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1.
J Am Geriatr Soc ; 70(11): 3273-3280, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-1968152

ABSTRACT

BACKGROUND: During the deadly 2020 SARS-CoV-2 surge in nursing homes (NHs), Massachusetts (MA) initiated a multicomponent infection control intervention to mitigate its spread. METHODS: We aimed to assess the intervention's impact by comparing the weekly risk of PCR-confirmed infections among MA NH residents to those in neighboring New England states, all managed similarly by a single NH provider. We studied 2085 residents in 20 MA NHs and 4493 residents in 45 comparator facilities. The intervention included: (1) A 28-item infection control checklist of best practices, (2) incentive payments to NHs contingent on scoring ≥24 on the checklist, meeting 6 core competencies, testing residents and staff for SARS-COV-2 RNA, uploading data, and enabling virtual visits; (3) on-site and virtual infection control consultations for deficient facilities; (4) 6 weekly webinars; (5) continuous communication with the MA Department of Public Health; and (6) access to personal protective equipment, temporary staff, and SARS-CoV-2 testing. Weekly rates of infection were adjusted for county COVID-19 prevalence. RESULTS: The adjusted risk of infection started higher in MA, but declined more rapidly in its NHs compared to similarly managed facilities in other states. The decline in infection risk during the early intervention period was 53% greater in MA than in Comparator States (state-by-time interaction HR = 0.47; 95% CI 0.37-0.59). By the late intervention period, the risk of infection continued to decline in both groups, and the change from baseline in MA was marginally greater than that in the Comparator States (interaction HR 0.80; 95% CI 0.64-1.00). CONCLUSIONS: The MA NH intervention was associated with a more rapid reduction in the rate of SARS-CoV-2 infections compared to similarly managed NHs in neighboring states. Although several unmeasured factors may have confounded our results, implementation of the MA model may help rapidly reduce high rates of infection and prevent future COVID-19 surges in NHs.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , COVID-19/prevention & control , SARS-CoV-2 , COVID-19 Testing , RNA, Viral , Nursing Homes , Infection Control/methods , Massachusetts/epidemiology
2.
Emerg Infect Dis ; 28(9): 1859-1862, 2022 09.
Article in English | MEDLINE | ID: covidwho-1963356

ABSTRACT

Given widespread use of spike antibody in generating coronavirus disease vaccines, SARS-CoV-2 nucleocapsid antibodies are increasingly used to indicate previous infection in serologic surveys. However, longitudinal kinetics and seroreversion are poorly defined. We found substantial seroreversion of nucleocapsid total immunoglobulin, underscoring the need to account for seroreversion in seroepidemiologic studies.


Subject(s)
COVID-19 , SARS-CoV-2 , Antibodies, Viral , COVID-19/epidemiology , Coronavirus Nucleocapsid Proteins/immunology , Humans , Kinetics , Nucleocapsid , Phosphoproteins/immunology , Seroepidemiologic Studies
3.
Obstetrics and Gynecology ; 139(SUPPL 1):41S, 2022.
Article in English | EMBASE | ID: covidwho-1925351

ABSTRACT

INTRODUCTION: To determine differences in cesarean postpartum length of stay (pLOS) before and during the COVID-19 pandemic as a function of social determinants of health. METHODS: Cesarean birth pLOS data between January 1 and June 30, 2020, were reviewed. Births after March 10, 2020, were considered pandemic births. Primary outcome was early discharge <5,760 minutes (96 hours). Rates of early discharge were analyzed by social determinants of health, with socially vulnerable patients defined as Black or Hispanic, publicly insured, or non-English-speaking. We compared rates of early discharge before and during the pandemic overall and then among socially vulnerable patients using probit regression analysis. RESULTS: There were 1,885 eligible deliveries: 694 before the start of the pandemic and 1,171 after. Median pLOS pre-pandemic was 5,696 (IQR, 4,686-6,060) minutes versus 4,655 (IQR, 3,897- 5,860) minutes during the pandemic. Of the eligible deliveries, 54% had early discharges pre-pandemic compared to 71% afterwards (P<.01). Overall, we found these variables predictive of early discharge pLOS: socially vulnerable (P<.01), payer type (P<.01), English ability (P<.01), and multiparity (P<.01). Race as a variable alone was not found to be significantly predictive of early discharge. CONCLUSION: Socially vulnerable patients are more likely to leave the hospital earlier than their counterparts both before and during the COVID-19 pandemic. Our findings suggest that increased early discharges fall disproportionately on socially vulnerable patients. Further research is needed to determine whether these results are due to provider bias or patient driven.

