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1.
European Respiratory Journal ; 14:14, 2022.
Article in English | MEDLINE | ID: covidwho-2029683

ABSTRACT

BACKGROUND: Patients who present to an emergency department with respiratory symptoms are often conservatively triaged in favour of hospitalization. We sought to determine if an inflammatory biomarker panel that identifies the host response better predicts hospitalization in order to improve the precision of clinical decision-making in the emergency department. PATIENTS AND METHODS: From April 2020 to March 2021, plasma samples of 641 patients with symptoms of respiratory illness were collected from emergency departments in an international multicentre study: Canada (n=310), Italy (n=131), and Brazil (n=200). Patients were followed prospectively for 28 days. Subgroup analysis was conducted on confirmed COVID-19 patients (n=245). An inflammatory profile was determined using a rapid, 50-minute, biomarker panel: Rapid Acute Lung Injury Diagnostic (RALI-Dx), which measures IL-6, IL-8, IL-10, sTNFR1, and sTREM1. RESULTS: RALI-Dx biomarkers were significantly elevated in patients who required hospitalization across all three sites. A machine learning algorithm that was applied to predict hospitalization using RALI-Dx biomarkers had an area under the receiver operating characteristic curve of 76+/-6% (Canada), 84+/-4% (Italy), and 86+/-3% (Brazil). Model performance in COVID-19 patients was 82+/-3% and 87+/-7% for patients with a confirmed pneumonia diagnosis. CONCLUSIONS: The rapid diagnostic biomarker panel accurately identified the need for inpatient care in patients presenting with respiratory symptoms, including COVID-19. The RALI-Dx test is broadly and easily applicable across many jurisdictions and represents an important diagnostic adjunct to advance emergency department decision-making protocols.

2.
Wellcome Open Research ; 7:39, 2022.
Article in English | MEDLINE | ID: covidwho-2025560

ABSTRACT

Background: The COVID-19 pandemic has accelerated adoption of remote consulting in healthcare. Despite opportunities posed by telemedicine, most hypertension services in Europe have suspended ambulatory blood pressure monitoring (ABPM). Methods: We examined the process and performance of remotely delivered ABPM using two methodologies: firstly, a Failure Modes and Effects Analysis (FMEA) and secondly, a quantitative analysis comparing ABPM data from a subgroup of 65 participants of the Screening for Hypertension in the INpatient Environment (SHINE) diagnostic accuracy study. The FMEA was performed over seven sessions from February to March 2021, with a multidisciplinary team comprising a patient representative, a research coordinator with technical expertise and four research clinicians.

3.
Annals of the Rheumatic Diseases ; 81:1616-1617, 2022.
Article in English | EMBASE | ID: covidwho-2008963

ABSTRACT

Background: There is an unmet need for new treatments for hand osteoarthri-tis (OA). Symptomatic hand OA is more common in women and its incidence increases round the age of menopause. Pre-clinical, epidemiological and post hoc studies in Hormone Replacement Therapy (HRT) trials implicate estrogen defciency as of likely importance in OA aetiopathogenesis. No clinical trials of HRT have been carried out in hand OA to date. The licensed HRT Duavive (conjugated estrogens + SERM bazedoxifene) was selected on its potential for efficacy and tolerability. Objectives: We set out to determine the feasibility and acceptability of this form of HRT in post-menopausal women with hand OA, to generate proof of concept data and refne methods for a full study. Methods: ISRCTN12196200. Females aged 40-65 yrs and 1-10yrs after fnal menstrual period with hand OA fulflling ACR criteria and 2+ painful hand joints were recruited. Eligibility incorporated best practice for HRT prescription but did not require menopausal symptoms. Recruitment was at 3 sites in primary/secondary care, including directly from the community. Design was parallel group, double-blind 1:1 randomisation of Duavive or placebo, orally once daily for 24 weeks, then weaning for 4 weeks before stopping. Routes and rates of recruitment and the acceptability of randomisation, medication (compliance, retention), and proposed outcomes were measured, and the likelihood of unblinding. Measures related to hand pain and function, menopause symptoms and joint appearance. Patient and Public Involvement actively informed study rationale, design and materials. An end of study questionnaire and 2 participant focus groups provided further acceptability data. Results: Recruitment was for 12/possible 18 months, interrupted due to COVID-19. Some study procedures were modifed to allow reopening whilst collecting all primary outcomes. 434 enquiries/referrals were received, leading to 96 telephone pre-screens, of which 33 gave written informed consent and attended face to face screening. 28/33 screened (85%) were eligible and randomised. The highest number of randomisations was from study web presence (n=7) followed by SMS text from GP surgeries (n=5). Of 401 not proceeding, 250 (62%) were ineligible, most commonly due to contraindicated medication, followed by medical contraindication, whilst 55 (14%) decided not to take part, for reasons including not wanting to take a hormone-based drug or difficulty attending study visits. Retention and compliance were excellent. All 28 participants completed all study follow ups, with only 3 withdrawals from treatment due to AEs, 2 of these at week 24 and all in the placebo arm. There were no serious AEs. High levels of completeness of all study outcome measures were achieved. Bang's blinding index suggested that participants/investigators were well blinded. There were overall high/good levels of satisfaction with taking part in the study. 26/28 (92%) would recommend taking part to others with hand OA (irrespective of study arm). Many found the fexibility offered by a combination of remote and face to face visits (due to the pandemic) attractive. Additional insights from focus groups were to include hand stiffness as well as pain measures but to reduce the overall number of questions. Conclusion: Despite COVID-19 and a reduced recruitment period, this study recruited sufficient numbers to assess feasibility outcomes. Randomisation of eligible people and retention rates were high. A mixture of remote and face to face visits due to COVID-19 probably improved recruitment and retention and was supported by participants, who were generally satisfed with the study design and medication. The study provided useful insight and improvements that would be incorporated into a future study. Overall, this feasibility study showed that with clear messaging on eligibility and a defned recruitment strategy, recruitment and retention to a study testing this treatment is possible.

