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1.
Crit Care Clin ; 38(3): 553-570, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1878086

ABSTRACT

Neurologic complications can be seen in mild to severe COVID-19 with a higher risk in patients with severe COVID-19. These can occur as a direct consequence of viral infection or consequences of treatments. The spectrum ranges from non-life-threatening, like headache, fatigue, malaise, anosmia, dysgeusia, to life-threatening complications, like stroke, encephalitis, coma, Guillain-Barre syndrome. A high index of suspicion can aid in early recognition and treatment. Outcomes depend on severity of underlying COVID-19, patient age, comorbidities, and severity of the complication. Postacute sequelae of COVID-19 range from fatigue, headache, dysosmia, brain fog, anxiety, depression to an overlap with postintensive care syndrome.


Subject(s)
COVID-19 , Nervous System Diseases , Stroke , COVID-19/complications , Disease Progression , Fatigue/complications , Headache/complications , Humans , Nervous System Diseases/etiology , Nervous System Diseases/therapy
2.
Intensive Care Med ; 47(9): 1021-1023, 2021 09.
Article in English | MEDLINE | ID: covidwho-1813636
4.
Critical care explorations ; 4(3), 2022.
Article in English | EuropePMC | ID: covidwho-1738096

ABSTRACT

OBJECTIVES: The multifaceted long-term impairments resulting from critical illness and COVID-19 require interdisciplinary management approaches in the recovery phase of illness. Operational insights into the structure and process of recovery clinics (RCs) from heterogeneous health systems are needed. This study describes the structure and process characteristics of existing and newly implemented ICU-RCs and COVID-RCs in a subset of large health systems in the United States. DESIGN: Cross-sectional survey. SETTING: Thirty-nine RCs, representing a combined 156 hospitals within 29 health systems participated. PATIENTS: None. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: RC demographics, referral criteria, and operating characteristics were collected, including measures used to assess physical, psychologic, and cognitive recoveries. Thirty-nine RC surveys were completed (94% response rate). ICU-RC teams included physicians, pharmacists, social workers, physical therapists, and advanced practice providers. Funding sources for ICU-RCs included clinical billing (n = 20, 77%), volunteer staff support (n = 15, 58%), institutional staff/space support (n = 13, 46%), and grant or foundation funding (n = 3, 12%). Forty-six percent of RCs report patient visit durations of 1 hour or longer. ICU-RC teams reported use of validated scales to assess psychologic recovery (93%), physical recovery (89%), and cognitive recovery (86%) more often in standard visits compared with COVID-RC teams (psychologic, 54%;physical, 69%;and cognitive, 46%). CONCLUSIONS: Operating structures of RCs vary, though almost all describe modest capacity and reliance on volunteerism and discretionary institutional support. ICU- and COVID-RCs in the United States employ varied funding sources and endorse different assessment measures during visits to guide care coordination. Common features include integration of ICU clinicians, interdisciplinary approach, and focus on severe critical illness. The heterogeneity in RC structures and processes contributes to future research on the optimal structure and process to achieve the best postintensive care syndrome and postacute sequelae of COVID outcomes.

5.
Chest ; 159(5): 1949-1960, 2021 05.
Article in English | MEDLINE | ID: covidwho-1664763

ABSTRACT

All aspects of medical education were affected by the COVID-19 pandemic. Several challenges were experienced by trainees and programs alike, including economic repercussions of the pandemic; social distancing affecting the delivery of medical education, testing, and interviewing; the surge of patients affecting redeployment of personnel and potential compromises in core training; and the overall impact on the wellness and mental health of trainees and educators. The ability of medical teams and researchers to peer review, conduct clinical research, and keep up with literature was similarly challenged by the rapid growth in peer-reviewed and preprint literature. This article reviews these challenges and shares strategies that institutions, educators, and learners adopted, adapted, and developed to provide quality education during these unprecedented times.


Subject(s)
COVID-19 , Communicable Disease Control/methods , Education, Medical , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Education, Medical/organization & administration , Education, Medical/standards , Education, Medical/trends , Humans , Organizational Innovation , SARS-CoV-2
6.
Crit Care Med ; 49(9): 1427-1438, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1434524