4.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925289

ABSTRACT

Objective: To further characterize the relationship between markers of inflammation and outcome in patients undergoing mechanical thrombectomy for acute stroke. Background: Inflammation and infection after ischemic stroke are known to exacerbate tissue injury and worsen clinical outcome. Thrombectomy has become standard of care in stroke, but little data exist regarding how inflammation affects outcome after thrombectomy. Design/Methods: We performed retrospective chart review of stroke patients who underwent mechanical thrombectomy at 2 tertiary academic centers between December 2018 and November 2020. The relationship between discharge mortality, admission WBC count, admission neutrophil percentage, peak WBC count, and fever (peak temperature >38°C) were analyzed using the Wilcoxon rank sum test, Student's t-test, and Fisher's exact test. Multivariable analysis was performed to test for independent predictors of discharge mortality. Analyses were performed for the entire cohort, then repeated in a cohort excluding COVIDpositive patients. Results: Of 254 patients who had thrombectomy for acute stroke, 42 (16.5%) died prior to discharge. Mortality was associated with admission WBC count (10.7 [8.9-14] vs. 8.6 [7-12], p=0.0064), admission neutrophil percentage (78% ± 11 vs. 70% ± 14, p=0.0001), peak WBC count (17 [13-22] vs. 12 [8.9-15], p<0.0001), and fever (71% vs. 29%, p<0.0001). In multivariable analysis, admission WBC count (OR 14, CI 1.5-158, p=0.024), neutrophil percentage (OR 1.04, CI 1.0-1.1, p=0.039), peak WBC count (OR 343, CI 27-5702, p<0.0001) and fever (OR 8.6, CI 3.6-23, p<0.0001) were significantly predictive of discharge mortality after controlling for age, admission NIHSS and post-thrombectomy ASPECTS score. Fifteen patients tested positive for COVID-19. In analyses excluding these patients, peak WBC count and fever remained independent predictors of discharge mortality. Conclusions: Elevated markers of inflammation during hospitalization predict discharge mortality in patients who undergo mechanical thrombectomy for acute stroke. Further study is warranted to investigate causation and identify opportunities to improve quality of care in this patient population.

5.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925264

ABSTRACT

Objective: To examine long-term outcomes of disorders of consciousness (DoC) after severe COVID-19. Background: Some patients with severe COVID-19 experience persistently impaired arousal and/or awareness after discontinuation of sedation, consistent with DoC. In our recently published analysis of 21 such patients, 12 (57%) recovered to minimally conscious state (MCS) or better before hospital discharge. Recovery to MCS-especially within 8 weeks of injury-is an important prognostic indicator in DoC of other etiologies, but its significance in COVID-19 remains unknown. Design/Methods: All 21 patients were included in a prospectively followed cohort involving telephonic assessment 6 and 12 months after discharge. We examined relationships between recovery to MCS and survival. For patients completing telephone assessments, we report functional outcomes including Barthel Index, extended Glasgow Outcome Scale (E-GOS), and modified Rankin Scale (mRS);and psychological outcomes using Quality of Life in Neurological Disorders (Neuro-QOL) anxiety, depression, fatigue, and sleep disturbance inventories. Results: Recovery to MCS within 8 weeks of illness onset-but not later-was associated with 12-month survival (6/8 versus 2/9, p=0.024). Six patients completed both assessments. Of these, 2 were in DoC at 6 months and died by 12 months;1 recovered consciousness after 6 months but remained severely disabled;1 was moderately disabled;and 2 achieved functional independence (Barthel Index 100;E-GOS 5-7;mRS 1-2). Neuro-QOL scores were elevated at 6 but not 12 months. Conclusions: Ten percent (2/21) of our original cohort achieved functional independence by 12 months, demonstrating that recovery is possible after COVID-19-associated DoC. Consistent with the literature on non-COVID DoC, recovery to MCS within 8 weeks of illness onset may be prognostically favorable. Psychological symptoms in this severely ill group were less common than in patients with neurologic sequelae of COVID-19 generally. More work is needed to understand the natural history of long-term recovery from severe COVID-19.

