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2.
Public Health ; 213: 91-93, 2022 Oct 17.
Article in English | MEDLINE | ID: covidwho-2069605

ABSTRACT

OBJECTIVES: The aim of the present study was to explore self-interest, kin altruism and non-kin altruism reasons that influence people to vaccinate against COVID-19. STUDY DESIGN: This was a cross-sectional study using a fully repeated measures design. METHODS: Participants (N = 178) answered questions on perceived threat and likelihood of infection, vaccination status and opinion on mandatory vaccination. Participants also rated a set of statements that asked how likely these would influence them and others to vaccinate against COVID-19. Statements reflected self-interest, kin altruism or non-kin altruism. RESULTS: Just more than half of the sample (50.8%) reported the likelihood of infection as somewhat or extremely likely, and almost three-fourths (74.2%) reported that COVID-19 posed a minor or moderate threat to their physical health. Almost three-fourths (74.3%) of the sample were vaccinated, with just more than half (56.2%) in favour of mandatory vaccination. A 2 (self/other) × 3 (self-interest/kin altruism/non-kin altruism) fully repeated measures analysis of variance showed that kin-altruistic reasons were rated most highly, regardless of whether this was regarding oneself or others. Participants rated others as having greater self-interest reasons for vaccination compared with oneself, whereas non-kin altruism reasons for vaccination were rated higher for oneself, compared with others. CONCLUSION: Highlighting the benefits of vaccination for close relatives and vulnerable others in the population would be a useful strategy for government to use when urging the public to vaccinate against COVID-19.

3.
Clinical Toxicology ; 60(Supplement 2):79, 2022.
Article in English | EMBASE | ID: covidwho-2062723

ABSTRACT

Background: As we continue to treat patients during the ongoing opioid overdose epidemic, it is ever more important that providers have adequate experience in understanding and treating patients with addiction, substance use disorder and withdrawal states. Additionally, throughout the COVID-19 pandemic, there have been numerous reports demonstrating that substance use is exponentially increasing. This increases the likelihood that addiction medicine will occupy a more prominent position in our medical field. Until recently, addiction medicine education was not an ACGME program requirement for medical toxicology fellowship programs. We aimed to evaluate the percentage of bedside medical toxicology consultations addressing addiction-related issues, over time, at a tertiary care hospital system. Method(s): We reviewed bedside toxicology consults performed by a tertiary care hospital system's Division of Medical Toxicology consultation service between January 2017 and December 2021 for addiction, substance use, and withdrawal-related cases. Consultation data is entered by bedside toxicologists and maintained in a secure database. Descriptive statistics were analyzed for various variables and were compared between years, utilizing SPSS28. Result(s): Over the 5-year period, the toxicology service was consulted on a total of 4733 patients, of which, 2549 were addiction- related (53.9%). The majority of consults were male (65.6%), with 1 transgender (male-to-female) patient treated during this time. The proportion of addiction medicine consults increased steadily over the five-year time period. In 2017, there were 345 total consults, with 88 addiction-related (25.5%). In 2018, the service was consulted on 509 patients, of which 168 were addiction related (33%). In 2019, this trend continued to increase, with addiction medicine consults accounting for 52.8% of the total consults (478 of 905 consults). 58.7% of the toxicology services' consults were addiction related in 2020 (627 of 1069). As of this past year, of the 1905 total consults, 1188 were for addiction or substance-use complaints (62.4%). The most common primary reason for a medical toxicologist consult, was alcohol withdrawal (803 cases, 31.5%). In 2021, alcohol withdrawal accounted for 44.2% of the total consults, which was a 25.7% increase from pre-pandemic levels. Opioid withdrawal as the primary reason for consultation accounted for 9.1% of total consults across the time-period. In 2017, opioid withdrawal accounted for 2.3% of consults, but increased to 13.0% of the consultations by 2021. Opioid agonist therapy (buprenorphine, methadone) was initiated in 12.7% of total consults. In 2017, there were no cases where opioid agonist therapy was a topic of consultation, but this increased to 12.0% of consults throughout 2021. Conclusion(s): At a tertiary care hospital system, addiction medicine consults by bedside medical toxicologists have continued to increase disproportionately compared to other consults. As of this past year, addiction related complaints made up roughly two-thirds of all medical toxicology consults, increasing almost 40% over 5-years. This single center phenomenon could represent a national trend;however, larger-scale studies would need to assess this pattern. This data further supports the recent ACGME medical toxicology program requirement changes, emphasizing the importance of addiction medicine and its relationship to medical toxicology.