ABSTRACT

OBJECTIVE: Determine the characteristics of postintensive care syndrome in the cognitive, physical, and psychiatric domains in coronavirus disease 2019 ICU survivors. DESIGN: Single-center descriptive cohort study from April 21, to July 7, 2020. SETTING: Critical care recovery clinic at The Mount Sinai Hospital in New York City. PATIENTS: Adults who had critical illness due to coronavirus disease 2019 requiring an ICU stay of 7 days or more and who agreed to a telehealth follow-up in the critical care recovery clinic 1-month post hospital discharge. INTERVENTIONS: None. MEASURES AND MAIN RESULTS: Patient-reported outcome measures assessing physical and psychiatric domains were collected electronically, a cognitive test was performed by a clinician, and clinical data were obtained through electronic medical records. Outcome measures assessed postintensive care syndrome symptoms in the physical (Modified Rankin Scale, Dalhousie Clinical Frailty Scale, Neuro-Quality of Life Upper Extremity and Lower Extremity Function, Neuro-Quality of Life Fatigue), psychiatric (Insomnia Severity Scale; Patient Health Questionnaire-9; and Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), and cognitive (Telephone Montreal Cognitive Assessment) domains. The 3-Level Version of Euro-QoL-5D was used to assess the physical and psychiatric domains. A diagnosis of postintensive care syndrome was made in cases with evidence of impairment in at least one postintensive care syndrome domain. We included 45 patients with a mean (sd) age of 54 (13) years, and 73% were male. Ninety-one percent of coronavirus disease 2019 ICU survivors fit diagnostic criteria for postintensive care syndrome. 86.7 % had impairments in the physical domain, 22 (48%) reported impairments in the psychiatric domain, and four (8%) had impairments on cognitive screening. We found that 58% had some degree of mobility impairment. In the psychiatric domain, 38% exhibited at least mild depression, and 18 % moderate to severe depression. Eighteen percent presented Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, scores suggestive of posttraumatic stress syndrome diagnosis. In the Telephone Montreal Cognitive Assessment, 9% had impaired cognition. CONCLUSIONS: Survivors of critical illness related to coronavirus disease 2019 are at high risk of developing postintensive care syndrome. These findings highlight the importance of planning for appropriate post-ICU care to diagnose and treat this population.


Subject(s)
COVID-19/complications , Critical Illness , COVID-19/psychology , COVID-19/therapy , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/etiology , Cohort Studies , Critical Care , Female , Humans , Intensive Care Units , Male , Middle Aged , New York City , Patient Reported Outcome Measures , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Survivors/psychology
7.
Intensive Care Med ; 47(9): 1021-1023, 2021 09.
Article in English | MEDLINE | ID: covidwho-1391832
8.
Intensive Care Med ; 47(9): 1021-1023, 2021 09.
Article in English | MEDLINE | ID: covidwho-1258192
9.
Chest ; 159(5): 1949-1960, 2021 05.
Article in English | MEDLINE | ID: covidwho-1114400

ABSTRACT

All aspects of medical education were affected by the COVID-19 pandemic. Several challenges were experienced by trainees and programs alike, including economic repercussions of the pandemic; social distancing affecting the delivery of medical education, testing, and interviewing; the surge of patients affecting redeployment of personnel and potential compromises in core training; and the overall impact on the wellness and mental health of trainees and educators. The ability of medical teams and researchers to peer review, conduct clinical research, and keep up with literature was similarly challenged by the rapid growth in peer-reviewed and preprint literature. This article reviews these challenges and shares strategies that institutions, educators, and learners adopted, adapted, and developed to provide quality education during these unprecedented times.


Subject(s)
COVID-19 , Communicable Disease Control/methods , Education, Medical , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Education, Medical/organization & administration , Education, Medical/standards , Education, Medical/trends , Humans , Organizational Innovation , SARS-CoV-2
10.
Chest ; 159(5): 1949-1960, 2021 05.
Article in English | MEDLINE | ID: covidwho-1111517

ABSTRACT

All aspects of medical education were affected by the COVID-19 pandemic. Several challenges were experienced by trainees and programs alike, including economic repercussions of the pandemic; social distancing affecting the delivery of medical education, testing, and interviewing; the surge of patients affecting redeployment of personnel and potential compromises in core training; and the overall impact on the wellness and mental health of trainees and educators. The ability of medical teams and researchers to peer review, conduct clinical research, and keep up with literature was similarly challenged by the rapid growth in peer-reviewed and preprint literature. This article reviews these challenges and shares strategies that institutions, educators, and learners adopted, adapted, and developed to provide quality education during these unprecedented times.


Subject(s)
COVID-19 , Communicable Disease Control/methods , Education, Medical , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Education, Medical/organization & administration , Education, Medical/standards , Education, Medical/trends , Humans , Organizational Innovation , SARS-CoV-2
12.
Neurology ; 95(12): 537-542, 2020 09 22.
Article in English | MEDLINE | ID: covidwho-945311

ABSTRACT

Inclusion is the deliberate practice of ensuring that each individual is heard, all personal traits are respected, and all can make meaningful contributions to achieve their full potential. As coronavirus disease 2019 spreads globally and across the United States, we have viewed this pandemic through the lens of equity and inclusion. Here, we discuss how this pandemic has magnified preexisting health and social disparities and will summarize why inclusion is an essential tool to traverse this uncertain terrain and discuss strategies that can be implemented at organizational and individual levels to improve inclusion and address inequities moving forward.