6.
Journal of Forensic Practice ; 24(3):298-311, 2022.
Article in English | ProQuest Central | ID: covidwho-1901411

ABSTRACT

Purpose>Global evidence suggests a potential displacement of youth offending from the physical to the digital landscape, requiring revision of existing detection and intervention methods. This study aims to explore pathways from harmful to illegal online activity perpetrated by young people, legislation and police perspectives, current detection methods and interventions.Design/methodology/approach>This perspective paper examines issues observed within a larger systematic literature review on digital youth offending.Findings>A trajectory from acceptable to harmful and subsequently illegal behaviour was identified, with a particular pathway from unethical video game activity to digitally dependent offending. Legislation and police perspectives vary by jurisdiction, with a common theme that increased officer education is key to the level of preparedness to investigate cases. Machine learning and automatic prevention show promise as detection and disruption processes, with education recommended for young people as a deterrent and redirection of skills to positive outcomes.Research limitations/implications>Recommendations for further research include a broad survey of school students to include all identified areas of digital offending, which could drive the development of targeted education by law enforcement and partner agencies for young people.Practical implications>The shift in youth offending requires the justice and educational systems to adjust how they respond to youth crime. Policy and practise shifts can include further exploration of investigative hacking, education for law enforcement and educational prevention and redirection programmes aimed at youth.Originality/value>The digital displacement of youth offending is a progressively emerging concept. This paper examines the current state of response from educational and law enforcement agencies and discusses the next steps based on what is currently known.

7.
Journal of the American College of Cardiology ; 79(9):2516-2516, 2022.
Article in English | Web of Science | ID: covidwho-1848903
8.
Brain Injury ; 36(SUPPL 1):100-101, 2022.
Article in English | EMBASE | ID: covidwho-1815745

ABSTRACT

Objective: Early neurorehabilitation improves outcomes in patients with disorders of consciousness after brain injury, but its applicability in COVID-19 is unknown. We demonstrate the feasibility of an early neurorehabilitation protocol for patients with COVID-19-associated disorders of consciousness in the intensive care unit (ICU) and evaluate factors associated with recovery. Methods: Between March 10 and May 20, 2020, we prospectively enrolled 21 ICU patients with delayed recovery of consciousness after severe COVID-19 in a pilot early neurorehabilitation protocol including serial Coma Recovery Scale - Revised (CRS-R) assessments and multimodal treatment. We retrospectively compared clinical features of patients who did and did not achieve a CRS-R total score (TS) ≥8, consistent with minimally conscious state, before discharge. We additionally present preliminary 6-month follow-up data for 8 patients who survived to discharge. Results: Patients underwent CRS-R a median of 6 (interquartile range [IQR] 3-10) times before discharge, beginning a median of 48 days (IQR 40-55) from admission. Twelve (57%) patients achieved at least one CRS-R TS ≥8, after a median of 8 days (IQR 2-14) off continuous sedation;they had lower body mass index (p = 0.009), lower peak serum C-reactive protein (p = 0.023), higher minimum arterial partial pressure of oxygen (p = 0.028) and earlier fentanyl discontinuation (p = 0.018). CRS-R scores fluctuated over time and best CRS-R TS was significantly higher than last CRS-R TS (median 8 [IQR 5- 23] vs 5 [IQR 3-18], p = 0.002). Earlier fentanyl (p = 0.001) and neuromuscular blockade (p = 0.015) discontinuation correlated with higher last CRS-R TS. Six-month follow-up data was obtained for 8 of 12 patients who survived to hospital discharge: of these, one patient (13%) had expired;3 (38%) remained in a disorder of consciousness;one (13%) was conscious but moderately disabled;and 3 (38%) achieved functional independence. Conclusion: It is feasible to provide early neurorehabilitation to patients with impaired consciousness after severe COVID-19 in the ICU. These patients can recover, but hypoxia, systemic inflammation, sedation and neuromuscular blockade may impact CRS-R scores and short-term outcomes. Return to functional independence is possible for some patients. Further research should evaluate factors influencing longer-term neurologic recovery and benefits of early rehabilitation in patients with severe COVID-19.

