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1.
Camb Q Healthc Ethics ; 31(3): 355-367, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1960189

ABSTRACT

The genetic modification of pigs as a source of transplantable organs is one of several possible solutions to the chronic organ shortage. This paper describes existing ethical tensions in xenotransplantation (XTx) that argue against pursuing it. Recommendations for lifelong infectious disease surveillance and notification of close contacts of recipients are in tension with the rights of human research subjects. Parental/guardian consent for pediatric xenograft recipients is in tension with a child's right to an open future. Individual consent to transplant is in tension with public health threats that include zoonotic diseases. XTx amplifies concerns about justice in organ transplantation and could exacerbate existing inequities. The prevention of infectious disease in source animals is in tension with the best practices of animal care and animal welfare, requiring isolation, ethologically inappropriate housing, and invasive reproductive procedures that would severely impact the well-being of intelligent social creatures like pigs.


Subject(s)
Organ Transplantation , Tissue and Organ Procurement , Animal Welfare , Animals , Child , Ethics, Medical , Humans , Swine , Transplantation, Heterologous
2.
Frontiers in pediatrics ; 10, 2022.
Article in English | EuropePMC | ID: covidwho-1958477

ABSTRACT

Background The COVID-19 pandemic has highlighted the importance of mental wellbeing. The identification and implementation of quality measures can improve health outcomes and patient experience. The objective was to identify and define a core set of valid and relevant pediatric mental health quality measures that will support health system evaluation and quality improvement in British Columbia, Canada. Methods The study consisted of four phases. First, a comprehensive database search identified valid pediatric quality measures focused on mental health and substance use (MH/SU). Second, the identified quality measures were mapped to focus areas, which were then prioritized by two stakeholder groups consisting of 26 members. Third, up to two representative measures for each prioritized focus area were pre-selected by an expert panel (n = 9). And fourth, a three-step modified Delphi approach was employed to (1) assess each quality measure on a 7-point Likert scale against three relevance criteria (representative of a quality problem, value to intended audience and actionable), (2) discuss the results, and (3) select and rank the most relevant measures. Forty-eight stakeholders were invited to participate;of those 24 completed the round 1 survey, 21 participated in the round 2 discussion and 18 voted in the round 3 selection and ranking survey. For round 1, consensus was determined when at least 70% of the response rates were within the range of five to seven. For round 3, Kendall's coefficient of concordance W was used as an estimator of inter-rater reliability. Results One-hundred pediatric mental health quality measures were identified in the database search. Of those, 37 were mapped to ten focus areas. Pre-selection resulted in 19 representative measures moving forward to the Delphi study. Eleven measures met the consensus thresholds and were brought forward to the round 2 discussion. Round 3 ranking showed moderate to strong raters' agreement (Kendall's W = 0.595;p < 0.01) and resulted in the following five highest-ranked measures: level of satisfaction after discharge from inpatient admission due to MH/SU, number of patients experiencing seclusion or restraint, length of time from eating disorder referral to assessment, number of ED visits due to MH/SU, and number of readmissions to ED. Conclusion The selected core set of valid and relevant pediatric quality measures will support sustainable system change in British Columbia. The five top-ranked measures will be refined and tested for data collection feasibility before being implemented in the province.