4.
Investigative Ophthalmology and Visual Science ; 63(7):3776-F0197, 2022.
Article in English | EMBASE | ID: covidwho-2058428

ABSTRACT

Purpose : Assessing the impact of COVID-19 on visual acuity (VA) in eyes treated for Diabetic Macular Edema. Methods : Anonymized data from 21 UK centers were extracted from Medisoft for eyes receiving treatment with aflibercept and with VA data in the pre-COVID baseline period (01/10/19 to 30/03/20, N=3,248). Comparisons for period 1 (01/04/20 to 30/09/20, N=2,077)-lockdown following RCOphth Medical Retinal Management Plan, period 2 (01/10/20 to 30/03/21, N=1,850)-intermittent lockdown and period 3 (01/04/21 to 30/09/21, N=1,111;20 centers)-easing of COVID-19 restrictions. VA change was compared for baseline VA, <7 vs. ≥7 injections before period 1 and for eyes losing ≥5 ETDRS letters in period 1. Results : The mean change in VA for eyes with a baseline VA of ≤35 letters, was +4.9, +2.5 and +1.7 letters from baseline to period 1, period 1 to 2 and period 2 to 3, respectively. For baseline VA of 36-55 letters, +0.6, +1.7 and -0.2 letters, from baseline to period 1, period 1 to 2 and period 2 to 3, respectively. For baseline VA of 56-75 letters, +1.9, zero and -0.5 letters, from baseline to period 1, period 1 to 2 and period 2 to 3, respectively. For baseline VA of >75 letters, -4.3, -0.5 and zero letters, from baseline to period 1, period 1 to 2 and period 2 to 3, respectively. For eyes receiving <7 injections before period 1, the mean change in VA was -1.9 letters (N=1,335) from baseline to period 1, +0.5 letters (N=992) from period 1 to 2 and +0.1 letters (N=592) from period 2 to 3. For ≥7 injections before period 1, the mean change in VA was -3.4 letters (N=742) from baseline to period 1, -0.4 letters (N=515) from period 1 to 2 and -1.1 letters (N=303) from period 2 to 3. For eyes losing ≥5 letters before period 1, the mean change in VA when receiving ≥1 injection in period 2 was +3.9 letters (N=283) from period 1 to 2 and -0.1 letters (N=140) from period 2 to 3. For eyes not retreated in period 2, the mean change in VA was -2.9 letters (N=162) from period 1 to 2 and zero letters (N=73) from period 2 to 3. Conclusions : Visual gain between time periods was more likely for lower baseline vision. For eyes with <7 or ≥7 injections before period 1, the mean VA change was a loss in vision in the first period with little change in later periods. For eyes with ≥5 letter loss in period 1, subsequent visual gain was more likely if treatment continued.

5.
Investigative Ophthalmology and Visual Science ; 63(7):1336-F0170, 2022.
Article in English | EMBASE | ID: covidwho-2057546