9.
PLoS One ; 17(4): e0266238, 2022.
Article in English | MEDLINE | ID: covidwho-1775454

ABSTRACT

Strict lockdown measures were introduced in response to the COVID-19 pandemic, which caused mass disruption to adolescent swimmers' daily routines. To measure how lockdown impacted nutritional practices in this cohort, three-day photograph food diaries were analysed at three time points: before (January), during (April), and after (September) the first UK lockdown. Thirteen swimmers (aged 15 ± 1 years) from a high-performance swimming club submitted satisfactory food diaries at all time points. During lockdown, lower amounts of energy (45.3 ± 9.8 vs. 31.1 ± 7.7 kcal∙kg BM∙day-1, p<0.001), carbohydrate (5.4 ± 1.2 vs. 3.5 ± 1.1 g∙kg BM∙day-1, p<0.001), protein (2.3 ± 0.4 vs. 1.7 ± 0.4 g∙kg BM∙day-1, p = 0.002), and fat (1.6 ± 0.4 vs. 1.1 ± 0.3 g∙kg BM∙day-1, p = 0.011) were reported. After lockdown, no nutritional differences were found in comparison compared to before lockdown (energy: 44.0 ± 12.1 kcal∙kg BM∙day-1; carbohydrate: 5.4 ± 1.4 g∙kg BM∙day-1; protein: 2.1 ± 0.6 g∙kg BM∙day-1; fat: 1.5 ± 0.6 g ∙kg BM∙day-1, all p>0.05), despite fewer training hours being completed (15.0 ± 1.4 vs. 19.1 ± 2.2 h∙week-1, p<0.001). These findings highlight the ability of adolescent swimmers to alter their nutrition based on their changing training circumstances when receiving sport nutrition support. However, some individuals displayed signs of suboptimal nutrition during lockdown that were not corrected once training resumed. This warrants future research to develop interactive education workshops that maintain focus and motivation towards optimal nutrition practices in isolated periods away from training.


Subject(s)
COVID-19 , Adolescent , COVID-19/epidemiology , Carbohydrates , Communicable Disease Control , Eating , Humans , Pandemics
10.
Journal of the American College of Cardiology ; 79(9):2746, 2022.
Article in English | EMBASE | ID: covidwho-1757980

ABSTRACT

Background: Acute respiratory distress syndrome (ARDS) is characterized by hypoxemia and non-hydrostatic pulmonary edema. While ARDS is associated with a high mortality rate, its conjunction with cardiogenic shock (CS) can lead to devastating outcomes. ARDS is managed via lung protective ventilation with low tidal volumes and positive end expiratory pressures. Prone positioning has emerged as a supplementary strategy with beneficial effects on gas exchange, respiratory mechanics, and hemodynamics. Our case underlines the feasibility of intra-aortic balloon pump counterpulsation (IABP) with concurrent prone positioning in a patient with ARDS and CS. Case: 71-year-old male with history of coronary artery disease, hypertension, hyperlipidemia, and chronic kidney disease, presented to the emergency department with new onset chest pain. EKG showed ST-segment elevations in leads V1-V2 consistent with acute anterior wall myocardial infarction. Patient underwent percutaneous coronary intervention to the left anterior descending artery.Due to worsening hemodynamics and CS, it was decided to place a left axillary IABP. Hospital course was further complicated by acute pulmonary edema and ARDS requiring emergent intubation and mechanical ventilation. Patient was also started on renal replacement therapy given progression of renal failure. Decision-making: Given the onset of ARDS, the patient was placed in prone position for 12-16 hours/day for 5 days. There was no special technique required during proning, other than additional staff to ensure IABP stability. Gradual improvement in hemodynamics was attained, including an increase in cardiac index from 2.1 to 3.4, and a decrease in pulmonary vascular congestion. Conclusion: With the emergence of COVID-19 pandemic, the incidence of ARDS has increased significantly, with simultaneous occurrence of CS in some of these patients. Prone positioning has become one of the main therapeutic modalities in the management of ARDS. Our case highlights the feasibility of axillary IABP while implementing prone positioning in patients with concomitant ARDS and CS.