4.
Journal of Humanistic Psychology ; 2022.
Article in English | Web of Science | ID: covidwho-2005555

ABSTRACT

The City of Brownsville was made vulnerable to the COVID-19 pandemic due to high rates of obesity and diabetes, high rates of poverty, and adverse social determinants of health. To address the unique challenges faced by the community, Brownsville's COVID-19 response brought together the skills of academia with the local understanding and health expertise of the city's public health department to craft a pandemic response that addressed the specific needs and unique challenges of the residents. This article explores the response partnerships formed and the data-driven, community-oriented campaigns that were designed by the Brownsville Public Health Department. The collaborative partnership of the COVID-19 working group and the innovative dissemination strategies designed by the health department provided an effective method of disease mitigation among the city's most vulnerable residents. The article demonstrates the impact of the response campaigns by including a resident's perspective on the impact of the response, specifically how the health department tailored their efforts to meet the needs of the Brownsville community.

5.
Wang, K.; Goldenberg, A.; Dorison, C. A.; Miller, J. K.; Uusberg, A.; Lerner, J. S.; Gross, J. J.; Agesin, B. B.; Bernardo, M.; Campos, O.; Eudave, L.; Grzech, K.; Ozery, D. H.; Jackson, E. A.; Garcia, E. O. L.; Drexler, S. M.; Jurković, A. P.; Rana, K.; Wilson, J. P.; Antoniadi, M.; Desai, K.; Gialitaki, Z.; Kushnir, E.; Nadif, K.; Bravo, O. N.; Nauman, R.; Oosterlinck, M.; Pantazi, M.; Pilecka, N.; Szabelska, A.; van Steenkiste, I. M. M.; Filip, K.; Bozdoc, A. I.; Marcu, G. M.; Agadullina, E.; Adamkovič, M.; Roczniewska, M.; Reyna, C.; Kassianos, A. P.; Westerlund, M.; Ahlgren, L.; Pöntinen, S.; Adetula, G. A.; Dursun, P.; Arinze, A. I.; Arinze, N. C.; Ogbonnaya, C. E.; Ndukaihe, I. L. G.; Dalgar, I.; Akkas, H.; Macapagal, P. M.; Lewis, S.; Metin-Orta, I.; Foroni, F.; Willis, M.; Santos, A. C.; Mokady, A.; Reggev, N.; Kurfali, M. A.; Vasilev, M. R.; Nock, N. L.; Parzuchowski, M.; Espinoza Barría, M. F.; Vranka, M.; Kohlová, M. B.; Ropovik, I.; Harutyunyan, M.; Wang, C.; Yao, E.; Becker, M.; Manunta, E.; Kaminski, G.; Boudesseul, J.; Marko, D.; Evans, K.; Lewis, D. M. G.; Findor, A.; Landry, A. T.; Aruta, J. J. B.; Ortiz, M. S.; Vally, Z.; Pronizius, E.; Voracek, M.; Lamm, C.; Grinberg, M.; Li, R.; Valentova, J. V.; Mioni, G.; Cellini, N.; Chen, S. C.; Zickfeld, J.; Moon, K.; Azab, H.; Levy, N.; Karababa, A.; Beaudry, J. L.; Boucher, L.; Collins, W. M.; Todsen, A. L.; van Schie, K.; Vintr, J.; Bavolar, J.; Kaliska, L.; Križanić, V.; Samojlenko, L.; Pourafshari, R.; Geiger, S. J.; Beitner, J.; Warmelink, L.; Ross, R. M.; Stephen, I. D.; Hostler, T. J.; Azouaghe, S.; McCarthy, R.; Szala, A.; Grano, C.; Solorzano, C. S.; Anjum, G.; Jimenez-Leal, W.; Bradford, M.; Pérez, L. C.; Cruz Vásquez, J. E.; Galindo-Caballero, O. J.; Vargas-Nieto, J. C.; Kácha, O.; Arvanitis, A.; Xiao, Q.; Cárcamo, R.; Zorjan, S.; Tajchman, Z.; Vilares, I.; Pavlacic, J. M.; Kunst, J. R.; Tamnes, C. K.; von Bastian, C. C.; Atari, M.; Sharifian, M.; Hricova, M.; Kačmár, P.; Schrötter, J.; Rahal, R. M.; Cohen, N.; FatahModares, S.; Zrimsek, M.; Zakharov, I.; Koehn, M. A.; Esteban-Serna, C.; Calin-Jageman, R. J.; Krafnick, A. J.; Štrukelj, E.; Isager, P. M.; Urban, J.; Silva, J. R.; Martončik, M.; Očovaj, S. B.; Šakan, D.; Kuzminska, A. O.; Djordjevic, J. M.; Almeida, I. A. T.; Ferreira, A.; Lazarevic, L. B.; Manley, H.; Ricaurte, D. Z.; Monteiro, R. P.; Etabari, Z.; Musser, E.; Dunleavy, D.; Chou, W.; Godbersen, H.; Ruiz-Fernández, S.; Reeck, C.; Batres, C.; Kirgizova, K.; Muminov, A.; Azevedo, F.; Alvarez, D. S.; Butt, M. M.; Lee, J. M.; Chen, Z.; Verbruggen, F.; Ziano, I.; Tümer, M.; Charyate, A. C. A.; Dubrov, D.; Tejada