ABSTRACT

Purpose : To assess the impact of COVID-19 on eyes treated for neovascular AMD. Methods : Anonymized data from 21 UK centers were extracted from Medisoft for patients receiving treatment with aflibercept and VA data in the pre-covid baseline (01/10/19 to 31/03/20 n=8,313). Comparisons were made for period 1 (01/04/20 to 30/09/20 n=4,011)-lockdown following RCOphth Medical Retinal Management Plan during COVID-19, period 2 (01/10/20 to 31/03/21 n=4,551)-intermittent lockdown following updated RCOphth COVID-19 guidelines, and period 3 (01/04/21 to 30/09/21 n=2,630)-easing COVID-19 restrictions. VA change was compared for baseline VA, <7 vs. ≥7 injections before period 1 and for eyes losing ≥5 letter in period 1. Results : The mean change in VA for eyes with a baseline VA of ≤35 ETDRS letters was +0.7, +0.1 and -1.6 letters, 36-55 letters was -3.0, -1.2 and -1.3 letters, 56-75 letters was -2.1, -1.1 and -1.5, and >75 letters was -4.3, -0.7 and -0.4 letters in periods 1, 2 and 3 respectively. The median VA change was zero letters for all baseline VA groups and time periods except for the >75 letter group in period 1 (median 2 letter loss). The mean change in VA from baseline for eyes with <7 injections before period 1, was -2.0, -0.6 and -1.2 letters from 2,083, 2,465 and 1,420 eyes in periods 1, 2 and 3, and ≥7 injections before period 1, was -2.9 from 1,928 eyes in period 1 and -1.3 letters from 2,086 and 1,210 eyes in periods 2 and 3. For both groups and time periods the median VA change was zero letters. For eyes that lost ≥5 ETDRS letters before period 1 the mean change in VA for eyes receiving no injections was +2.3 letters (n=155) and -3.5 letters (n=107), 1-3 injections was +1.4 letters (n=740) and -1.3 letters (n=340), and >3 injections was +2.3 letters (n=199) and -0.8 letters (n=122) in periods 2 & 3 respectively. The median VA change was zero letters for all time periods and injection number groups except for >3 injection eyes in period 2 (median 3 letter gain) and no injection eyes in period 3 (median 1 letter loss). Conclusions : In period 1, a small VA loss was experienced by many eyes dependent on baseline VA. Similar VA changes were present for eyes receiving <7 and ≥7 injections before period 1. For eyes that lost ≥5 ETDRS letters during period 1, many had visual gain with more improvement linked to receiving more injections in period 2, falling back in period 3.

6.
European psychiatry : the journal of the Association of European Psychiatrists ; 64(Suppl 1):S596-S596, 2021.
Article in English | EuropePMC | ID: covidwho-2045501

ABSTRACT

Introduction The delivery of medical education has changed alongside the effects of COVID-19. As a result, the undergraduate psychiatry training for medical students at Guy’s King’s and St Thomas’ School of Medicine had to adapt rapidly. This poster portrays the journey in which the teaching sessions were developed and delivered throughout the first academic term of 2020-2021. Objectives To deliver an interactive online teaching day that can provide students with the knowledge and understanding of common psychiatric disorders in the interface of other medical conditions. Methods A clinical skills teaching day was developed to deliver the sessions via the online video calling platform Zoom. Published articles regarding online medical education as well as guidelines from the Royal College of Psychiatry were used as a resource to develop the structure. Feedback of the teaching day was collected via an anonymous survey. Results 78 responses were collected in total from 4 teaching days. Overall satisfaction was high with a score of 86.5/100 in overall satisfaction. Themes for positive feedback included utilising actors in simulation (38% 30/78) and high interactivity within the teaching (31% 24/78). There were a number of students who found the whole day session online tiring (13% 10/78) and others felt the variation of scenarios were too limited (12% 9/78). Conclusions As lockdown has forced students to have less patient contact, they have suffered from the lack of learning opportunities. This teaching day showed the importance of organising high fidelity scenarios in order to try and fill the void that has been created due to COVID-19.

7.
Wellcome Open Research ; 5:209, 2020.
Article in English | MEDLINE | ID: covidwho-2030332

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) has resulted in an unprecedented research response, demonstrating exceptional examples of rapid research and collaboration. There has however been an ongoing need for greater coordination, with limited resources for research and the shifting global pandemic.