11.
New Zealand Medical Journal ; 133(1519):70-80, 2020.
Article in English | Scopus | ID: covidwho-1755597

ABSTRACT

AIM: There is concern the low incidence of coronavirus disease 2019 (COVID-19) in children reflects undertesting in this population. This study sought to describe the age-distribution of SARS-CoV-2 testing in the Northern Region of New Zealand. METHODS: A retrospective single-centre review of all SARS-CoV-2 tests performed at LabPLUS, Auckland City Hospital, between 12 February and 18 April 2020. RESULTS: A total of 22,333 tests were performed, with 313 (1.40%) positive results. The age-adjusted SARS-CoV-2 testing rate was three times higher in adults than in children. The overall proportion of positive tests was lower in children (0.86%) than adults (1.45%). However, within the paediatric population the proportion of tests positive differed significantly between those <10 years old (0.08%) and those 10-14 years old (2.6%). CONCLUSION: The lower proportion of tests positive in children <10 years of age suggests they are appropriately tested relative to their rates of disease. A large high school-associated cluster makes the higher proportion of tests positive in children 10-14 years old difficult to interpret. Older children may have a higher risk of infection and increasing testing in intermediate and high school aged children may be indicated. © 2020 New Zealand Medical Association. All rights reserved.

13.
HemaSphere ; 6(1):33-34, 2022.
Article in English | EMBASE | ID: covidwho-1735664

ABSTRACT

The pandemic in 2020 and measures to control the COVID-19 virus led to many teenagers and Young People(YP) isolated from their friends, through shielding and extended home schooling. It has affected their mental health and wellbeing, with an increasing demand upon mental health services (BMJ 2021, Miller et al 2020, Jeffery et al 2021). In the Thames Valley we look after approx 200 YP with haemoglobinopathy disorders, a third between the ages of 13 & 18 years. A low prevalence area, a very wide geographical spread, making access to specialist services challenging. Access to technology and virtual connections, and a newly appointed psychologist led us to look at provision of an online wellbeing support group for teenagers. Aims: To invite teenagers between 13-18 years to a weekly 'drop in' group, where they would be able to access strategies and resources to support with varying aspects of well-being, as well as the opportunity to ask questions, in a safe supportive environment. Method: The group initially ran on a weekly basis for one hour at the end of the school day, led by 2 specialist nurses and a clinical psychologist. We covered subjects such as: stress, anxiety, low mood, fatigue, as well as more media related content like vaccinations and navigating social media. We used the Zoom platform, but then moved to Microsoft Teams, as this was the Trust's preferred platform. Our YP and their parents were contacted and asked if they would like to join and then they would be sent an invite via email. A reminder was also sent the day before the next meeting. Parents would be included in any email communication and resources;however, they were not encouraged to join the meeting. Meeting etiquette and ground rules were explained at the beginning of the meeting and with each new attendee, in order to establish trust and inclusion. Following the meeting, a summary and any material used was circulated to the whole group. Results: 13 meetings January- November 2021 (Initially weekly, however we changed to monthly over the summer as demand dropped off). Subjects covered include: COVID-19 & dealing with anxiety, stress, Low mood/dealing with sadness, Vaccine safety, fatigue, returning to school, Paintalking to people about your diagnosis.Attendance was variable - with the maximum being 6 young people. A short survey was circulated to try and identify what was working, what needed to change and to have input from the YP on content. As a result of this feedback, we moved to a different day of the week and a later session time. Summary: small numbers YP would regularly attend, parents commented they looked forward to this group, which we took to be a sign of success. Other attendees, joined sporadically on 1 or more occasions. We found the YP to be engaged. Most were happy to say hello and introduce themselves on camera but would then prefer the camera off. We didn't have anyone comment on difficulties with access, many used their smartphone devices. Session preapration was time consuming, but as we progressed, we became more efficient at re-using material and needing less 'team brief' time as we understood how the sessions ran. It is an expensive service, professional time wise. However, we haven't compared to using a clinic environment or education room on site, which would take more organising and possibly less availability. There are no transport cost or travel time, so equitable for all Conclusion: This has been a valuable service for a small cohort.

