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1.
Journal of the Intensive Care Society ; 24(1 Supplement):46-47, 2023.
Article in English | EMBASE | ID: covidwho-20244863

ABSTRACT

Introduction: The COVID-19 pandemic has required clinical teams to function with an unprecedented amount of uncertainty, balancing complex risks and benefits in a highly fluid environment. This is especially the case when considering the delivery of a pregnant woman critically unwell with COVID-19. This is one maternal critical care team's reflections on establishing best practice and a shared mental model when undertaking a Caesarean section in critically unwell patients with COVID-19. Objective(s): We describe our experience of balancing the risks and streamlining the process of this high-risk intervention. Method(s): We used our standard clinical governance forums across four specialties (Obstetrics, Intensive care, Anaesthetics and Neonatology) to identify key challenges and learning points. We developed a working group to combine our learning and develop a shared mental model across the involved teams. Result(s): 1. The decision to deliver must be multidisciplinary involving Obstetrics, Intensive care, Anaesthetics, Neonatology and the patient according to their capacity to participate. The existing structure of twice daily ITU ward rounds could be leveraged as a 'pause' moment to consider the need for imminent delivery and review the risk-benefit balance of continued enhanced pharmacological thromboprophylaxis. 2. We identified a range of scenarios that our teams might be exposed to: 3. Perimortem Caesarean section 4. Critically unwell - unsafe to move to theatre 5. Critically unwell - safe to move to theatre 6. Recreating an obstetric theatre in the ICU Advantages Avoids moving a critically unstable patient, although our experience is increasing moving patients for ECMO. Some forms of maximal non-invasive therapy such as High Flow Nasal Oxygen may require interruption to move to theatre with resultant risk of harm or be difficult to continue in transport mode through a bulky ICU ventilator e.g. CPAP Disadvantages Significant logistics and coordination burden: multiple items of specialist equipment needing to be brought to the ICU. Human factors burden: performing a caesarean section in an unfamiliar environment is a significant increase in cognitive load for participating teams. Environmental factors: ICU side rooms may offer limited space vs the need to control the space if performed on an open unit. Delivering a Neonate into a COVID bubble. Conclusion(s): Developing a shared mental model across the key teams involved in delivering an emergency caesarean section in this cohort of critically unwell patients has enabled our group to own a common understanding of the key decisions and risks involved. We recommend a patient centred MDT decision making model, with a structure for regular reassessment by senior members of the teams involved. In most circumstances the human factors and logistical burden of recreating an operating theatre in the ICU outweighs the risk of transport to theatre. Pre-defined checklists and action cards mitigate the cognitive and logistical burden when multiple teams do perform an operative delivery in ICU. Action cards highlight key aspects of routine obstetric care to be replicated in the ICU environment.

2.
Frontiers in Environmental Science ; 10, 2022.
Article in English | Web of Science | ID: covidwho-2121274

ABSTRACT

The COVID-19 pandemic led to global public health campaigns enacting strict orders to slow the spread of the disease. The public health initiatives were communicated broadly through diverse news sources and social media channels, spreading both factual information and misinformation about the environmental benefits related to the shelter-in-place orders. This quantitative study of United States residents (N = 1,048), guided by selective exposure theory, examined if demographics, news and/or social media source use, and public knowledge of environmental changes that took place as a result of COVID-19 shelter-in-place orders predicted intent to engage in environmentally-conscious behavior. Results indicated demographics and social media used predicted intent to engage in environmentally-conscious behaviors. Intent to engage in environmental behaviors is critical for environmental sustainability and the media may provide one avenue for engaging the public in environmental behaviors. Discussion points include environmental communication strategies and understanding messaging strategies within the politicization process of communicating about environmental issues during the COVID-19 pandemic.