8.
HemaSphere ; 6(Suppl), 2022.
Article in English | EuropePMC | ID: covidwho-2011671
9.
Journal of General Internal Medicine ; 37:S322, 2022.
Article in English | EMBASE | ID: covidwho-1995630

ABSTRACT

BACKGROUND: African-Americans (AA) are underrepresented in mobile health (mHealth) intervention research studies which can perpetuate health inequities and the digital divide. A community based, user-centered approach to designing mHealth interventions may increase their sociocultural relevance and effectiveness, especially with increased smartphone use during the COVID-19 pandemic. We aimed to refine an existing mHealth intervention via a virtual focus group series for use in a randomized controlled trial (RCT) aiming to improve cardiovascular health (CVH) in AAs. METHODS: AA community members (N=15) from churches in Minneapolis and Rochester, Minnesota were enrolled in a virtual, 3-session focus group series over 5 months to refine an existing CVH focused mHealth application (FAITH! App). Participants completed a baseline electronic survey capturing sociodemographics, mobile technology use, and electronic health information sources prior to start of focus groups. Participants accessed the FAITH! App via their smartphones and received a Fitbit synced to the app. Participants engaged with multimedia CVH focused education modules, a sharing board for social networking, and diet/PA self-monitoring. Participant feedback on app features prompted iterative revisions to yield a refined app. Primary outcomes were app usability (assessed via Health Information Technology Usability Evaluation Scale [Health-ITUES], range 0-5) and user satisfaction which were evaluated via electronic survey after the final focus group. A predetermined goal of mean overall Health-ITUES score of ≥4 was set for the app to advance for use in the RCT. RESULTS: Participants (mean age [SD] 56.9 [12.3] years, 13, 86.7% female) attended a mean 2.8 focus groups (80% attended all sessions). Participant feedback resulted in app refinements to increase visual appeal, increase diversity and gender balance in testimonial videos, further improve ease of diet/PA self-monitoring, and add fitness videos as well as a moderated sharing board. The revised FAITH! App achieved a mean overall Health-ITUES score of ≥4 (mean 4.39, range 3.20-4.95). Participants positively rated updated app content, visual appeal, and use of social incentives to maintain engagement. Increasing user control and further refinement of the moderated sharing board were identified as areas for future improvement. CONCLUSIONS: Virtual focus group data can improve usability and increase participant satisfaction in mHealth lifestyle interventions aiming to promote CVH in AAs.

10.
Wellcome Open Research ; 5:209, 2020.
Article in English | MEDLINE | ID: covidwho-1988531

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) has resulted in an unprecedented research response, demonstrating exceptional examples of rapid research and collaboration. There has however been an ongoing need for greater coordination, with limited resources for research and the shifting global nature of the pandemics.

11.
Journal of Gender-Based Violence ; 6(2):393-405, 2022.
Article in English | Scopus | ID: covidwho-1951484

ABSTRACT

Technology is an ever-increasing part of most people’s lives and it has been crucial for the delivery of support by domestic violence and abuse (DVA) services during the COVID-19 pandemic. Paradoxically, this same technology has provided perpetrators with new and growing opportunities to continue or escalate their abusive behaviours. This article draws on the experiences of a specialist DVA service for children and young people (CYP) in the United Kingdom reflecting on the use of technology in service delivery during the COVID-19 pandemic. We applied a safety systems approach – a failure modes and analysis (FMEA) to analyse the nature and impacts of service responses. The FMEA shed light on the risks within the environment in which children and young people engage with remote, digital-enabled support. Practitioners, for example, have been unable to determine potential ‘lurking’, whereby other people, including the abusive parent or partner, are present within the room, but out of sight. The FMEA generated 13 ‘corrective actions’ that will be helpful to specialist practitioners supporting children and young people experiencing DVA and to operational managers modifying current services and designing those for the future. © Centre for Gender and Violence Research University of Bristol 2022.

12.
Microscopy and Microanalysis ; 28(S1):3220-3222, 2022.
Article in English | ProQuest Central | ID: covidwho-1947162
13.
Frontiers in Education ; 7:7, 2022.
Article in English | Web of Science | ID: covidwho-1928412