Rivera, Mdcmc, Aberson, C.; Pálfi, B.; Maldonado, M. A.; Hubena, B.; Sacakli, A.; Ceary, C. D.; Richard, K. L.; Singer, G.; Perillo, J. T.; Ballantyne, T.; Cyrus-Lai, W.; Fedotov, M.; Du, H.; Wielgus, M.; Pit, I. L.; Hruška, M.; Sousa, D.; Aczel, B.; Hajdu, N.; Szaszi, B.; Adamus, S.; Barzykowski, K.; Micheli, L.; Schmidt, N. D.; Zsido, A. N.; Paruzel-Czachura, M.; Muda, R.; Bialek, M.; Kowal, M.; Sorokowska, A.; Misiak, M.; Mola, D.; Ortiz, M. V.; Correa, P. S.; Belaus, A.; Muchembled, F.; Ribeiro, R. R.; Arriaga, P.; Oliveira, R.; Vaughn, L. A.; Szwed, P.; Kossowska, M.; Czarnek, G.; Kielińska, J.; Antazo, B.; Betlehem, R.; Stieger, S.; Nilsonne, G.; Simonovic, N.; Taber, J.; Gourdon-Kanhukamwe, A.; Domurat, A.; Ihaya, K.; Yamada, Y.; Urooj, A.; Gill, T.; Čadek, M.; Bylinina, L.; Messerschmidt, J.; Kurfalı, M.; Adetula, A.; Baklanova, E.; Albayrak-Aydemir, N.; Kappes, H. B.; Gjoneska, B.; House, T.; Jones, M. V.; Berkessel, J. B.; Chopik, W. J.; Çoksan, S.; Seehuus, M.; Khaoudi, A.; Bokkour, A.; El Arabi, K. A.; Djamai, I.; Iyer, A.; Parashar, N.; Adiguzel, A.; Kocalar, H. E.; Bundt, C.; Norton, J. O.; Papadatou-Pastou, M.; De la Rosa-Gomez, A.; Ankushev, V.; Bogatyreva, N.; Grigoryev, D.; Ivanov, A.; Prusova, I.; Romanova, M.; Sarieva, I.; Terskova, M.; Hristova, E.; Kadreva, V. H.; Janak, A.; Schei, V.; Sverdrup, T. E.; Askelund, A. D.; Pineda, L. M. S.; Krupić, D.; Levitan, C. A.; Johannes, N.; Ouherrou, N.; Say, N.; Sinkolova, S.; Janjić, K.; Stojanovska, M.; Stojanovska, D.; Khosla, M.; Thomas, A. G.; Kung, F. Y. H.; Bijlstra, G.; Mosannenzadeh, F.; Balci, B. B.; Reips, U. D.; Baskin, E.; Ishkhanyan, B.; Czamanski-Cohen, J.; Dixson, B. J. W.; Moreau, D.; Sutherland, C. A. M.; Chuan-Peng, H.; Noone, C.; Flowe, H.; Anne, M.; Janssen, S. M. J.; Topor, M.; Majeed, N. M.; Kunisato, Y.; Yu, K.; Daches, S.; Hartanto, A.; Vdovic, M.; Anton-Boicuk, L.; Forbes, P. A. G.; Kamburidis, J.; Marinova, E.; Nedelcheva-Datsova, M.; Rachev, N. R.; Stoyanova, A.; Schmidt, K.; Suchow, J. W.; Koptjevskaja-Tamm, M.; Jernsäther, T.; Olofsson, J. K.; Bialobrzeska, O.; Marszalek, M.; Tatachari, S.; Afhami, R.; Law, W.; Antfolk, J.; Žuro, B.; Van Doren, N.; Soto, J. A.; Searston, R.; Miranda, J.; Damnjanović, K.; Yeung, S. K.; Krupić, D.; Hoyer, K.; Jaeger, B.; Ren, D.; Pfuhl, G.; Klevjer, K.; Corral-Frías, N. S.; Frias-Armenta, M.; Lucas, M. Y.; Torres, A. O.; Toro, M.; Delgado, L. G. J.; Vega, D.; Solas, SÁ, Vilar, R.; Massoni, S.; Frizzo, T.; Bran, A.; Vaidis, D. C.; Vieira, L.; Paris, B.; Capizzi, M.; Coelho, G. L. H.; Greenburgh, A.; Whitt, C. M.; Tullett, A. M.; Du, X.; Volz, L.; Bosma, M. J.; Karaarslan, C.; Sarıoğuz, E.; Allred, T. B.; Korbmacher, M.; Colloff, M. F.; Lima, T. J. S.; Ribeiro, M. F. F.; Verharen, J. P. H.; Karekla, M.; Karashiali, C.; Sunami, N.; Jaremka, L. M.; Storage, D.; Habib, S.; Studzinska, A.; Hanel, P. H. P.; Holford, D. L.; Sirota, M.; Wolfe, K.; Chiu, F.; Theodoropoulou, A.; Ahn, E. R.; Lin, Y.; Westgate, E. C.; Brohmer, H.; Hofer, G.; Dujols, O.; Vezirian, K.; Feldman, G.; Travaglino, G. A.; Ahmed, A.; Li, M.; Bosch, J.; Torunsky, N.; Bai, H.; Manavalan, M.; Song, X.; Walczak, R. B.; Zdybek, P.; Friedemann, M.; Rosa, A. D.; Kozma, L.; Alves, S. G.; Lins, S.; Pinto, I. R.; Correia, R. C.; Babinčák, P.; Banik, G.; Rojas-Berscia, L. M.; Varella, M. A. C.; Uttley, J.; Beshears, J. E.; Thommesen, K. K.; Behzadnia, B.; Geniole, S. N.; Silan, M. A.; Maturan, P. L. G.; Vilsmeier, J. K.; Tran, U. S.; Izquierdo, S. M.; Mensink, M. C.; Sorokowski, P.; Groyecka-Bernard, A.; Radtke, T.; Adoric, V. C.; Carpentier, J.; Özdoğru, A. A.; Joy-Gaba, J. A.; Hedgebeth, M. V.; Ishii, T.; Wichman, A. L.; Röer, J. P.; Ostermann, T.; Davis, W. E.; Suter, L.; Papachristopoulos, K.; Zabel, C.; Onie, S.; Ebersole, C. R.; Chartier, C. R.; Mallik, P. R.; Urry, H. L.; Buchanan, E. M.; Coles, N. A.; Primbs, M. A.; Basnight-Brown, D. M.; H, I. Jzerman, Forscher, P. S.; Moshontz, H..
Nat Hum Behav ; 2022.
Article in English | PubMed | ID: covidwho-2000902
6.
The International journal of pharmacy practice ; 30(Suppl 1):i38-i38, 2022.
Article in English | EuropePMC | ID: covidwho-1999525

