Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 9 de 9
Filter
1.
Journal of Social Work in End-of-Life & Palliative Care ; : 1-16, 2022.
Article in English | Taylor & Francis | ID: covidwho-1819738
2.
Eur Respir J ; 2021 Nov 25.
Article in English | MEDLINE | ID: covidwho-1538054

ABSTRACT

INTRODUCTION: Dexamethasone decreases mortality in coronavirus disease 2019 (COVID-19) patients on intensive respiratory support (IRS) but is of uncertain benefit if less severely ill. We determined whether early (within 48 h) dexamethasone was associated with mortality in patients hospitalised with COVID-19 not on IRS. METHODS: We included patients admitted to Veterans Affairs hospitals between June 7, 2020-May 31, 2021 within 14-days after SARS-CoV-2 positive test. Exclusions included recent prior corticosteroids and IRS within 48 h. We used inverse probability of treatment weights (IPTW) to balance exposed and unexposed groups, and Cox proportional hazards models to determine 90-day all-cause mortality. RESULTS: Of 19 973 total patients (95% men, median age 71, 27% black), 15 404 (77%) were without IRS within 48 h. Of these, 3514/9450 (34%) patients on no oxygen received dexamethasone and 1042 (11%) died; 4472/5954 (75%) patients on low-flow nasal cannula (NC) received dexamethasone and 857 (14%) died. In IPTW stratified models, patients on no oxygen who received dexamethasone experienced 76% increased risk for 90-day mortality (hazard ratio [HR] 1.76, 95% confidence interval [CI] 1.47 to 2.12); there was no association with mortality among patients on NC (HR 1.08, 95% CI 0.86 to 1.36). CONCLUSION: In patients hospitalised with COVID-19, early initiation of dexamethasone was common and was associated with no mortality benefit among those on no oxygen or NC in the first 48 h; instead, we found evidence of potential harm. These real-world findings do not support the use of early dexamethasone in hospitalised COVID-19 patients without IRS.

3.
Clin Epidemiol ; 13: 1011-1018, 2021.
Article in English | MEDLINE | ID: covidwho-1502184

ABSTRACT

PURPOSE: To estimate the positive predictive value (PPV) of International Classification of Diseases, Tenth Revision (ICD-10) code U07.1, COVID-19 virus identified, in the Department of Veterans of Affairs (VA). PATIENTS AND METHODS: Records of ICD-10 code U07.1 from inpatient, outpatient, and emergency/urgent care settings were extracted from VA medical record data from 4/01/2020 to 3/31/2021. A weighted, random sample of 1500 records from each quarter of the one-year observation period was reviewed by study personnel to confirm active COVID-19 infection at the time of diagnosis and classify reasons for false positive records. PPV was estimated overall and compared across clinical setting and quarters. RESULTS: We identified 664,406 records of U07.1. Among the 1500 reviewed, 237 were false positives (PPV: 84.2%, 95% CI: 82.4-86.0). PPV ranged from 77.7% in outpatient settings to 93.8% in inpatient settings and was 83.3% in quarter 1, 80.5% in quarter 2, 86.1% in quarter 3, and 83.6% in quarter 4. The most common reasons for false positive records were history of COVID-19 (44.3%) and orders for laboratory tests (21.5%). CONCLUSION: The PPV of ICD-10 code U07.1 is low, especially in outpatient settings. Directed training may improve accuracy of coding to levels that are deemed adequate for future use in surveillance efforts.

4.
Open Forum Infect Dis ; 8(7): ofab176, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1309619

ABSTRACT

We describe a case of prolonged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a patient receiving ocrelizumab for multiple sclerosis. Viral RNA shedding, signs, and symptoms persisted for 69 days with resolution after administration of convalescent plasma and antiviral therapy. This case suggests risk for persistent SARS-CoV-2 infection in patients treated with anti-CD-20 monoclonal antibodies and supports a role for humoral immunity in disease resolution.