3.
European Stroke Journal ; 7(1 SUPPL):488-489, 2022.
Article in English | EMBASE | ID: covidwho-1928072

ABSTRACT

Background and aims: Covid-19 has disrupted essential stroke prevention and treatment services, stroke rehabilitation and support services and delivery of stroke research. We examine recruitment data for two stroke rehabilitation trials recruiting within a single centre in November 2019 and November 2021, to identify if/how Covid-19 impacted upon recruitment rates and processes. Both studies were managed by the same research team and comprised of comparable protocols and selection criteria. Methods: Recruitment data from the two corresponding time periods, are reported using descriptive statistics. Field notes and direct researcher experiences are used to support observations derived from the data. Results: Patients screened reduced by >40% in November 2021 compared to the same period in 2019, despite an almost 20% increase in admissions, recruitment reduced by 75%. Research staffing issues (sickness) resulted in missed recruitment data and opportunities in November 2021. There were changes in participant identification methods, resulting from restricted researcher screening within clinical areas;more remote screening, less attendance at clinical meetings and increased initiation of referrals from the clinical staff (Table 1). While the centre's clinical trials portfolio expanded between 2019 and 2021 (from 11 to 17), we noted a reduction in research co-enrolment;reasons for this are unclear, however lower recruitment rates more broadly may have contributed to this. Conclusions: Covid-19 has changed how we engage with/in clinical research. Understanding the ways in which Covid-19 has altered the research recruitment landscape will be important in the continued delivery of vital stroke research, driving clinical advancements in the field.

4.
Journal of Neurological Surgery, Part B: Skull Base ; 2022.
Article in English | EMBASE | ID: covidwho-1868040

ABSTRACT

Purpose  Due to the potential risk of COVID-19 transmission during endonasal surgery, we studied methods to reduce droplet and aerosol generation during these procedures. Methods  Droplet spread was assessed using ultraviolet light and a camera that detected fluorescence in the operative field and surgeon's personal protective equipment. Density of aerosols sized <10 μm was measured using a photometric particle counter. We designed a face-mounted negative-pressure mask placed on the patients' face during endoscopic endonasal surgery. Sixteen patients were recruited between October 2020 and March 2021 and randomly assigned to the mask and no-mask groups. We compared droplet spread and aerosols generated in both groups, with copious irrigation and continuous suction during drilling forming the mainstay of surgical technique in all cases. Results  Droplet contamination due to direct spillage of fluorescein from the syringe was noted in two patients. Aerosol density rose during sphenoid drilling in both groups, with no significant difference when continuous suction and irrigation were employed (1.27 times vs. 1.07 times the baseline, p = 0.248). Aerosol density rose significantly when suction and irrigation were interrupted in the no-mask group (44.9 times vs. 1.2 times, p = 0.028), which was not seen when the mask was used. Conclusion  Aerosol generation increases during drilling in endonasal procedures and is a concern during this pandemic. The use of a rigid suction close to the drill along with copious irrigation is effective in reducing aerosol spread. The use of a negative pressure mask provides additional safety when inadvertent blockage of suction and inadequate irrigation occur.

5.
University of Illinois Law Review ; - (2):897-928, 2022.
Article in English | Web of Science | ID: covidwho-1819249

ABSTRACT

COVID-19 highlighted inherent problems existing within the Bankruptcy Code (the "Code"), namely, the inflexible timelines in 365(d)(4) given to real property tenant-debtors to assume or reject leases. The Consolidated Appropriations Act of 2021 attempted to solve this problem by modifying the treatment of unexpired leases of real property in bankruptcy. This Note argues that the legislation ultimately failed to address underlying issues present in the Code. Instead, this Note analogizes the debtor's assumption or rejection power in bankruptcy as a costless option. Understanding 365 under this option-value paradigm allows us to realize that prolonged waiting periods in the Code cause landlords to lose-out on value of their unexpired leases. Debtors should be allowed more flexibility to extend the period to assume or reject their leases, but in return they should be required to internalize the added costs of waiting. If we take the perspective that, at the moment of commencement, an unexpired lease converts to a costless option for the tenant-debtor, we can calculate the value of such an option using the Black-Scholes model and allow for the landlord to recover the lease-value amount as an administrative expense in bankruptcy. As such, we can allow the landlord to recoup some of the lost value of the unexpired lease as compensation for letting the tenant-debtor extend their option over time.