ABSTRACT

Introduction Due to propellants, metered dose inhalers (pMDIs) have a higher carbon footprint than low carbon footprint inhalers (LCFIs), such as dry powder or soft mist inhalers (1). Consequently, pMDIs contribute 3.5% of the NHS’s CO2 equivalent emissions (2). Local and national guidelines (NICE, British Thoracic Society) have attempted to increase use of LCFIs, but their effects and factors influencing success are unknown. Aim To investigate temporal and geographical variation in LCFI dispensing in England over five years. Methods Clinical commissioning group (CCG) dispensed items (March 2016-February 2021) were obtained from openprescribing.net for five classes of inhaler where a choice between pMDIs and LCFIs is available: short-acting beta-agonists (SABAs), long-acting beta-agonists (LABAs), inhaled corticosteroids (ICS), ICS plus LABA inhalers (ICS/LABA) and ICS/LABA plus long-acting muscarinic antagonist inhalers (ICS/LABA/LAMA). CCG population age profiles were obtained from the Office for National Statistics. CCG emergency hospital admission and mortality rates were obtained from Public Health England. CCG formularies and guidelines were reviewed to identify where guidance is available to prescribers. To control for total inhaler dispensing, the key measure used is the %LCFI: the number of LCFI items dispensed relative to the total number of pMDI and LCFI items. Multivariate regression models were used to investigate geographical variation. Results The total annual %LCFI increased from 19.5% to 26.3% over the study period. This was driven by the introduction of ICS/LABA/LAMA inhalers in 2018, as %LCFI decreased for SABA, ICS and ICS/LABA inhalers. %LCFI varied between classes. In the final year, it ranged from 6% for both SABA and ICS inhalers, to 41.2% and 43.9% for ICS/LABA and ICS/LABA/LAMA inhalers, respectively. Interestingly, the cost per item for ICS/LABA and ICS/LABA/LAMA inhalers was similar for both pMDIs and LCFIs, but for SABA and ICS inhalers LCFIs were more expensive. %LCFI in the final year varied between CCGs (10.7% to 30.9%). The North West, and Birmingham and London areas had consistently higher %LCFI for all classes. For SABA and ICS inhalers, both the presence of advice on climate change in CCG guidelines or formularies, and greater CCG asthma prevalence, were significantly associated with higher %LCFI (p<0.05). The proportion of CCG population <15 years had a significant negative association with %LCFI for ICS and ICS/LABA inhalers (p<0.05). There were no clinically significant associations between %LCFI and either emergency hospital admission or mortality rates. Conclusion Current initiatives have not been successful in increasing the use of LCFIs, indicating limited implementation of guidelines for unknown reasons. Further action is required to reduce the carbon footprint of inhaler prescribing. Actions to address the financial disincentives to LCFI prescribing, CCG leadership (e.g. guidelines) and the appropriate use of LCFI in young people should be considered. Research into facilitators and barriers to LCFI use would support this. An important limitation is the use of dispensed items data rather than the number of inhalers, although there is no evidence that the number of inhalers per item varies between pMDIs and LCFIs. In addition, the Covid-19 pandemic disrupted prescribing patterns and long-term NHS projects. References (1) Wilkinson AJK, Braggins R, Steinbach I, Smith K. Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England. BMJ Open. 2019;9:e028763. (2) Environmental Audit Committee. UK progress on reducing F-Gas emissions inquiry: Fifth report of session 2017-19. London (UK): House of Commons Environmental Audit Committee;25 April 2018. Available from https://publications.parliament.uk/pa/cm201719/cmselect/cmenvaud/469/469.pdf: [Accessed 27 September 2021].

7.
The International journal of pharmacy practice ; 30(Suppl 1):i47-i47, 2022.
Article in English | EuropePMC | ID: covidwho-1999446