3.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009555

ABSTRACT

Background: With the murder of George Floyd and health disparities laid bare by the COVID pandemic, the US is reckoning with racial injustice. Across medicine and oncology, institutions are grappling with how to address systemic racism and improve care for patients of color. At the University of North Carolina (UNC), trainees developed an educational curriculum to raise awareness of implicit bias and introduce methods to address racial inequities. We present our findings on feasibility and acceptability of a fellow-led course on racism in medicine at a major academic medical center. Methods: UNC oncology fellows adapted a curriculum on implicit bias and racism in medicine in spring 2021. Our aims were 1) to improve knowledge and awareness about implicit bias and systemic racism and 2) introduce methods to address racial inequities. We used lived experiences and collated materials from scientific literature and lay media to illustrate key points. Sessions were: 1) Introduction and Implicit Bias, 2) Implicit Bias in Action: A Case Study, 3) Race-Based Metrics: Journal Club, 4) Career Perspective on Equity in Oncology. Videos, journal articles, and group discussion were employed to appeal to many learning styles. Results: Four sessions were held virtually for the Divisions of Oncology and Hematology. Attendance ranged from 28 to 35 per session. A post curriculum survey assessed perception of racial inequality in medicine and the series' effects using a Likert scale. Twenty-nine participants completed the survey, 12 of whom were fellows. Of all participants, 71% reported that the course improved knowledge or awareness of racial inequities “some” or “a great deal” and 61% reported that it improved their comfort level addressing racial inequities “some” or “a great deal.” All participants endorsed at least “some” racial inequity in medicine. Notably, over 75% of participants indicated interest in further sessions. Conclusions: Formulation of an educational curriculum by fellows and delivered in a division wide setting was feasible and well received by participants with robust discussion and interest in further work. Fundamental to this series' effectiveness was creating a space for discussion and reflection among colleagues. The goals of improving knowledge and introducing methods to address racial inequities were met. Importantly, our course was integrated alongside institutional efforts on DEI. We were limited by a lack of pre-course survey results due to a technical error. Given the current groundswell of interest and focus in improving racial equity in our society, we encourage other institutions to take similar steps to highlight issues of systemic racism and continue to move our field in the right direction.

4.
Topics in Antiviral Medicine ; 30(1 SUPPL):77, 2022.
Article in English | EMBASE | ID: covidwho-1880731

ABSTRACT

Background: COVID-19 has been a devastating disease and a major public health concern mainly to susceptible populations. Methods: We accessed two groups of pregnant women at the time of delivery: SARS-CoV2 active infection and convalescents. To investigate the factors contributing to COVID19 severity we have assessed several immunological parameters including cytokines/chemokine levels in the maternal and cord blood plasma. We have evaluated 33 cytokines. Our findings were validated in vitro in HTBE (Human tracheobronchial epithelial) cells infected with live SARS-COV2 (wild type). Results: Our cohort was enriched in high-risk subjects, including African American and obese women. Only 6% had severe or critical disease, contrasting with the 20-25% reported in some pregnant cohorts. TGFb2 levels were significantly associated with asymptomatic/mild disease in both active and convalescent cohorts, and inversely correlated with IP10, IL6 and IL8, known to be part of the cytokine storm post-infection. Pre-treatment of HTBE with TGFb2 for 48 hours led to a significant decay in viral loads at 72h post-infection. This control was associated with significantly higher IL-6 (IFNb2) levels prior to infection, and significantly higher expression of anti-viral genes at 72h pi (MX1, IFNA1, IFNA2, IFNL1, STAT1). Additionally, TGFb2 pre-treatment suppressed the expression of the cytokines IP-10, IL1b and IL8. Conclusion: Altogether this data suggested that TGFB2 plays a protective role in SARS-COV2 infection in this high-risk population by improving epithelial cells intrinsic antiviral function and by modulating the expression of the cytokines associated to the heightened inflammation in severe cases.

5.
National Technical Information Service; 2020.
Non-conventional in English | National Technical Information Service | ID: grc-753582

ABSTRACT

A new coronavirus (SARS-CoV-2) emerged in the winter of 2019 in Wuhan, China, and rapidly spread around the world. The extent and efficiency of SARS-CoV-2 pandemic is far greater than previous coronaviruses that emerged in the 21st Century. Here, we modeled stability of SARS-CoV-2 on skin, paper currency, and clothing to determine if these surfaces may factor in the fomite transmission dynamics of SARS-CoV-2. Skin, currency, and clothing samples were exposed to SARS-CoV-2 under laboratory conditions and incubated at three different temperatures (4 deg C + or - 2 degC, 22 deg C + or - 2 deg C, and 37 deg C + or - 2 deg C). We evaluated stability at 0 hours (h), 4 h, 8 h, 24 h, 72 h, 96 h, 7 days, and 14 days post-exposure. SARS-CoV-2 was stable on skin through the duration of the experiment at 4 deg C (14 days). Virus remained stable on skin for at least 96 h at 22 deg C and for at least 8h at 37 deg C. There were minimal differences between the tested currency samples. The virus remained stable on the $1 U.S.A. Bank Note for at least 96 h at 4 deg C while we did not detect viable virus on the $20 U.S.A. Bank Note samples beyond 72 h. The virus remained stable on both Bank Notes for at least 8 h at 22 deg C and 4 h at 37 deg C. Clothing samples were similar in stability to the currency. Viable virus remained for at least 96 h at 4 deg C and at least 4 h at 22 deg C. We did not detect viable virus on clothing samples at 37 deg C after initial exposure. This study confirms the inverse relationship between virus stability and temperature. Furthermore, virus stability on skin demonstrates the need for continued hand hygiene practices to minimize fomite transmission both in the general population as well as in workplaces where close contact is common.

