroids was not associated with COVID-19-related hospitalization.


Subject(s)
Asthma/epidemiology , Betacoronavirus/pathogenicity , Coronary Artery Disease/epidemiology , Coronavirus Infections/epidemiology , Diabetes Mellitus/epidemiology , Hypertension/epidemiology , Obesity/epidemiology , Pneumonia, Viral/epidemiology , Administration, Inhalation , Adrenal Cortex Hormones/therapeutic use , Adult , Age Factors , Aged , Anti-Asthmatic Agents/therapeutic use , Asthma/diagnosis , Asthma/drug therapy , Asthma/physiopathology , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Comorbidity , Coronary Artery Disease/diagnosis , Coronary Artery Disease/physiopathology , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Diabetes Mellitus/diagnosis , Diabetes Mellitus/physiopathology , Female , Hospitalization/statistics & numerical data , Humans , Hypertension/diagnosis , Hypertension/physiopathology , Illinois/epidemiology , Male , Middle Aged , Models, Statistical , Obesity/diagnosis , Obesity/physiopathology , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Prevalence , Retrospective Studies , Risk Factors , SARS-CoV-2
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