ABSTRACT

BackgroundSelf-harm is a major public health concern with evidence suggesting that the rates are higher in the United Kingdom than anywhere else in Europe. Increasingly, policy highlights the role of school staff in supporting young people (YP) who are self-harming, yet research indicates that school staff often feel ill-equipped to provide support and address self-harm behaviors. Here, we assess the impact of a bespoke eLearning module for United Kingdom secondary school teachers on teacher's actual and perceived knowledge of self-harm, and their self-reported confidence in supporting and talking to YP who self-harm. MethodsTwenty-one secondary schools across the West Midlands and South East of England were invited to complete a 30-min web-based eLearning module on self-harm in schools. Participants completed pre-and post-intervention measures. ResultsOne-hundred and seventy-three teachers completed the eLearning, and pre-and post-measures. The eLearning significantly enhanced participants' perceived knowledge, actual knowledge, and confidence in talking to and supporting YP who self-harm. The majority of participants (90.7%) felt that eLearning was a good way to receive training. ConclusionThe 30-min eLearning module was rated highly and may be an effective way to increase secondary school teachers' knowledge of self-harm, and confidence in supporting and talking to YP who self-harm.

14.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927743

ABSTRACT

Rationale: The ROSE trial was a multicenter unblinded randomized clinical trial comparing early neuromuscular blockade (NMB) to usual care in patients with moderate to severe ARDS (NEJM 2019). This trial (n=1006) was stopped early for futility yet a subgroup analysis found that among Hispanic/Latino participants the NMB intervention group had a significantly lower mortality (32%) compared to those in the control group (53.7% p=0.02 for interaction). To evaluate potential contributors to these differences we compared baseline clinical and biological characteristics among Hispanic/Latino participants in the intervention vs control group. Methods: We compared demographics primary ARDS risk factor illness severity ventilatory parameters comorbidities and plasma biomarkers at baseline between the NMB intervention and control group for all 118 Hispanic/Latino patients recruited to the ROSE trial (11.6% of the trial population). We used multiple logistic regression to examine whether the mortality difference by treatment group would persist after controlling for the factors that differed significantly between groups. Results: At baseline Hispanic/Latino participants randomized to the control group had greater disease severity scores (APACHE III SOFA;p<0.05 for both) and a higher prevalence of shock (p=0.01) compared to those randomized to the intervention. There were no significant differences between groups in causes of lung injury or baseline ventilatory parameters. In an unadjusted logistic regression model the NMB intervention was significantly associated with mortality (OR 0.42;95%CI 0.20-0.89 p=0.02). The NMB intervention was no longer significantly associated with mortality when adjusting for severity of by illness by either SOFA score (OR 0.53;95%CI 0.24-1.20 p=0.13), APACHE III (OR 0.51, 95%CI 0.20- 1.30 p=0.16) or shock as defined by the need for vasopressors (OR 0.48, 95%CI 0.22-1.03, p=0.06). Hispanic/Latino participants in the control group had significantly higher interleukin-8 (p=0.02) and lower bicarbonate (p=0.045) than those in the intervention group. Conclusion: Together these clinical and biomarker data support the conclusion that the lower mortality associated with NMB in the Hispanic/Latino subgroup may have been partially due to baseline imbalances in systemic severity of illness. This finding underscores the need to cautiously interpret apparent treatment benefits within small subgroups. The COVID-19 pandemic has highlighted ethnic and racial disparities in ARDS. Future trials will benefit from increased representation of populations that are disproportionately affected to minimize the impact of spurious findings related to small sample sizes while creating more statistical power to prospectively address disparities.