6.
Journal of Forensic Medicine and Toxicology ; 38(1):102-106, 2021.
Article in English | EMBASE | ID: covidwho-1818625

ABSTRACT

In view of the ongoing pandemic, healthcare workers are rightfully concerned about performing autopsies, due to the risk of infection. An autopsy surgeon and his/her team can inadvertently be exposed to infectious diseases. Use of appropriate personal protective equipment (PPE) and mortuaries equipped with negative pressure are essential to protect the autopsy team from exposure to potentially infected bodies, bodily fluids, tissues, and aerosolized particles. Unfortunately, in a developing country like India, due to a lack of funding most mortuaries have only the bare minimum facilities. Taking these issues into consideration, the authors have developed a prototype of a Low-Cost Infection Containment Chamber (LCICC) within which autopsies or sample collection from suspected or confirmed highly infectious cadaver can be performed. This innovation could provide infectious disease experts and pathologists a safer alternative to collect specimens to aid in the management outbreaks of highly infectious diseases.

7.
Open Forum Infectious Diseases ; 8(SUPPL 1):S323, 2021.
Article in English | EMBASE | ID: covidwho-1746554

ABSTRACT

Background. Mortality from COVID-19 is associated with male sex, older age, black race, and comorbidities including obesity. Our study identified risk factors for in-hospital mortality from COVID-19 using survival analysis at an urban center in Detroit, MI. Methods. This was a single-center historical cohort study. We reviewed the electronic medical records of patients positive for severe acute respiratory syndrome coronavirus 2 (the COVID-19 virus) on qualitative polymerase-chain-reaction assay, who were admitted between 3/8-6/14/20. We assessed risk factors for mortality using Kaplan-Meier analysis and Cox proportional hazards models. Results. We included 565 patients with mean age (standard deviation) 64.4 (16.2) years, 52.0% male (294) and 77.2% (436) black/African American. The overall mean body mass index (BMI) was 32.0 (9.02) kg/m2. At least one comorbidity was present in 95.2% (538) of patients. The overall case-fatality rate was 30.4% (172/565). The unadjusted mortality rate among males was 33.7% compared to 26.9% in females (p=0.08);the median time to death (range) for males was 16.8 (0.3, 33.9) compared to 14.2 (0.32, 47.7) days for females (p=0.04). Univariable survival analysis with Cox proportional hazards models revealed that age (p=< 0.0001), admission from a facility (p=0.002), public insurance (p< 0.0001), respiratory rate ≥ 22 bpm (p=0.02), lymphocytopenia (p=0.07) and serum albumin (p=0.007) were additional risk factors for mortality (Table 1). From multivariable Cox proportional hazards modeling (Table 2), after controlling for age, Charlson score and qSofa, males were 40% more likely to die than females (p=0.03). Conclusion. After controlling for risk factors for mortality including age, comorbidity and sepsis-related organ failure assessment, males continued to have a higher hazard of death. These demographic and clinical factors may help healthcare providers identify risk factors from COVID-19.

8.
American Journal of Pharmaceutical Education ; 85(9):887-890, 2021.
Article in English | ProQuest Central | ID: covidwho-1628044