14.
Psychology of Sport and Exercise ; : 102163, 2022.
Article in English | ScienceDirect | ID: covidwho-1706800

ABSTRACT

Many elite sporting codes have imposed severe restrictions on crowd attendance at games to minimise COVID-19 infection risk, which created a rare opportunity to examine the influence of absent crowds on elite sporting performance. This study used a retrospective observational design to investigate the influence of the crowd in the National Rugby League (NRL) by comparing player statistics and Global Positioning System (GPS) metrics between Round 1 (crowds) and Round 2 (no crowd). Data were obtained for 203 professional NRL players. A linear mixed model with a random intercept (Player ID) was used to assess the relationship between crowd removal and match location on performance indicators and GPS metrics. Effect sizes (ES) were also calculated to determine the magnitude of change. The effect of a crowd and match location were trivial to small (ES range: 0.213 to 0.224). Without crowds, performance indicators relating to decoys (p = 0.022), post-contact metres (p = 0.020), tackle breaks (p = 0.035) and missed tackles increased (p = 0.018), whereas supports decreased (p = 0.005). Without crowds, GPS metrics maximal velocity increased (p = 0.027), and acceleration load decreased (p < 0.001). In away games, relative high-speed running increased (p = 0.020). However, it is possible that margin, opponent tactics, and weather could have influenced changes. The findings suggest that NRL players’ performance appears unlikely to be affected by the presence or absence of a crowd.

15.
Physiotherapy (United Kingdom) ; 114:e19-e20, 2022.
Article in English | EMBASE | ID: covidwho-1703459

ABSTRACT

Keywords: Digital, Respiratory, Rehabilitation Purpose: SARS-CoV-2 restricted access to face-to-face delivery of Pulmonary Rehabilitation (PR). Evidence suggests that telehealth-PR is non-inferior to outpatient PR but studies had not evaluated an approach encompassing virtual assessment in addition to delivery. Gloucestershire Health and Care PR team worked in partnership with the University of Gloucestershire (UoG) to deliver a virtual-only PR service for patients who had attended face-to-face sessions prior to lockdown. Initial evaluation of two groups showed this approach was feasible with outcome measures exceeding the MCID for face to face groups (Lewis, A., Knight, E., Bland, M., et al: 2021). More data were required to understand if these results would be replicated with patients who had no prior experience of PR;this submission evaluates the outcomes of seven additional groups where participants had no prior experience of PR. Methods: Patients on the waiting list for PR were contacted to be offered an assessment for virtual PR between September and December 2020. All participating patients were issued pulse oximeters and IPads were issued to patients who did not have an appropriate device at home. Assessments took place remotely using ‘Attend Anywhere’ software and consisted of history taking, Rockwood frailty scoring and a one minute sit to stand test. Patients received login details for the ‘eLearn’ moodle platform for the UoG and completed two live streamed exercise classes/week for six weeks and were asked to watch 12 educational videos in their own time with support phone calls from a clinician at two and four weeks. Patients completed the Medical Research Council Score Breathlessness scale (MRC), Chronic Respiratory Disease Questionnaire (CRQ), Generalised Anxiety Disorder-7 scale (GAD7) and Patient Health Questionnaire-9 (PHQ9) on eLearn at the start and finish of the course. Completion was set at attendance for 9/12 exercise sessions and at least nine educational videos watched. Results: One hundred and thirty patients were invited to participate of which 63 underwent pre assessment and started on the course. Twenty three people declined any form of PR and were discharged, and 44 declined remote classes. Forty-five patients completed the course. Reasons for drop out were: too unwell to continue (5), technical issues (7), poor attendance (4) and other/unknown (2). Statistically significant improvements were achieved in all outcome domains of the CRQ: dyspnoea: CI 0.4(0.3-0.9) p: 0.001**, fatigue: CI 0.25(0.2-0.8) p:0.025** mastery: CI 0.25(0.3-0.9) p:0.0003** emotion: 0.3(0.2-0.7) p:0.0002**, GAD7: 0(-2.9- -0.2) p:0.019**,PHQ9: -1(-3.5 - -0.8) p:0.002**, MRC -1(-3.5 - -0.8) p:0.002**and the one minute sit to stand: CI 2.6(0.89-4.3)p: 0.004*. Conclusion(s): These results reinforce our previous findings that PR can be delivered effectively using an entirely virtual approach for appropriate patients. Further research is warranted to investigate the MCID for tele-rehabilitation physical and patient reported outcome measures. Impact: These results demonstrate the potential of Moodle as a platform to deliver tele-conferencing rehabilitation programmes;Cardiac Rehabilitation colleagues have started to deliver online rehab via the same platform, and there is potential for numerous other rehabilitation services to replicate this model. This collaboration with UoG offers potential for virtual placement models. Funding acknowledgements: The feasibility study was supported by a grant of £8000 from the University Of Gloucestershire Sport, Nutrition and Exercise programme.