5.
PLoS One ; 16(4): e0248080, 2021.
Article in English | MEDLINE | ID: covidwho-1199975

ABSTRACT

BACKGROUND: Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) may positively or negatively impact outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We investigated the association of ARB or ACEI use with coronavirus disease 2019 (COVID-19)-related outcomes in US Veterans with treated hypertension using an active comparator design, appropriate covariate adjustment, and negative control analyses. METHODS AND FINDINGS: In this retrospective cohort study of Veterans with treated hypertension in the Veterans Health Administration (01/19/2020-08/28/2020), we compared users of (A) ARB/ACEI vs. non-ARB/ACEI (excluding Veterans with compelling indications to reduce confounding by indication) and (B) ARB vs. ACEI among (1) SARS-CoV-2+ outpatients and (2) COVID-19 hospitalized inpatients. The primary outcome was all-cause hospitalization or mortality (outpatients) and all-cause mortality (inpatients). We estimated hazard ratios (HR) using propensity score-weighted Cox regression. Baseline characteristics were well-balanced between exposure groups after weighting. Among outpatients, there were 5.0 and 6.0 primary outcomes per 100 person-months for ARB/ACEI (n = 2,482) vs. non-ARB/ACEI (n = 2,487) users (HR 0.85, 95% confidence interval [CI] 0.73-0.99, median follow-up 87 days). Among outpatients who were ARB (n = 4,877) vs. ACEI (n = 8,704) users, there were 13.2 and 14.8 primary outcomes per 100 person-months (HR 0.91, 95%CI 0.86-0.97, median follow-up 85 days). Among inpatients who were ARB/ACEI (n = 210) vs. non-ARB/ACEI (n = 275) users, there were 3.4 and 2.0 all-cause deaths per 100 person months (HR 1.25, 95%CI 0.30-5.13, median follow-up 30 days). Among inpatients, ARB (n = 1,164) and ACEI (n = 2,014) users had 21.0 vs. 17.7 all-cause deaths, per 100 person-months (HR 1.13, 95%CI 0.93-1.38, median follow-up 30 days). CONCLUSIONS: This observational analysis supports continued ARB or ACEI use for patients already using these medications before SARS-CoV-2 infection. The novel beneficial association observed among outpatients between users of ARBs vs. ACEIs on hospitalization or mortality should be confirmed with randomized trials.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , COVID-19/pathology , Hypertension/drug therapy , Aged , COVID-19/mortality , COVID-19/virology , Female , Hospitalization/statistics & numerical data , Humans , Hypertension/pathology , Male , Middle Aged , Propensity Score , Proportional Hazards Models , Retrospective Studies , Risk Factors , SARS-CoV-2/isolation & purification , Survival Rate , Veterans
6.
J Psychosoc Oncol ; 39(3): 428-444, 2021.
Article in English | MEDLINE | ID: covidwho-1196920

ABSTRACT

PURPOSE: Describe the impact of the COVID-19 pandemic on the work structure, daily care provided, personal lives, and practice models for pediatric oncology social workers (POSW). RESEARCH APPROACH: Cross-sectional online survey on APOSW professional listserv from 10/5/2020 to 11/20/2020. SAMPLE: 101 surveys were completed by POSW from 31 states and the District of Columbia. METHODS: Data were summarized descriptively and with semantic content analyses. FINDINGS: Surveys were completed by social workers from diverse work settings. Seventy-five percent of social workers were deemed "essential," and 45% reported working primarily from home. Most (56%) adopted a form of telehealth for patient care, although 71% did not receive telehealth training and 87% perceived lesser quality of care with telehealth. Nearly 80% of respondents reported not being able to provide optimum psychosocial care. Notable stressors on social work practice included worry about exposure to COVID-19, limited resources, lack of contact with and increased emotional needs of patients and families, managing patient and family concerns about COVID-19, and isolation from colleagues. Inequity and social justice issues were identified. Despite challenges, over 60% of POSW endorsed positive changes to their work life resulting from the pandemic. CONCLUSIONS/INTERPRETATION: As the COVID-19 pandemic persists, POSW have adapted to a changing work environment, different modes of service provision, and stark health inequities to meet the needs of patients and families in a crisis. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS: COVID-19 vastly impacted the personal and professional lives of POSW, warranting attentiveness to lessons learned and future directions.