ABSTRACT

Introduction It is a common patient perception that their discharge from hospital is delayed by waiting for medicines (1). However, it is important to consider the entire discharge process when addressing this problem (2). In our large tertiary referral hospital, clinical pharmacy services were moved from wards to the dispensary following a staffing crisis during 2018. Ward-based services were reintroduced in 2020, but doubts remained over the practicality and benefits of doing this. Aim To compare the efficiency of ward and dispensary based clinical pharmacy services in our hospital in terms of interventions made and time taken. Methods We completed an observational service evaluation. Data on the time taken to process discharge medication requests with the dispensary-based service were collected retrospectively from the hospital electronic discharge system for 12 months (2018) for five medical wards. Equivalent data for the ward-based service were collected prospectively over three days (2020) by pharmacists delivering the service to seven medical wards, as this was considered more accurate, and several process steps did not exist in the ward-based model. For example, prescriber sending request to pharmacy and pharmacy acknowledging receipt of a request. The prospective data collection period was curtailed by Covid-19. Descriptive statistics were produced using Excel. Results Using the dispensary-based service (2018), 4459 medicine requests were processed from 5 medical wards, during a 12-month period. The mean time between prescribing and reaching the screening pharmacist was 175 minutes [95%CI ± 25.4]. It took an estimated time of 62 minutes [95%CI ± 2.99] to screen and resolve an intervention, with a mean of 3 interventions/ward/day. In 2020, using the ward-based approach to clinical pharmacy which screened medicine requests on the ward, 142 requests were screened over three days from seven wards, with no delay between prescribing and clinical screening. It took a mean of 17 minutes [95%CI ± 10.63] to screen and resolve an intervention, with a mean of 15 interventions/ward/day. Conclusion Ward based pharmacy yielded five times more interventions, took an average of 45 minutes less to screen and resolve issues per request and removed 175 minutes of process time. The additional time required to resolve issues identified in the dispensary-based screening process was thought to be the delay in contacting either the appropriate member of the ward staff referencing a particular patient for information or identifying and contacting the prescriber, or a combination of both. This study is limited by the long delay between data collection periods and the small sample size in 2020, but the differences between the two systems were large and there had been few other changes to hospital systems. Other limitations include changes related to Covid-19 and the lack of a control group, so it is not possible to establish a causal relationship between the type of pharmacy service and study outcomes. References (1) Wright S, Morecroft CW, Mullen R, Ewing AB. UK hospital patient discharge: the patient perspective. Eur J Hosp Pharm. 2017 Nov;24(6):338-342. (2) Green CF, Hunter L, Jones L, Morris K. The TTO Journey: How much of it is actually in pharmacy? Pharm Man. 2015 Oct;31(4):16-20.

8.
Journal of Cystic Fibrosis ; 21:S5, 2022.
Article in English | EMBASE | ID: covidwho-1996739

ABSTRACT

As new therapies emerge for cystic fibrosis (CF), it is important to understand their psychiatric implications. Studies have shown cystic fibrosis transmembrane conductance regulator (CFTR) modulators to be associated with worsening of depression and anxiety symptoms. Trikafta® (elexacaftor/tezacaftor/ivacaftor) is a newly-approved CFTR modulator that significantly improves lung function, decreases pulmonary exacerbations, and improves the quality of life. Further studies are needed to evaluate the effects of Trikafta® on anxiety and depression. Objectives: To evaluate the effects of Trikafta® on PHQ-9 (depression screening questionnaire) and GAD-7 (anxiety screening questionnaire), scores in adult patients with CF seen at an academic health centre in the Southeastern United States. Methods:We conducted a retrospective chart review of 127 adult patients with CF who initiated Trikafta® between (11/2019 to 08/2021). We gathered data, including demographic information (age, sex, race, CF mutation), annual PHQ-9 and GAD-7 scores, corresponding FEV1 percent predicted, BMI, mental health diagnoses, counseling/psychotherapy use, psychiatric medication use, prescriber of those medications, number of psychiatric emergency department visits and psychiatric admissions, and sleep disturbances. We then ran linear mixed models examining the effect of Trikafta® on PHQ- 9 and GAD-7 scores after controlling for timing with respect to the COVID- 19 pandemic. Results: Of the 127 adult patient charts reviewed,100were included. These patients yielded 562 PHQ-9 and 562 GAD-7 scores taken from 01/2015–01/ 2022. No change in PHQ-9 scores was found after initiating Trikafta® or after the beginning of COVID (designated as March 15, 2020). Similarly, GAD-7 scores showed no significant change after Trikafta® or COVID. Table 1. Patient demographics: N = 100 (Table Presented) Conclusion: There is no significant change in PHQ-9 and GAD-7 scores of patients with CF after initiating Trikafta®

9.
Journal of General Internal Medicine ; 37:S154, 2022.
Article in English | EMBASE | ID: covidwho-1995733

ABSTRACT

BACKGROUND: The COVID-19 pandemic forced many primary care visits from in-person to remote via telemedicine, including phone and video visits. Health systems face challenges ensuring telemedicine access for patients with limited English proficiency (LEP) who are disproportionately seen in safetynet health settings. METHODS: We examined safety-net health settings delivering primary care via telemedicine during the pandemic and participating in a quality improvement collaborative across California (n=43 sites, n=11 interview sites). All sites reported the number and modality of primary care visits (in-person, phone, video), patient demographics, payer mix, and language needs. For qualitative data, we purposively sampled to capture sites representing geographic diversity, a range of telemedicine maturity, and with large populations of patients best served in non-English languages. We then conducted semistructured interviews focused on barriers and facilitators to use and uptake of telemedicine among patients, providers, and staff. Interviews were audio recorded, transcribed, and analyzed with a focus on language-specific considerations, using a mixed inductive/deductive approach informed by the Consolidated Framework for Implementation Research. RESULTS: The sites cared for racially and ethnically diverse patients with nearly 75% on Medicaid. Over half of patients (52%) across sites were better served in a language other than English (median: 50%, range 39-83%). All sites experienced an immense increase in the number of telemedicine visits conducted in the six months after March 2020 compared with the six months prior (range: 258-8,273,200%). As of February 2021, most sites provided a minority of telemedicine visits over video compared with phone (median: 5% video, range 0-69%). Interview data showed that most sites mapped telephone visits workflows onto pre-existing infrastructure and resources. Telemedicine vendors provided limited language options and sites faced challenges integrating interpretation services into video visits. Interview respondents were concerned that patients with LEP faced intersecting challenges related to technology access and limited digital literacy, exacerbating language-related barriers to telemedicine. Sites relied on language concordant staff and additional technical support to overcome barriers and facilitate access for LEP patients. CONCLUSIONS: While telemedicine has potential to increase access to primary care, care settings must prioritize language concordance among patients, providers, and staff, and telemedicine platform developers must adapt existing tools to improve their accessibility for patients with LEP.