ABSTRACT

Inequities put racial and ethnically marginalized communities at increased risk of becoming ill and dying from COVID-19 due to discrimination, racism, implicit bias, lack of access to quality health care, occupational risks, educational/wealth and income gaps, and crowded or poor housing situations, among many other issues.5,6 Deaths resulting from COVID-19 are 2.0-2.4 times higher for African American/Black, Hispanic/Latino, and American Indian/Alaska Native individuals as compared to White individuals.5 Moreover, multiple social, geographic, political, economic, and environmental factors have created challenges to vaccination access and acceptance that often more adversely affect racial and ethnic minority groups, as evident in data from the Centers for Disease Control and Prevention. [...]based on information from September 4, 2021, data from 63.5% of people who had been fully vaccinated for COVID-19, indicate that racial and ethnic disparities continue to exist in vaccination rates.7 Specifically, although Hispanic and Black individuals represent 17.2% and 12.4%, respectively, of the US population, as of September 4, 2021, only 16.3% of individuals receiving the vaccine were Hispanic and 9.8% were Black.7 DISCUSSION Why a Theme Issue on Injustice Was Needed While pharmacy curricula address cultural sensitivity as required by the Accreditation Council for Pharmacy Education standards, many programs fail to adequately discuss the impact of racism and discrimination on social injustices and health inequities.8 While a lack of cultural awareness and sensitivity are independent factors influencing racial and ethnic health disparities, and therefore training in this area is a positive step forward, cultural competency training by itself has not been shown to strongly impact patient outcomes.9 Cultural competence must be accompanied by actions promoting social justice that rely in part on addressing structural racism and social determinants of health. "10 While social science literature is robust in conceptualizing structural racism, limited information is geared to health care professionals, especially pharmacists.11 In 2007, the American Association of Colleges of Pharmacy-Pharmaceutical Services Support Center (AACP-PSSC) Commission encouraged students and faculty members to deliver culturally competent care in efforts to eliminate disparities in health care delivery.12 The guest editors for this issue postulate that, while some action has been taken, it has not been adequate and more aggressive efforts are needed to change adverse outcomes and trajectories. In the 2010 US Census, African Americans accounted for nearly 13.6% of the US population and Hispanics accounted for nearly 16.3%,14 whereas the 2010 Equal Employment Opportunity Census indicated that, of the 253,925 individuals identifying as pharmacists, only 3.6% identified as Hispanic or Latino and 5.7% identified as Black or African American.15 The authors recognize that health care professionals who are from diverse backgrounds tend to better understand the culture, background, and historical events affecting minorities and thereby build greater trust, which can influence the achievement of better outcomes.16 While precise numbers for pharmacists are lacking, we know that only 23% of African Americans and 26% of Hispanics report having a physician who is the same race or ethnicity as themselves, compared to 82% of White Americans.17,18 One way to address these workforce needs is to diversify the student body for health professions.

9.
Journal of the American College of Surgeons ; 233(5):S236-S236, 2021.
Article in English | Web of Science | ID: covidwho-1535582
10.
Professional Psychology: Research and Practice ; 2021.
Article in English | Scopus | ID: covidwho-1532015

ABSTRACT

During the Coronavirus disease (COVID-19) pandemic, supporting the emotional wellbeing of healthcare staff is essential to help prevent burnout and promote self-care, given the emotional demands and increased workload. An overview of the development of a staff support service in a large teaching hospital is provided. The Leeds Clinical and Health Psychology department set up a face to face, drop-in service, and telephone support service for all staff. A comprehensive evaluation database and attendance log wasdeveloped. This ensured that data were recorded from each staff support session. A short anonymous electronic survey was sent to staff who had accessed the service. Over an 18-week period, a total of 458 sessions were offered to support staff;318 were face to face, 134 were telephone sessions, and six were email enquiries. Three hundred and ninety-four unique individuals accessed the service over this period. In response to the data collected, adjustments were made to when the service was available. Work-related stress was the most consistent reason for staff accessing support. Of the 458 staff contacts, 243 contacts specifically named COVID-19 related issues. Psychological first aid and coping strategy development were the most widely used interventions offered. The data collected highlights the benefit of offering a staff support service during COVID-19, and the benefit of evaluating a service, ensuring that the service is responsive to staff need © 2021 American Psychological Association