Subject(s)
COVID-19 , Neoplasms/rehabilitation , Psychosocial Intervention/statistics & numerical data , Social Workers/psychology , Social Workers/statistics & numerical data , Telemedicine/statistics & numerical data , Adult , Child , Cross-Sectional Studies , Humans , Teleworking/statistics & numerical data
7.
Nurs Leadersh (Tor Ont) ; 33(4): 62-67, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1094388

ABSTRACT

This case study outlines the journey of a home-care organization to support practice change during the COVID-19 crisis. The leadership attributes and organizational structures and processes required for a nimble knowledge-to-action response are explored in relation to client screening, personal protective equipment and development of virtual care. A home and community practice lens was often not evident in the literature or guidance documents. This added complexity to the process of rapidly evaluating evidence and guidance across two provinces and issuing practice direction to a widely dispersed and mobile workforce. A cross-functional clinical response team has been invaluable in the organization's pandemic response.


Subject(s)
Community Health Services/trends , Delivery of Health Care/methods , Evidence-Based Practice/methods , Home Care Services/standards , COVID-19/prevention & control , COVID-19/transmission , Community Health Services/methods , Delivery of Health Care/trends , Evidence-Based Practice/trends , Home Care Services/organization & administration , Home Care Services/trends , Humans , Pandemics/prevention & control , Personal Protective Equipment/standards , Personal Protective Equipment/trends , Telemedicine/methods , Telemedicine/trends
8.
Soc Work Health Care ; 60(1): 49-61, 2021.
Article in English | MEDLINE | ID: covidwho-1072244

ABSTRACT

The COVID-19 pandemic has exposed the systemic inequities in our health care system and society has called for actions to meet the clinical, psychosocial and educational needs in health care settings and communities. In this paper we describe how an organized Department of Health Social Work in a medical school played a unique role in responding to the challenges of a pandemic with community, clinical, and educational initiatives that were integral to our community's health.


Subject(s)
COVID-19/epidemiology , Leadership , Schools, Medical/organization & administration , Social Work/organization & administration , Compassion Fatigue/epidemiology , Food Supply/methods , Health Status , Hotlines/organization & administration , Humans , Inservice Training/organization & administration , Mental Health , Palliative Care/organization & administration , Pandemics , SARS-CoV-2 , Telemedicine/organization & administration , United States/epidemiology
9.
Depress Anxiety ; 37(8): 822-826, 2020 08.
Article in English | MEDLINE | ID: covidwho-645210

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has brought a health care crisis of unparalleled devastation. A mental health crisis as a second wave has begun to emerge in our front-line health care workers. OBJECTIVE: To address these needs, The Healthcare Worker Mental Health COVID-19 Hotline, based on crisis intervention principles, was developed and launched in 2 weeks. METHODS: Upon reflection of why this worked, we decided it might be useful to describe what we now recognize as 13-steps which led to our success. The process included the following: (1) anticipate mental health needs; (2) use leadership capable of mobilizing the systems and resources; (3) convene a multidisciplinary team; (4) delegate tasks and set timelines; (5) choose a clinical service model; (6) motivate staff as a workforce of volunteers; (7) develop training and educational materials; (8) develop personal, local, and national resources; (9) develop marketing plans; (10) deliver the training; (11) launch a 24 hr/7days per week Healthcare Worker Mental Health COVID-19 Hotline, and launch follow-up sessions for staff; (12) structure data collection to determine effectiveness and outcomes; and (13) obtain funding (not required). DISCUSSION: We believe the process we used is specifically useful for others who may want to develop a COVID-19 hotline services for health care workers and generally useful for the development of other mental health services. CONCLUSION: We hope that this process may serve as a guide for other heath care systems.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Health Personnel/psychology , Hotlines , Mental Health Services/organization & administration , Mental Health/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , COVID-19 , Humans , Leadership , Mental Health Services/economics , Pandemics
SELECTION OF CITATIONS
SEARCH DETAIL