6.
Open Forum Infectious Diseases ; 8(SUPPL 1):S291-S292, 2021.
Article in English | EMBASE | ID: covidwho-1746614

ABSTRACT

Background. The COVID-19 pandemic has disproportionately affected nursing home (NH) patients, accounting for 5% of all cases and 32% of all COVID-19 deaths nationwide. Little is known about the frequency and persistence of SARSCoV-2 environmental contamination in NHs. We characterize SARS-CoV-2 contamination in the rooms of COVID-19 patients and common areas in and around COVID-19 units. Methods. A prospective cohort study was conducted at four NHs in Michigan between October 2020 and January 2021. Clinical research personnel obtained swab specimens from high-touch room surfaces of COVID-19 infected patients, up to three times per patient. Weekly swab specimens from six high-touch surfaces in common areas were also obtained. Demographic and clinical data were collected from patient clinical records. Our primary outcome of interest was the probability of SARS-CoV-2 detection from specific environmental surfaces in COVID-19 patient rooms. Results. One hundred four patients with COVID-19 were enrolled and followed for 241 visits. Patient characteristics included: 61.5% over the age of 80;67.3% female;89.4% non-Hispanic white;50.1% short-stay. The study population had significant disabilities in activities of daily living (ADL;81.7% dependent in four or more ADLs) and comorbidities including dementia (55.8%), diabetes (40.4%) and heart failure (32.7) (Table 1). Over the 3-month study period, 2087 swab specimens were collected (1896 COVID-19 patient room surfaces, 191 common area swabs). Figure 1 shows contamination rates at sites proximate and distant to the patient bed. SARS-CoV-2 positivity was 28.4% (538/1896 swabs) on patient room surfaces and 3.7% (7/191 swabs) on common area surfaces. Over the course of follow-up, 89.4% (93/104) of patients had SARS-CoV-2 contamination in their room at least once (Figure 2). Environmental contamination detected on enrollment correlated with contamination of the same site during follow-up. Functional independence increased the odds of proximate contamination. Conclusion. We conclude that environmental contamination of surfaces in the rooms of COVID-19 patients is nearly universal and persistent. Patients with greater independence are more likely than fully dependent patients to contaminate their immediate environment.

7.
Anesthesia and Analgesia ; 132(5S_SUPPL):609-612, 2021.
Article in English | Web of Science | ID: covidwho-1695209
9.
Sage Open ; 11(4):12, 2021.
Article in English | Web of Science | ID: covidwho-1561449

ABSTRACT

Coronavirus Disease 2019 (COVID-19), a highly infectious virus transmitted through droplets from sneezes and coughs, was declared a global pandemic in 2020. Measures implemented by organizations as a result of COVID-19 were controversial among United States (U.S.) citizens. Perceptions of governmental and scientific information further divided U.S. citizens and distrust in science fostered conspiratorial thinking toward the origin of the virus. The purpose of this study was to determine if critical thinking style (CTS), the use of COVID-19 information sources, and social media connections were predictors of origin of COVID-19 beliefs. A survey was disseminated to 1,048 U.S. adults in May 2020 when most states were under shelter-in-place orders. Results indicated select COVID-19 information sources used and social media connections predicted origin of COVID-19 beliefs. CTS was not a significant predictor. Findings revealed a partisan divide between COVID-19 information sources. Implications for science communicators engaging the public during crisis were discussed.