11.
American Journal of Transplantation ; 21(SUPPL 4):512, 2021.
Article in English | EMBASE | ID: covidwho-1494542

ABSTRACT

Purpose: A national shortage of immediate release (IR) tacrolimus (FK) fully impacted our center in May 2020. The conversion process was immediately challenging during the peak of the COVID-19 pandemic in our state. The aim of this analysis was to assess the healthcare burden that resulted from a national IRFK shortage. Methods: This is a retrospective analysis of the conversion from IRFK to tacrolimus XR for all adult kidney recipients transplanted during the 2019 calendar year who had a functioning graft at the start of conversion (May 2020). Pts were divided into converted and not converted cohorts. Health care resource utilization as evidenced by notes in the EHR and encounters for therapeutic drug monitoring (TDM) were captured for 180 days for all pts;for converted pts these data were collected pre and post-conversion. The avg salary for a RN coord is $75K/yr or $38.46/hr. For each EHR encounter the average est cost was 30 mins ($19.23) and TDM was 15 mins ($9.62). Est PharmD costs per 17$/15 mins based on average base salary of $150K and a phone call time was est at 10 mins/call, provider costs estimated on avg base salary $75/hr consider 30 mins, $37.50 required for conversion and education for single post-conversion visit that would not have been required if conversion were not necessary. Results: 226 pts were transplanted in 2019 with 113 pts included for analysis (Figure 1). Pts without conversion had less EHR encounters during the study period (Table 1). TDM did not differ significantly pre and post-conversion among groups but did between groups. For the converted cohort total provider estimated costs was $3187.50 however if this were expanded to the estimated 2000 patients currently in follow-up the cost of provider time for conversion would be estimated around $75K. PharmD fielded an average of 10-15 calls/day (150 mins/day) for 6 wks following the initial conversion period for all patients. The cost for this time period was estimated at $4500. Conclusions: Converted pts overall had more healthcare encounters and TDM encounters pre and post-conversion compared to those that were not converted. Additional provider, coordinator and PharmD time were required for conversion efforts.

12.
Int J STEM Educ ; 8(1): 55, 2021.
Article in English | MEDLINE | ID: covidwho-1470623

ABSTRACT

BACKGROUND: The Learning Assistant (LA) model with its subsequent support and training has evidenced significant gains for undergraduate STEM learning and persistence, especially in high-stakes courses like Calculus. Yet, when a swift and unexpected transition occurs from face-to-face to online, remote learning of the LA environment, it is unknown how LAs are able to maintain their motivation (competence, autonomy, and relatedness), adapt to these new challenges, and sustain their student-centered efforts. This study used Self-Determination Theory (SDT) to model theoretical aspects of LAs' motivations (persistence and performance) both before and after changes were made in delivery of a Calculus II course at Texas Tech University due to COVID-19 interruptions. RESULTS: Analysis of weekly written reflections, a focus group session, and a post-course questionnaire of 13 Calculus II LAs throughout Spring semester of 2020 showed that LAs' reports of competence proportionally decreased when they transitioned online, which was followed by a moderate proportional increase in reports of autonomy (actions they took to adapt to distance instruction) and a dramatic proportional increase in reports of relatedness (to build structures for maintaining communication and building community with undergraduate students). CONCLUSIONS: Relatedness emerged as the most salient factor from SDT to maintain LA self-determination due to the COVID-19 facilitated interruption to course delivery in a high-stakes undergraduate STEM course. Given that online learning continues during the pandemic and is likely to continue after, this research provides an understanding to how LAs responded to this event and the mounting importance of relatedness when LAs are working with undergraduate STEM learners. Programmatic recommendations are given for enhancing LA preparation including selecting LAs for autonomy and relatedness factors (in addition to competence), modeling mentoring for remote learners, and coaching in best practices for online instruction.