Subject(s)
Coronavirus Infections , Delivery of Health Care , Leadership , Neurology , Organizational Culture , Pandemics , Pneumonia, Viral , Societies, Medical , Vulnerable Populations , Betacoronavirus , COVID-19 , Health Workforce , Humans , Nervous System Diseases , Poverty , Racism , SARS-CoV-2 , Sexual and Gender Minorities , Socioeconomic Factors , United States
13.
Stroke ; 51(9): e215-e218, 2020 09.
Article in English | MEDLINE | ID: covidwho-636399

ABSTRACT

BACKGROUND AND PURPOSE: Young patients with malignant cerebral edema have been shown to benefit from early decompressive hemicraniectomy. The impact of concomitant infection with coronavirus disease 2019 (COVID-19) and how this should weigh in on the decision for surgery is unclear. METHODS: We retrospectively reviewed all COVID-19-positive patients admitted to the neuroscience intensive care unit for malignant edema monitoring. Patients with >50% of middle cerebral artery involvement on computed tomography imaging were considered at risk for malignant edema. RESULTS: Seven patients were admitted for monitoring of whom 4 died. Cause of death was related to COVID-19 complications, and these were either seen both very early and several days into the intensive care unit course after the typical window of malignant cerebral swelling. Three cases underwent surgery, and 1 patient died postoperatively from cardiac failure. A good outcome was attained in the other 2 cases. CONCLUSIONS: COVID-19-positive patients with large hemispheric stroke can have a good outcome with decompressive hemicraniectomy. A positive test for COVID-19 should not be used in isolation to exclude patients from a potentially lifesaving procedure.


Subject(s)
Brain Ischemia/complications , Brain Ischemia/surgery , Coronavirus Infections/complications , Decompressive Craniectomy/methods , Neurosurgical Procedures/methods , Pneumonia, Viral/complications , Stroke/complications , Stroke/surgery , Adult , Brain Edema/complications , Brain Edema/surgery , Brain Ischemia/diagnostic imaging , COVID-19 , Cause of Death , Clinical Decision-Making , Critical Care , Decompressive Craniectomy/adverse effects , Female , Humans , Male , Middle Aged , Monitoring, Physiologic , Neurosurgical Procedures/adverse effects , Pandemics , Retrospective Studies , Stroke/diagnostic imaging , Tomography, X-Ray Computed , Treatment Outcome
14.
Int J Equity Health ; 19(1): 93, 2020 06 10.
Article in English | MEDLINE | ID: covidwho-592367

ABSTRACT

BACKGROUND: The purpose of this study is to report the clinical features and outcomes of Black/African American (AA) and Latino Hispanic patients with Coronavirus disease 2019 (COVID-19) hospitalized in an inter-city hospital in the state of New Jersey. METHODS: This is a retrospective cohort study of AA and Latino Hispanic patients with COVID-19 admitted to a 665-bed quaternary care, teaching hospital located in Newark, New Jersey. The study included patients who had completed hospitalization between March 10, 2020, and April 10, 2020. We reviewed demographics, socioeconomic variables and incidence of in-hospital mortality and morbidity. Logistic regression was used to identify predictor of in-hospital death. RESULTS: Out of 416 patients, 251 (60%) had completed hospitalization as of April 10, 2020. The incidence of In-hospital mortality was 38.6% (n = 97). Most common symptoms at initial presentation were dyspnea 39% (n = 162) followed by cough 38%(n = 156) and fever 34% (n = 143). Patients were in the highest quartile for population's density, number of housing units and disproportionately fell into the lowest median income quartile for the state of New Jersey. The incidence of septic shock, acute kidney injury (AKI) requiring hemodialysis and admission to an intensive care unit (ICU) was 24% (n = 59), 21% (n = 52), 33% (n = 82) respectively. Independent predictors of in-hospital mortality were older age, lower serum Hemoglobin < 10 mg/dl, elevated serum Ferritin and Creatinine phosphokinase levels > 1200 U/L and > 1000 U/L. CONCLUSIONS: Findings from an inter-city hospital's experience with COVID-19 among underserved minority populations showed that, more than one of every three patients were at risk for in-hospital death or morbidity. Older age and elevated inflammatory markers at presentation were associated with in-hospital death.


Subject(s)
African Americans/statistics & numerical data , Coronavirus Infections/ethnology , Coronavirus Infections/therapy , Minority Groups/statistics & numerical data , Pneumonia, Viral/ethnology , Pneumonia, Viral/therapy , Aged , COVID-19 , Female , Hospital Mortality/ethnology , Hospitalization/statistics & numerical data , Hospitals, Urban , Humans , Incidence , Intensive Care Units , Male , Middle Aged , New Jersey/epidemiology , Pandemics , Retrospective Studies , Risk Assessment , Treatment Outcome
16.
Clin Transl Med ; 10(2): e44, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-245425

ABSTRACT

Patients with severe COVID-19 disease have been characterized as having the acute respiratory distress syndrome (ARDS). Critically ill COVID-19 patients have relatively well-preserved lung mechanics despite severe gas exchange abnormalities, a feature not consistent with classical ARDS but more consistent with pulmonary vascular disease. Many patients with severe COVID-19 also demonstrate markedly abnormal coagulation, with elevated d-dimers and higher rates of venous thromboembolism. We present four cases of patients with severe COVID-19 pneumonia with severe respiratory failure and shock, with evidence of markedly elevated dead-space ventilation who received tPA. All showed post treatment immediate improvements in gas exchange and/or hemodynamics. We suspect that severe COVID-19 pneumonia causes respiratory failure via pulmonary microthrombi and endothelial dysfunction. Treatment for COVID-19 pneumonia may warrant anticoagulation for milder cases and thrombolysis for more severe disease.

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