16.
Fertility and Sterility ; 116(3 SUPPL):e170, 2021.
Article in English | EMBASE | ID: covidwho-1880415

ABSTRACT

OBJECTIVE: To significantly reduce the number of in person visits during an IVF cycle without compromising cycle outcomes, patient safety, or patient satisfaction. MATERIALS AND METHODS: This was a multi-modal QI initiative at an academic fertility centre. After the temporary closure of many fertility services across IVF clinics in North America in March 2020, we identified that new policies and procedures were necessary in order to safely resume patient care during a pandemic. The primary intervention of this study was a change in our IVF monitoring protocol. Our default settings in our electronic medical record order sets were changed, and education sessions were held for clinic staff. Baseline data was collected from 2019 for comparison. A patient satisfaction survey using a 5-point likert scale was created and sent to every patient undergoing IVF on the day of their oocyte retrieval. The number of in person visits during an IVF cycle were counted for each patient undergoing treatment from June 2020 to August 2020. This was compared to the number of in person visits during the same time frame in 2019. Balancing measures included patient satisfaction, pregnancy rates, risk and incidence of ovarian hyperstimulation syndrome (OHSS), incidence of cycle cancellation, and number of eggs retrieved per cycle. Pre- and postintervention data was compared using univariate and multivariate poisson models to control for patient characteristics such as age, AMH, and BMI. RESULTS: A significant reduction in the number of in person visits (8 vs 4, p<0.001) during an IVF treatment cycle was observed post-intervention compared with the previous year. There was no significant difference in pregnancy rates, risk or incidence of OHSS, cycle cancellation, or number of eggs retrieved per cycle. Patient surveys were reassuring that the intervention did not change patient experience or satisfaction. CONCLUSIONS: IVF Monitoring Protocol changes aimed at reducing the number of in person visits allowed our team to continue to provide ongoing care for patients during the Covid-19 pandemic without compromising IVF outcomes or patient satisfaction. IMPACT STATEMENT: This study allows for safer and socially distanced care for patients undergoing IVF cycles during a pandemic, and will also shape our future practise of cycle monitoring during IVF stimulation as we have shown that a reduction in bloodwork and ultrasound does not negatively impact patient outcomes.

17.
Rheumatology (United Kingdom) ; 61(SUPPL 1):i133-i134, 2022.
Article in English | EMBASE | ID: covidwho-1868418

ABSTRACT

Background/Aims Rituximab is a chimeric type-1 anti-CD20 monoclonal antibody approved by NHS England for refractory SLE. Secondary inefficacy with infusion reactions and anti-rituximab-antibodies occurs in 14% of re-treated patients. Obinutuzumab is a next-generation humanised type-2 anti-CD20 antibody licensed for the treatment of haematological malignancies. Methods We collated data from nine SLE patients receiving off-label obinutuzumab for secondary non-response to rituximab with infusion reactions across six centres (Leeds, Bradford, York, UCL, Birmingham and Nottingham). Disease activity was assessed using BILAG-2004 and SLEDAI-2K and serology in local diagnostic laboratories before, and 6 months after, obinutuzumab 2x1000mg infusions 2 weeks apart alongside methylprednisolone 100mg. Results All patients received concomitant oral immunosuppression and prednisolone. 6/9 received hydroxychloroquine. The median number of rituximab cycles before obinutuzumab therapy was 2.5. Before obinutuzumab 6/9 patients had BILAG A/B mucocutaneous, 6/9 had BILAG A/B musculoskeletal and 4/9 had BILAG A/B renal. 6 months after obinutuzumab 1/9 patients had BILAG B mucocutaneous, no patients had BILAG A/B musculoskeletal and 2/9 patients had BILAG A/B renal. Median dsDNA reduced from 118 to 83 IU/mL, C3 increased from 0.53 to 1.02g/L and C4 increased from 0.095 to 0.23g/L. Prednisolone dose was reduced in 5/9 patients;before obinutuzumab all patients received 10mg or more. After obinutuzumab, 4/9 patients received 5mg and were in Lupus Low Disease Activity State (LLDAS). Patient 5 did not respond and required further methylprednisolone and cyclophosphamide at 4 months. Patient 6 had a partial renal response but required renal transplantation, which was successful. Patient 8 responded well to obinutuzumab but died from severe COVID-19 infection (unvaccinated). After obinutuzumab 6 patients with B-cell data all achieved complete depletion including 4/4 assessed with highly sensitive assays. Conclusion These results demonstrate obinutuzumab's efficacy in patients with secondary non-response to rituximab. These patients have severe disease with few treatment options, but previous responsiveness to Bcell depletion. Therefore, switching to another therapy in this class is mechanistically logical. Obinutuzumab appeared effective in renal and non-renal SLE as well as steroid-sparing. Immunological markers also improved. Obinutuzumab was generally well tolerated and will be further investigated for treatment-refractory lupus in the REGENCY and ALLEGORY trials.