15.
Asian Economic Papers ; 20(1):55-60, 2021.
Article in English | Scopus | ID: covidwho-1329076
16.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277106

ABSTRACT

Introduction: Before the COVID-19 pandemic, 20-30% of family members had symptoms of Post-Traumatic Stress Disorder (PTSD) or anxiety, while 15-30% had symptoms of depression. Interventions supporting family members have reduced burden of these symptoms. COVID-19 has resulted in prolonged ICU stays, high morbidity/mortality, and hospital policies severely limiting family presence at the bedside. We hypothesized the combination of prolonged critical illness and the necessary reduction of family presence would lead to high rates of PTSD, anxiety, and depression;likely higher than observed in previous studies. Methods: This was a multicenter study including 12 US hospitals, 8 academic and 4 community-based hospitals. A consecutive sample of family members of all patients with COVID-19 receiving ICU admission during the spring US peak in 2020 were called 3-4 months after the patients' ICU admission, except for New York City hospitals where a random sample was generated given the large number of hospitalizations. Consented participants completed the Impact-of- Events Scale-6 (IES-6;scored 0-30, higher scores indicate more symptoms of PTSD), Hospital-Anxiety- Depression Score (HADS, scored 0-20 for anxiety and 0-20 for depression, higher scores indicate more symptoms), and a subset of questions from Family-Satisfaction in the ICU-27 (FS-ICU27;scored on a Likert scale 1 to 5, with higher scores indicating more positive responses) selected as most likely impacted by restrictive family presence.Results: There were 945 eligible family members during the study period. Of those, 594 were contacted and 269 (45.3%) consented and completed surveys. The mean IES-6 score was 12.6 (95% CI 11.8- 13.4) with 65.4% having a score of 10 or greater, consistent with high levels of symptoms of PTSD. The mean score on the HADS-anxiety was 9.4 (95% CI 8.8-10.1) with 59.5% having a score of 8 or greater, consistent with high levels of symptoms of anxiety. Finally, the mean score for the HADS-depression was 8.0 (95% CI 7.3-8.7) with 47.6% having scores of 8 or greater, consistent with high level of symptoms of depression. The mean response for the FSICU27 questions of “I felt I had control” was 3.5 (95% CI 3.3-3.6), “I felt supported” was 3.8 (95% CI 3.6-4.0), and “I felt included” was 4.3 (95% CI 4.2-4.4).Conclusion: The consequences of a family member admitted to the ICU with COVID-19 infection are significant. We identify rates of PTSD, anxiety, and depression higher than recorded in non-COVID population. Further analysis is warranted to understand modifiable risk factors for developing these symptoms.

17.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277046

ABSTRACT

RATIONALE: Currently, there are over 20,000 COVID-19 positive patients requiring intensive care unit (ICU) care in the United States (US). Even prior to the pandemic, up to 30% of family members of ICU patients experience post-traumatic stress disorder and up to 50% sustain potentially prolonged anxiety and/or depression. Although family bedside engagement improves both short-and long-term outcomes for patients and their families, nationwide social distancing recommendations have curtailed hospital visitation, potentially heightening the risk of stress-related disorders in these family members. The goal of this analysis is to explore the experiences of physically distanced family members of COVID-19 ICU patients in order to inform future best practices. Methods: This qualitative analysis is part of a multisite, observational, mixed-methods study of 12 US hospitals. Qualitative interviews were conducted with 75 participants from five sites;14 interviews were analyzed in this preliminary analysis. Adult family members of COVID-19 positive patients admitted to the ICU from March-June 2020 were interviewed three months post-discharge. After sequential screening by site coordinators, participants were contacted by the qualitative team until all interviews (10-15 per site) were completed. Qualitative interviews explored the illness stories, communication perceptions, and explored stressors. Thematic analysis was applied to the verbatim transcripts of the phone interviews. Four coders utilized an iteratively-developed codebook to analyze transcripts using a round-robin method with two analysts per transcript. Discrepant codes were adjudicated by a third analyst to attend to inter-rater reliability. Results: Five preliminary themes and seven subthemes emerged (Table 1). Positive communication experiences were more common than negative ones. Communication themes were: 1) Participants were reassured by proactive and frequent communication, leaving them feeling informed and included in care;and 2) Mixed feelings were expressed about the value of video-conferencing technology. Themes from the emotional and stress experiences were: 3) Profound sadness and distress resulted from isolation from patients, clinicians, and supportive family;4) Stress was amplified by external factors;and 5) Positive experiences centered upon appreciation for healthcare workers and gratitude for compassionate care. Conclusion: Incorporating the voices of family members during the COVID-19 pandemic establishes a foundation to inform family-centered, best practice guidelines to support the unique needs of family members who are physically distant from their critically ill and dying loved ones.