10.
Nonprofit Management & Leadership ; : 14, 2022.
Article in English | Web of Science | ID: covidwho-1976761

ABSTRACT

In this research note, we propose a classification method for identifying whether a 501c3 nonprofit organization is considered essential for economic recovery. During the first few months of the COVID-19 pandemic, many nonprofit organizations experienced negative financial effects from the economic recession. While these nonprofits saw increased demand for their services, the weakness in the overall economy led to a decline in donations. Fiscal assistance by local, state, and federal government to essential organizations was a critical element to an economic recovery, and governments needed to prioritize aid to the most essential organizations first. By identifying essential nonprofit organizations in advance, these organizations could quickly and efficiently receive financial assistance. Using descriptive text data provided by Ohio nonprofit organizations in their IRS tax filings, we propose a novel natural language processing (NLP) technique to measure the degree of "essentialness" to a nonprofit's work. We show that our model offers an improvement to the classification system known as the National Taxonomy of Exempt Organizations (NTEE). Our machine learning model is also compared to an independent evaluation of a nonprofit's essentialness produced by human researchers.

11.
Journal of College Student Development ; 63(3):239-254, 2022.
Article in English | Scopus | ID: covidwho-1970554

ABSTRACT

COVID-19 has had a deleterious impact on both the Black community and college students. Studies on this topic have taken a general approach and thus do not consider how the effects of the pandemic are distinct and potentially exacerbated among subgroups of students. The current study addressed this gap in the literature by examining the psychological impact of COVID-19 on Black college students. A sample of Black college students (Mage = 20.09) was interviewed and asked to describe their emotional reactions to COVID-19 and their coping processes in response to the pandemic. Interview data were analyzed using a consensual qualitative research approach (Hill et al., 1997, 2005). Findings showed that a majority of students had a negative emotional reaction to the pandemic (e.g., low mood and stress), and a small subset of students had a positive emotional reaction (e.g., emotional growth). In addition, students tended to cope with the pandemic most commonly via engagement (e.g., positive reframing) and social support coping strategies. We discuss the implications of our findings and offer recommendations for how institutions may better support Black college students’ mental health in the midst of the ongoing pandemic. © 2022, Johns Hopkins University Press. All rights reserved.

13.
Sleep ; 45(SUPPL 1):A23-A24, 2022.
Article in English | EMBASE | ID: covidwho-1927385

ABSTRACT

Introduction: The emergence of CoVID-19 has created an immense burden on healthcare systems across the world, placing healthcare workers (HCWs) under significant, additional stress while they also confront multiple personal, family and sociopolitical challenges during the pandemic. Many studies have reported the negative impact of pandemic-related stress on sleep of HCWs. Our mixedmethods investigation sought to extend existing research by characterizing the themes of HCWs' primary concerns during the early pandemic and identifying the most salient concerns which might be impacting sleep. Methods: North American HCWs (n = 1331) were surveyed during the second wave of CoVID-19 case increases (6/9/2020 - 8/17/2020), which included a questionnaire with measures of sleep health (RU-SATED) and nightmare frequency (PSQI). Additionally, each HCW was asked to openly-describe their most salient concern with regard to the pandemic. Each response was categorized by topic. T-tests were conducted to compare frequencies of each response category with sleep health and nightmare frequency. Results: The study sample comprised 1331 HCWs (91.7% female;74.5% non-Hispanic white;64.31% with exposure to CoVID-19 patients;85.1% working in-person). Primary concerns were grouped into 8 categories including combinations of personal/familiallevel concerns (e.g. concern about CoVID-19 infection/spread), and work-related stressors (e.g. increased workload). Concerns about lack of PPE/equipment was significantly associated with lower scores on RU-SATED (t = -2.69;p = .007) and increased nightmare frequency (t = 2.70;p = .007). Additionally, concerns about increased workload were significantly associated with lower scores on both RU-SATED (t = -2.79;p = .005) and increased nightmare frequency (t = 5.24;p = .000). Individually, primary concerns for CoVID-19 infection/spread was significantly associated with more-frequent nightmares (t = 2.01;p = .045). Neither sleep measure was associated with categories involving societallevel concerns (e.g. sociopolitical concerns) among the sample. Conclusion: Our results indicate that the HCWs most concerned about workplace stressors during the pandemic indicated poorer sleep health and more frequent nightmares. Further analyses could help guide proper stratification of therapeutic approaches to improve sleep health and related distress for HCWs.

14.
Journal of Neurology, Neurosurgery and Psychiatry ; 93(6):115, 2022.
Article in English | EMBASE | ID: covidwho-1916434

ABSTRACT

Introduction In 2019 the ABN delivered the first Acute Neurology Boot Camp. This addressed an unmet need in postgraduate training. We designed a one-day series of seminars covering common or critical presentations for neurology registrars on-call. In 2020, face-to-face events weren't feasible, and while having to adapt to a new model of working including tele-neurology, virtual radiology meetings, we adapted the boot camp to this model. Methods We designed an online version of the boot camp over two weeks. Videos were recorded for repeat viewing. All delegates were encouraged to complete surveys on confidence levels, before and after each session, and with reference to the course as a whole. Results 77 participants provided feedback. 289 logged-in live and YYY have viewed the videos on-demand. This compares to XYZ in the 2019 iteration. 30% of respondents were confident or very confident at being the neurology registrar oncall prior to the course, compared to 88% at the end of the course (p< 0.00001). Participants were very happy with the delivery, content and format of the talks, with 'very good' ratings for 60%, 56% and 57% respectively. Conclusion The Covid-19 pandemic brought tumultuous shifts in practice that were uncharted waters for the entire neurological community. As we all tried to stay afloat, we also provided a necessary life-raft to trainees who were negotiating the challenge of the transition to being a neurology registrar.