17.
J Gerontol A Biol Sci Med Sci ; 77(7): 1361-1365, 2022 07 05.
Article in English | MEDLINE | ID: covidwho-1672194

ABSTRACT

BACKGROUND: Nursing home (NH) residents, especially those who were Black or with dementia, had the highest infection rates during the COVID-19 pandemic. A 9-week COVID-19 infection control intervention in 360 Massachusetts NHs showed adherence to an infection control checklist with proper personal protective equipment (PPE) use and cohorting was associated with declines in weekly infection rates. NHs were offered weekly webinars, answers to infection control questions, resources to acquire PPE, backup staff, and SARS-CoV-2 testing. We asked whether the effect of this intervention differed by racial and dementia composition of the NHs. METHODS: Data were obtained from 4 state audits using infection control checklists, weekly infection rates, and Minimum Data Set variables on race and dementia to determine whether adherence to checklist competencies was associated with decline in average weekly rates of new COVID-19 infections. RESULTS: Using a mixed-effects hurdle model, adjusted for county COVID-19 prevalence, we found the overall effect of the intervention did not differ by racial composition, but proper cohorting of residents was associated with a greater reduction in infection rates among facilities with ≥20% non-Whites (n = 83). Facilities in the middle (>50%-62%; n = 121) and upper (>62%; n = 115) tertiles of dementia prevalence had the largest reduction in infection rates as checklist scores improved. Cohorting was associated with greater reductions in infection rates among facilities in the middle and upper tertiles of dementia prevalence. CONCLUSIONS: Adherence to proper infection control procedures, particularly cohorting of residents, can reduce COVID-19 infections, even in facilities with high percentages of high-risk residents (non-White and dementia).


Subject(s)
COVID-19 , Dementia , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Testing , Dementia/epidemiology , Dementia/prevention & control , Humans , Infection Control/methods , Massachusetts/epidemiology , Nursing Homes , Pandemics/prevention & control , Prevalence , SARS-CoV-2
18.
Crit Care Clin ; 38(3): 623-637, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1616400

ABSTRACT

Hospitals and health care systems with active critical care organizations (CCOs) that unified ICU units before the onset of the COVID-19 Pandemic were better positioned to adapt to the demands of the pandemic, due to their established standardization of care and integration of critical care within the larger structure of the hospital or health care system. CCOs should continue to make changes, based on the real experience of COVID-19 that would lead to improved care during the ongoing pandemic, and beyond.