18.
Front Pediatr ; 9: 638070, 2021.
Article in English | MEDLINE | ID: covidwho-1256396

ABSTRACT

Introduction: Adoption of virtual health (VH) solutions in healthcare has been challenging; this changed rapidly after implementation of physical distancing measures due to the COVID-19 pandemic. In response to the pandemic, British Columbia's Children's and Women's sub-specialty hospitals rapidly trained and scaled up support to equip staff and clinicians to use VH. Methods: Ninety-minute live online training workshops and frequently updated online support materials were offered for 6 weeks. Training was monitored via feedback collected at training sessions and a brief post-training survey. After training completion, a second survey was circulated to measure utilization outcomes and experiences with VH. Results: Eight hundred and ninety-five participants representing 82% of staff requiring support were trained through 101 sessions; 348 (38.9%) and 272 (30.4%) responses were collected for the monitoring and outcome surveys, respectively. Overall, 89% agreed that training was relevant to their needs; participants indicated average 58.1% (SD = 26.6) and 60.6% (SD = 25.2) increase in knowledge and confidence in VH after training; 90.1% had booked or conducted VH sessions. Increase in confidence was more pronounced in participants with lesser previous exposure to VH, but number of sessions conducted post-training and percentage of successful sessions were independent of previous exposure. For future training and support, participants suggested subject-tailored trainings, asynchronous trainings, and availability of experienced users. Discussion: Training is key to success of VH implementation. Moving forward, core competencies in VH should be developed to support standardization and allow for evaluation and quality improvement. Incorporation of VH training in continuous professional development and onboarding is also highly recommended.

19.
Open Forum Infectious Diseases ; 7(SUPPL 1):S343, 2020.
Article in English | EMBASE | ID: covidwho-1185917

ABSTRACT

Background: During the early COVID-19 pandemic a large number of investigational agents were utilized due to lack of therapeutic options. We evaluate the utility of commonly-used investigational agents combined with hydroxychloroquine (HCQ). Methods: This multicenter observational cohort study included patients admitted with COVID-19 between March - May 2020 in Detroit, Michigan who received at least 2 doses of HCQ. Our primary outcome was the change in Sequential Organ Failure Assessment (SOFA) score from presentation to day 5 of HCQ therapy with a secondary outcome of in-hospital mortality. Data collected included demographics, Charlson Comorbidity index (CCI), daily SOFA score, laboratory data and COVID-directed therapies. Multiple linear regressions were performed to control for potential confounders between different therapies and change in SOFA score. Results: Three hundred thirty-five patients receiving HCQ were included. Patients were 62 ± 14.8 years of age, male (54%) and African-American (82%) with a mean CCI of 1.7 ± 1.9. In our cohort, 32% were admitted to the intensive care unit and 35% expired. Therapies received by more than 20% of patients in addition to HCQ included azithromycin (80%), zinc (76%) and vitamin D (29%). In our unadjusted analysis, a significant improvement in SOFA score was observed with zinc (0.76) while no significant change was observed with azithromycin (-0.46) or vitamin D (0.05). However, there was no significant change in SOFA score after adjusting for confounders for azithromycin, zinc and vitamin D. No difference in mortality was observed between the groups. Conclusion: Overall, no benefit in end-organ damage or mortality was observed with the addition of azithromycin, zinc or vitamin D to HCQ. Further studies are needed to confirm this observation.

20.
Oncology Nursing Forum ; 48(2):2, 2021.
Article in English | Web of Science | ID: covidwho-1151330
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