18.
British Journal of Haematology ; 197(SUPPL 1):180, 2022.
Article in English | EMBASE | ID: covidwho-1861253

ABSTRACT

Thrombocytopenia is a common complication of COVID-19 (coronavirus disease 2019). The possible mechanisms include decreased platelet production, increased platelet destruction and consumption. According to studies, thrombocytopenia indicates a poor prognosis and increased mortality in COVID-19 patients. Meanwhile, thrombocytopenia is often complicated in extracorporeal membrane oxygenation (ECMO) due to shearing force in the circuit and heparin-induced thrombocytopenia (HIT). COVID-19 patients who are managed on ECMO are at high risk of developing thrombocytopenia and life-threatening bleeding. Venous thromboembolism (VTE) prevention is critical in managing COVID-19 patients. The balance between bleeding secondary to thrombocytopenia and thromboembolic prophylaxis is challenging. ECMO support also increases the risk of thrombocytopenia. Our retrospective observation study reports the incidences of thrombocytopenia and major bleeding events in 17 COVID-19 patients who were managed with ECMO. We retrospectively reviewed the data of 23 patients who were diagnosed with COVID-19 and managed on ECMO. Thrombocytopenia is defined by platelet level lower than 150 000/ul. Incidences of thrombocytopenia and related complications were recorded and analysed. Twenty-three adult patients who were diagnosed with COVID-19 received ECMO support. The mean age of patients was 45-year-old and mean body mass index (BMI) was 31.29. Seventeen patients were males, and 11 patients had at least one of the following pre-ECMO comorbidity: 10 (43.5%) patients had hypertension, 11 (47.8%) patients had type 2 diabetes and four (17.3%) patients had hyperlipidaemia. None of the patients were active smokers or had chronic lung disease when admitted. Anticoagulation was initiated on the day of admission. Twenty-one (91.3%) patients developed thrombocytopenia and HIT was excluded. Eighteen (78.3%) patients had haemorrhage requiring transfusion, with the gastrointestinal tract being the most common site. Other bleeding sites included brain, chest, tracheostomy area and cannulation site. Thromboembolic prophylaxis was held for active bleeding or platelet count threshold of <30 000/ul. Based on our data, the incidence of thrombocytopenia was 91.3% in ECMO-managed COVID-19 patients;78.3% patients developed haemorrhage requiring transfusion. Given the high risk of thromboembolic events in COVID-19 patients, anticoagulation is recommended to all hospitalized COVID-19 patients unless there is active bleeding, previous bleeding history within 3 days or platelet count is lower than 30 000 cells/ul. However, anticoagulation further increases the risk of bleeding in the setting of thrombocytopenia, which may lead to sudden deterioration and death. Further investigation into the mechanisms, implications and management of thrombocytopenia will lead to significantly improved outcomes and prognosis for COVID-19 patients who are managed on ECMO..