15.
Proceedings of the Annual Congress South African Sugar Technologists' Association ; 94:1-23, 2021.
Article in English | CAB Abstracts | ID: covidwho-1904830

ABSTRACT

This paper characterises South African sugarcane production for the 2020/21 milling season from an agricultural perspective, in order to evaluate recent production strategies, and to identify priorities for improved efficiencies. The industry produced 18.22 million tons of cane, harvested from an estimated 254 028 ha (71.73 t/ha). The cane to sugar ratio was 8.89, and sugar production decreased from the 2019/20 season by 7%, to 2.28 million tons. After closing early in 2019/20, the Darnall Mill (along with Umzimkulu) remained closed in 2020/21, resulting in cane oversupply at some mills and considerable carryover tonnages. Cane quality improved in northern irrigated areas. Decreasing cane quality in the Noodsberg and UCL mill supply areas warrants investigation. Rainfall was generally below-average, with dry 2019 and 2020 winters;however, relief was offered by good spring/summer rains. Irrigation water supplies from the Bivane Dam and the Umhlatuze Catchment were significantly improved. The 2020 winter was particularly cold, and the Midlands cane was affected by frost. Eldana incidence decreased overall from the previous season, but flourished in carryover cane in the South Coast and Amatikulu regions. Smut prevalence was slightly higher than in 2019, and efforts to reduce these levels remain a priority in the northern parts of the industry, particularly in Pongola. A 19% increase in the Recoverable Value (RV) price saw a return to profitability for large- and small-scale growers alike. The negative impacts of the COVID-19 pandemic on local sugarcane producers were minimal, and the increase in the RV price is partly attributed to COVID. The Sugar Industry Value Chain Master Plan also contributed to the increase in the RV price, by securing local sales and more effectively discouraging imports.

16.
Alcoholism-Clinical and Experimental Research ; 46:91A-91A, 2022.
Article in English | Web of Science | ID: covidwho-1893856
17.
Pediatric Blood and Cancer ; 69(SUPPL 2):S24, 2022.
Article in English | EMBASE | ID: covidwho-1885434

ABSTRACT

Background: Therapeutic options for Sickle Cell Disease (SCD) have increased recently as well as the development of updated national guidelines. It is not known how these options are being offered or to what degree guidelines are incorporated into clinical practice. Objectives: To assess the clinical practice patterns of providers treating children with SCD. Design/Method: A survey study was performed which included nine sections: clinic structure, prophylaxis, immunizations, hydroxyurea, splenic sequestration, stroke, novel therapies, potential curative therapies, and transition. Survey was disseminated over a three-month period via SurveyMonkey, to members of the American Society of Pediatric Hematology-Oncology Hemoglobinopathy Special Interest Group. Results: There were 86 respondents;most were attending/faculty (85%, 73/86) who were part of a university/academic practice (65%, 56/86). Program size was most commonly 50-250 patients (44%, 37/86). Accessibility to support staff in clinic included 95% (81/86) social work;76% (65/86) child life;68% (58/86) nurse coordinator and 34% (29/86) school liaison and 15% (13/86) transition navigator. For preventive care, 72% prescribe penicillin prophylaxis before 2 months of age recommending 100% (83) for HbSS and Sβnull, 72% (60/83) for HbSC and 70% (58/83) for HbSβplus. Influenza was the most common vaccine offered in clinic at 96% (76/79) with 91% (72/79) offering pneumococcal vaccines, 84% (67/79) offering meningococcal vaccines and 50% (40/79) offering COVID vaccines. Transcranial doppler screening was offered in 95% (69/73) but only 42% (31/73) performed MRI screening for silent stroke. Transfusion therapy was recommended for primary stroke prevention by 90% (65/72) and 84% (59/70) attempt to transition to hydroxyurea following TWITCH guidelines. For secondary stroke prevention, 88% (63/72) recommend chronic transfusion therapy. Regarding disease-modifying therapy, 90% (70/78) report starting hydroxyurea routinely in patients with HbSS and Sβnull;initiated at 9 months of age by 69% (54/78). Laboratory monitoring recommended every 3 months for stable dosing by 62% (49/78) and hydroxyurea held by 56% (44/78) if platelets <75,000, 73% (56/78) for neutrophils <1000. New therapies were recommended for patients on hydroxyurea who were still experiencing SCD complications: L-glutamine 68% (37/54;crizanlizumab 93% (54/58). Voxelotor was recommended for patients on hydroxyurea with low hemoglobin 65% (43/66). Matched sibling transplant was considered for any disease severity by 55% (38/69). Gene therapy trial is offered on-site by 29% (20/69). Transition programs were endorsed by 61% (42/69), but only 45% (31/68) had dedicated staff. Conclusion: This survey is the only assessment of the application of SCD guidelines in clinical practice.