10.
Pediatric Pulmonology ; 55(SUPPL 2):77, 2020.
Article in English | EMBASE | ID: covidwho-1063884

ABSTRACT

Objective: We sought to study how an adult cystic fibrosis (CF) Patient Family Advisory Board (PFAB) can influence and co-produce patient and staff education in collaboration with their CF care team. Novel approaches in this study are: 1) learner needs analyses were driven by the PFAB, 2) study and abstract were created by patient PFAB member. Background: In addition to improving quality of care, patient safety, satisfaction, and engagement, the Institute for Patient and Family Centered Care (IPFCC) recommends the establishment of a PFAB to design patient-centric initiatives such as quality improvement, patient education, as well as healthcare provider and clinical staff education (Johnson, Abraham. 2012). Despite this recommendation, there are few studies on how patientdriven education is designed or implemented. The INOVA Adult CF Clinic PFAB articulated their perspective of clinical staff learner needs for Respiratory Therapy (RT), Emergency Department (ED), and Inpatient Nursing Teams (APU). They also helped to advise the need for and content of educational COVID-19 webinars to the patient population. Patients who were PFAB members provided educational content and the patient perspective in these workshops. Methods: Thematic analysis of educational sessions and PFAB meetings were used to study how PFABs can influence and co-produce clinical staff and patient education. Qualitative data were collected and analyzed from observation of 7 PFAB meetings and digital collaborative planning documents used by the PFAB to discuss patient-driven educational needs and session plans. Observational data were collected from 3 staff education sessions that were co-presented with a CF care team member and CF patient PFAB member who gave a short personal account of their experience with their disease. These included: one RT session, two inpatient nursing staff sessions. Plans were made for an ED session in August. Observational qualitative data was also collected from two COVID-19 webinars that were conducted with input and participation of the PFAB in sharing experiences and presenting content. Results: Thematic analysis showed that PFABs can increase engagement of clinical staff and augment educational opportunities for both patients and staff by addressing patient-centered learning needs. Patients who provided first-person accounts of their lived experience as part of a learning session promoted empathy and engagement amongst both staff and patients. Co-produced COVID webinars resulted in a 250% increase in attendance over a three-month period. Chat-box and verbal question participation of co-produced COVID webinars also increased. In addition, the PFAB-driven educational initiatives promoted psychological ownership (Avey, et al. 2009) within the PFAB itself. This has led to attitudes such as higher commitment, responsibility, and engagement of patient PFAB members and CF clinical staff. Opportunities for further research in this area include exploring the extent to which these themes are also promoted by administering formal pre- and post-intervention assessments to staff learners as well as PFAB members.

11.
Pediatric Pulmonology ; 55(SUPPL 2):341, 2020.
Article in English | EMBASE | ID: covidwho-1063770

ABSTRACT

Background: The Inova Adult CF Program developed a Patient Family Advisory Board (PFAB) to facilitate patient and family centered care. The PFAB has been actively involved in providing input on multiple issues and expressed interest in initiating and actively participating in a quality improvement project related to CF care. Together with the CF care team, it was decided to focus on inpatient care. Methods: We identified inpatient respiratory care as an area of focus. For baseline data, we developed a survey regarding inpatient experience of respiratory care. Three primary observations emerged as common themes: 1. Desire for a more personalized airway clearance schedule 2. Desire to be more independent with airway clearance regimen 3. Concern that nebulizer sets were not consistently cleaned in accordance with CF guidelines Based on this, the PFAB and CF team evaluated ways to provide personalized scheduling and administration of respiratory medications and chest physiotherapy. A respiratory therapy preference card was created to address this. It includes 1) preferences of timing of airway clearance, 2) preferred nebulized medicines and airway clearance modalities, 3) preferred level of supervision with airway clearance. Next, a combined CF provider-patient in-service for respiratory therapists (RT) was conducted to facilitate an open dialogue with regards to integration of the preference card. Implementation of the preference card involves the following: the preference card is included in a customized CF admissions folder, which is given to the CF patient on admission. The CF patient fills out the card and gives it to the respiratory therapist, who incorporates these preferences into their workflow. For monitoring, we will check in with the patients during the hospitalization to determine if the protocol was followed and if the respiratory medications were administered as per the preferred schedule. A check-in with RT would also be completed to determine any barriers. Data: Baseline data were collected through a pre-intervention survey sent to all CF adults hospitalized in the prior two years. A post-intervention survey is planned after the intervention to asses for changes in respiratory care satisfaction scores. Unfortunately, implementation of our project has been delayed by the COVID-19 pandemic. Conclusions: Partnership between the PFAB and care team helps direct quality improvement initiatives. The PFAB provides unique insight and can be engaged to help develop, implement, and study quality improvement initiatives to help provide improved care.

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