Subject(s)
COVID-19 , Critical Care , Humans , Intensive Care Units , Pandemics , SARS-CoV-2 , Surge Capacity
20.
Open forum infectious diseases ; 8(Suppl 1):S17-S18, 2021.
Article in English | EuropePMC | ID: covidwho-1563877

ABSTRACT

Background Allogeneic stem cell transplant (SCT) recipients are at an increased risk of poor outcomes from COVID-19. While the mRNA-1273 (Moderna) and BNT162b2 (Pfizer) COVID-19 mRNA vaccines are highly immunogenic in the general population, the immune response in SCT recipients is poorly understood. We characterized the immunogenicity and reactogenicity of COVID-19 mRNA vaccines in a cohort of SCT patients. Methods We performed a prospective cohort study of 16 allogeneic SCT patients and 23 healthy controls. Blood samples for both cohorts were collected prior to first vaccination (baseline), at the time of second vaccination, and approximately 28 days post-second vaccination. Anti-Spike (S), anti-S1, anti-receptor binding domain (RBD), and anti-Nucleocapsid (N) IgG levels were measured quantitatively from plasma using a multiplexed single molecule array (Simoa) immunoassay. Reactogenicity was captured for the SCT cohort via a self-reported post-vaccination diary for 7 days after each dose. Results Demographics and SCT recipients’ characteristics are shown in Table 1. In the SCT cohort, we observed a significantly lower anti-S (p< 0.0001), S1 (p< 0.0001), and RBD (p< 0.0001) IgG responses as compared to healthy controls, both at the time of dose 2 and 28 days post-vaccine series (Fig 1). Overall, 62.5% of SCT recipients were responders after vaccine series completion, as compared to 100% of healthy controls (Fig 2). While no patients had a reported history of COVID-19 diagnosis, 2 patients in the SCT cohort had elevated anti-S IgG levels and 1 showed elevated anti-N at baseline. 10/16 participants in the SCT cohort completed at least one post-vaccination diary. Local and systemic reactions were reported by 67% and 22% of participants, respectively, after dose 1, and 63% and 50% after dose 2 (Figure 3). All reported events were mild. Table 1: Demographics Figure 1: Plasma IgG Titers Anti-Spike (A), anti-S1 (B), anti-RBD (C), and anti-nucleocapsid (D) IgG titers were measured at baseline, time of second dose, and approximately 28 days after second vaccination. IgG levels were measured quantitatively using multiplexed single molecule array (Simoa) immunoassays, and are reported as Normalized Average Enzymes per Bead (AEB). Allogeneic stem cell transplant recipients (mauve) showed significantly lower anti-S, S1, and RBD IgG responses as compared to healthy controls (mint). Low titers of anti-N IgG demonstrates no history of COVID-19 natural infection during the course of the study. Figure 3. Solicited Local and Systemic Adverse Events 10 allogeneic stem cell transplant recipients completed at least one diary for 7 days after vaccination. Reactions after dose 1 are shown in light blue, and reactions after dose 2 are shown in dark blue. Local reactions (A) were reported by 67% (6/9) of participants after dose 1, and 63% (5/8) after dose 2. Systemic reactions (B) were reported by 22% (2/9) of participants after dose 1, and 50% (4/8) after dose 2. All reported events were mild (Grade 1). Conclusion Among SCT recipients, mRNA COVID-19 vaccines were well-tolerated but less immunogenic than in healthy controls. Further study is warranted to better understand heterogeneous characteristics that may affect the immune response in order to optimize COVID-19 vaccination strategies for SCT recipients. Figure 2: Response Rate to COVID-19 Vaccination An internally validated threshold for responders was established using pre-pandemic sera from healthy adults. A positive antibody response was was defined as individuals with anti-Spike IgG levels above the 1.07 Normalized AEB threshold. Disclosures Amy Joyce, NP, Kadmon (Advisor or Review Panel member) Lewis A. Novack, MS, Lumicell Inc. (Scientific Research Study Investigator, Research Grant or Support)Precision Healing, Inc. (Scientific Research Study Investigator, Research Grant or Support) David Walt, PhD, Quanterix Corporation (Board Member, Shareholder) Robert Soiffer, MD, alexion (Consultant)gilead (Advisor or Review Panel mem er)jazz (Advisor or Review Panel member)juno/bms (Advisor or Review Panel member)kiadis (Board Member)precision bioscience (Consultant)Rheos (Consultant)takeda (Consultant) Nicolas C. Issa, MD, AiCuris (Scientific Research Study Investigator)Astellas (Scientific Research Study Investigator)GSK (Scientific Research Study Investigator)Merck (Scientific Research Study Investigator)

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