19.
British Journal of Haematology ; 197(SUPPL 1):152-153, 2022.
Article in English | EMBASE | ID: covidwho-1861239

ABSTRACT

Venous thromboembolism (VTE) is a common complication of COVID-19 (coronavirus disease 2019), which often leads to sudden deterioration and death. There are multiple mechanisms contributing to this phenomenon. Endothelial injury from COVID-19 triggers platelet activation and adhesion, leucocyte aggregation, cytokine storm and complement activation. Cytokine storm triggers coagulation activation and thrombin generation. Complement activation is also thought to trigger the formation of systemic thrombus through recruiting inflammatory cytokines and possible complement-mediated thrombotic microangiopathy. Patients on extracorporeal membrane oxygenation (ECMO) are at risk of developing thromboembolism. Thrombus formation within the extracorporeal circuit is the main reason for systemic thromboembolism. Possibly that by contacting blood and nonendothelial surfaces, ECMO triggers activation of coagulation pathway and inflammatory response. Thromboembolic prophylaxis is critical in managing COVID-19 patients on ECMO. Anticoagulation is recommended to all hospitalised COVID-19 patients unless there are contraindications. However, patients are still found to develop VTE while on anticoagulation and the prevalence of VTE in COVID-19 patients on ECMO is still unclear. We aim to investigate the VTE incidence and contribute to anticoagulation strategy and management in this specific population. We retrospectively reviewed the data of 23 patients who were diagnosed with COVID-19 and managed with ECMO. All patients received thromboembolic prophylaxis since admission. We report our findings of the incidences of thromboembolism. Twenty-three adult patients who were diagnosed with COVID-19 received ECMO support. Sixteen patients were minorities, and seven patients were Caucasians. The mean age of patients was 44.8-year old. Seventeen patients were males, and 11 patients had at least one of the following pre-ECMO comorbidity: ten (43.5%) patients had hypertension, 11 (47.8%) patients had type 2 diabetes and four (17.3%) patients had hyperlipidaemia. None of the patients were active smokers or had chronic lung disease. During the hospital course, all patients received heparin for thromboembolic prophylaxis. The overall VTE rate was 34.7%. Six patients developed deep vein thrombosis (DVT) (26%) with lower extremities induration. Two patients were found to have pulmonary embolism (PE) (8.7%). Four patients had clotted circuit that requiring exchange. No stroke or myocardial infarction (MI) was diagnosed in these patients. Heparin-induced thrombocytopenia (HIT) was excluded in all cases. Based on our study, the overall VTE rate of COVID-19 patients on ECMO was 34.7% with 26% incidence of DVT and 8.7% incidence of PE. According to Jenner's recent systemic review of 28 studies, 34% of 2928 ICU-managed COVID-19 patients developed VTE. PE was found in 12.6% of patients and DVT was detected in 16.1% of patients. 529 patients (18.0%) received ECMO in the cohort. When compared with our study, there were no statistically significant differences of the incidences of VTE, DVT or PE between these two studies, although all our patients were on ECMO support. Further investigation into the prevalence, implications and management of thromboembolism in COVID-19 patients on ECMO will lead to significantly improved outcomes for this specific patient population..

20.
Modern Pathology ; 35(SUPPL 2):1371-1372, 2022.
Article in English | EMBASE | ID: covidwho-1857315

ABSTRACT

Background: Current research comparing CPR-associated injuries between those receiving LUCAS device and manual CPR has primarily focused on patients who suffered out-of-hospital cardiac arrest. During the SARS-CoV-2 pandemic, more hospitals leveraged mechanical CPR devices to provide distant yet high quality chest compressions for in-hospital cardiac arrest (IHCA) patients. We sought to investigate autopsy thoracic injury patterns in in-hospital non-traumatic cardiac arrests, comparing traditional manual compressions with the mechanical LUCAS device compressions. Design: Autopsies were screened for a history of in-hospital cardiopulmonary resuscitation in the absence of prior traumatic injuries at a single, large quaternary care center from 1/1/2018 to 06/30/2021. 20 received LUCAS compressions and 40 received manual compressions. Student's T-Tests were used to compare means for continuous variables, while chi-squared and Fischer's exact tests were used for categorical variables. An alpha of 0.05 was chosen as the threshold for statistical significance. Results: A statistically significant decrease in the rate of sternal fractures and rate of multiple sternal fractures during mechanical CPR was found. A statistically significant increase in other soft tissue injuries, such as pleural wall or lung injuries was seen in mechanical CPR cases, while an increased rate of bilateral rib fractures was noted in manual compression cases. Conversely, no difference in the number or laterality of rib fractures were noted. There was no significant difference in age, biological sex, or rate of scoliosis or kyphosis between cohorts. Results are listed in table 1. (Table Presented) Little research has looked at the injury patterns of mechanical CPR in the IHCA patient population. These results point to a potential difference in thoracic injury patterns from manual compressions when compared to LUCAS device compressions. The statistically significant decrease in sternal fractures with mechanical compressions is noteworthy. Conversely, the increase in other soft tissue injury demands further examination. The decrease in bilateral rib fractures with LUCAS use suggests that placement of the device may play a role in the epidemiology of rib injuries, but not in the number of ribs injured. Further research should examine rib injuries in more detail, and quantify additional comorbidities in both survivors and non-survivors of cardiac arrest.

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