18.
Topics in Antiviral Medicine ; 30(1 SUPPL):37-38, 2022.
Article in English | EMBASE | ID: covidwho-1880239

ABSTRACT

Background: Post-Acute Sequelae of SARS-CoV-2 (PASC) is characterized by persistent symptoms negatively impacting quality of life several weeks after SARS-CoV-2 diagnosis. Proposed risk factors include older age, female sex, comorbidities, and severe COVID-19, including hospitalization and oxygen requirement. Yet, associations of these factors with prolonged symptoms remain poorly understood globally. Methods: The global, observational cohort study HVTN 405/HPTN 1901 characterizes the clinical and immunologic course in the first year after SARS-CoV-2 infection among adults. The cohort was categorized by infection severity (asymptomatic;symptomatic with no oxygen requirement [NOR];non-invasive oxygen requirement [NIOR];or invasive oxygen requirement [IOR]). A regression model was applied to estimate geometric mean ratios (GMR) for duration and odds ratios (OR) for persistence of symptoms. Results: 759 participants from Peru (25.2%), USA (26.0%), Republic of South Africa (RSA, 37.7%), and non-RSA Sub-Saharan Africa (11.2%) were enrolled a median of 51 (IQR 35-66) days post-diagnosis, from May 2020 to Mar 2021. 53.8% were female, 69.8% were <55yo (median 44yo, IQR 33-58) and identified as non-Hispanic Black (42.7%), Hispanic (27.9%) or non-Hispanic White (15.8%). Comorbidities included obesity (42.8%), hypertension (24%), diabetes (14%), HIV infection (11.6%) and lung disease (7.5%). 76.2% were symptomatic (NOR 47.4%;NIOR 22.9%;and IOR 5.8%). Among symptomatic participants, median acute COVID-19 duration was 20 days (IQR 11-35);43.3% had ≥1 persistent symptom after COVID-19 resolution (39.8% NOR;49.1 % NIOR+IOR;p=0.037);16.8% reported ≥1 symptom >42 days (14.0% NOR;21.6% NIOR+IOR;p=0.025). Symptom duration was not associated with age or sex assigned at birth but was associated with disease severity (GMR 2.09;95%CI 1.5-2.91, p<0.001 for NIOR vs NOR;not significant for IOR vs NIOR), lung disease (GMR 2.43;95%CI 1.42-4.16, p=0.001), and global region (p<0.05, see Figure 1). Prolonged viral shedding was associated with persistent diarrhea (OR 6.59;95%CI 1.65-26.86;p=0.008). Conclusion: A recovery course consistent with PASC was significantly associated with infection severity, lung disease, and region. Regional differences in symptom profiles and duration may be influenced by viral diversity, genetic, or cultural factors and likely reflect disparities in healthcare access and interventions. Better understanding PASC associations may improve clinical assessment and management globally.

19.
Fertility and Sterility ; 116(3 SUPPL):e296, 2021.
Article in English | EMBASE | ID: covidwho-1879940

ABSTRACT

OBJECTIVE: To evaluate whether a shiftto virtual care during the COVID-19 pandemic negatively impacted patient satisfaction among REI patients. MATERIALS AND METHODS: A modified version of a validated multiple-choice survey assessing satisfaction with care was sent to current patients who agreed to participate in research at a tertiary medical center. The survey evaluated satisfaction with multiple aspects of care. Respondents were categorized by visit type: in-person only (n=23), virtual-only (n=12), and a mix of both settings (n=52). Responses were dichotomized into “Agree” or “Disagree”, with neutral grouped with “agree”. Chi-squared tests of independence to assess differences between groups were conducted in R (Version 3.4.4). P<0.05 was interpreted as statistically significant. The study was approved by the University of California San Francisco Institutional Review Board. RESULTS: Out of 1282 patients who received an invitation to participate, 526 patients (41.0%) completed our survey. Eighty-seven of these were seen by the Division of REI and included in this study. Median participant age was 36.5 (range: 21-76). There were no significant differences in respondents' satisfaction with the type of care received (in-person vs. virtual vs. mixed, p=0.43). There were no statistically significant differences in respondents' ability to develop a relationship with their provider (p=0.25), provider's friendliness (p=0.50), skills or knowledge (p=0.71), and concern (p=0.80) as rated by respondents. The frequency of visits starting on time (p=0.50), convenience of the visit date and time (p=0.78), and the amount of time spent with the provider (p=0.89) were also similar across all three groups. Although 56% of respondents who had mixed care reported that virtual visits may have compromised their health, this was not shown in either the virtual-only or in-person only groups, introducing the possibility of a confounder. Sixty-eight percent of respondents seen virtually were likely to recommend virtual visits to others. When asked about preferences for primary visit type after the COVID-19 pandemic, at least 50% of participants in all groups preferred in-person visits, with a minority choosing virtual visits (22%), alternating between virtual and in-person (16%), or expressing no preference (5%). CONCLUSIONS: A shift to virtual care during the COVID-19 pandemic did not appear to impact patient satisfaction with the care received as patients were highly satisfied regardless of the setting in which they received care. A majority of patients seen virtually were likely to recommend virtual visits to others. Nonetheless, a plurality of patients in all three groups preferred their primary visit type to be in-person. IMPACT STATEMENT: This study shows no significant differences in patient satisfaction regardless of visit type. Further research is needed to understand how to optimize virtual care delivery after the COVID-19 pandemic.

20.
Pilot Feasibility Stud ; 8(1): 102, 2022 May 18.
Article in English | MEDLINE | ID: covidwho-1849792

ABSTRACT

BACKGROUND: Symptom burden remains a critical concern for individuals with non-small cell lung cancer (NSCLC) following the completion of treatment. The most common symptom clusters, dyspnea (shortness of breath) and fatigue, can contribute to physical decline, reductions in quality of life, and a higher risk of comorbidities and mortality. Dyspnea is a primary limiter of exercise capacity in individuals with lung cancer, resulting in exercise avoidance and an accelerated physical decline. As such, designing resistance training with cluster sets to mitigate symptoms of dyspnea and fatigue may result in improved exercise tolerance. Thus, maintaining the exercise stimulus via cluster sets, combined with improved tolerance of the exercise, could result in the maintenance of physical function and quality of life. The purpose of this study is to investigate the feasibility and preliminary efficacy of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC. METHODS: Individuals with NSCLC (n = 15), within 12 months of completion of treatment, will be recruited to participate in this single-arm feasibility trial. Participants will complete 8 weeks of home-based resistance training designed to minimize dyspnea and fatigue. The hybrid delivery of the program will include supervised sessions in the participants' home and virtual supervision via video conferencing. The primary outcome of feasibility will be quantified by recruitment rates, retention, acceptability, and intervention fidelity. Exploratory outcomes (dyspnea, fatigue, quality of life, physical function, and body composition) will be assessed pre- and post-intervention. DISCUSSION: This study will provide important data on the feasibility of delivering this intervention and inform procedures for a future randomized controlled trial. TRIAL REGISTRATION: Record not yet public.

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