Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 14 de 14
Filter
2.
Reg Anesth Pain Med ; 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1774981

ABSTRACT

INTRODUCTION: Spontaneously breathing patients undergoing procedures under regional anesthesia can expose operating room personnel to infectious agents. The use of localized negative pressure within proximity of a patient's airway is expected to reduce the amount of bioaerosols dispersed particularly for anesthesia staff who are frequently near the patient's airway. METHODS: In the experiment, aerosols were produced using a polydisperse aerosol generator with nebulized saline. A portable negative pressure unit was set up at set distances of 10 cm and 30 cm with the aim of reducing aerosol particle counts detected by a laser-based particle counter. RESULTS: Without the portable negative pressure unit, the median concentration of 0.5 µm aerosols detected was 3128 (1533, 22832) particles/ft3/min. With the portable negative pressure unit 10 cm and 30 cm from the site of aerosol emittance, the median concentration compared with background concentration was -0.5 (-8, 8) particles/ft3/min and 398 (89, 1749) particles/ft3/min, respectively. CONCLUSIONS: For particle concentrations of 0.5 µm, 0.7 µm, and 1.0 µm a significant amount of aerosol reduction was observed (p<0.001). Further experiments are warranted to assess the safety of staff when encountering a potentially infectious patient in the operating room.

3.
Med Care ; 59(8): 694-698, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1393508

ABSTRACT

BACKGROUND: Concerns exist regarding exacerbation of existing disparities in health care access with the rapid implementation of telemedicine during the coronavirus disease 2019 (COVID-19) pandemic. However, data on pre-existing disparities in telemedicine utilization is currently lacking. OBJECTIVE: We aimed to study: (1) the prevalence of outpatient telemedicine visits before the COVID-19 pandemic by patient subgroups based on age, comorbidity burden, residence rurality, and median household income; and (2) associated diagnosis categories. RESEARCH DESIGN: This was a retrospective cohort study. SUBJECT: Commercial claims data from the Truven MarketScan database (2014-2018) representing n=846,461,609 outpatient visits. MEASURES: We studied characteristics and utilization of outpatient telemedicine services before the COVID-19 pandemic by patient subgroups based on age, comorbidity burden, residence rurality, and median household income. Disparities were assessed in unadjusted and adjusted (regression) analyses. RESULTS: With overall telemedicine uptake of 0.12% (n=1,018,092/846,461,609 outpatient visits) we found that pre-COVID-19 disparities in telemedicine use became more pronounced over time with lower use in patients who were older, had more comorbidities, were in rural areas, and had lower median household incomes (all trends and effect estimates P<0.001). CONCLUSION: These results contextualize pre-existing disparities in telemedicine use and are crucial in the monitoring of potential disparities in telemedicine access and subsequent outcomes after the rapid expansion of telemedicine during the COVID-19 pandemic.


Subject(s)
Ambulatory Care/trends , COVID-19/therapy , Health Services Accessibility/trends , Healthcare Disparities/statistics & numerical data , Telemedicine/trends , Adult , COVID-19/epidemiology , Humans , Infection Control/trends , Male , Middle Aged , Patient Satisfaction/statistics & numerical data , Quality Improvement , Retrospective Studies
4.
Reg Anesth Pain Med ; 46(2): 164-168, 2021 02.
Article in English | MEDLINE | ID: covidwho-1241057

ABSTRACT

Anesthesiologists are innovative and adaptable problem solvers. Despite these talents, our field is still working to consistently develop and support the translation of innovation and creativity into productive scientists. This article is focused on opening the discussion on identifying the gaps and move toward developing a sustainable and diverse research pipeline.


Subject(s)
Anesthesiology , Anesthesiologists , Humans
5.
Br J Anaesth ; 127(1): 15-22, 2021 07.
Article in English | MEDLINE | ID: covidwho-1184858

ABSTRACT

BACKGROUND: The COVID-19 pandemic has impacted healthcare in various vulnerable patient subpopulations. However, data are lacking on the impact of COVID-19 on hip fractures, seen mainly in older patients. Using national claims data, we aimed to describe the epidemiology during the first COVID-19 wave in the USA. METHODS: We compared patients admitted for hip fractures during March and April of 2020 with those admitted in 2019 in terms of patient and healthcare characteristics, COVID-19 diagnosis, and outcomes. An additional comparison was made between COVID-19-positive and -negative patients. Outcomes included length of hospital stay (LOS), admission to an ICU, ICU LOS, use of mechanical ventilation, 30-day readmission, discharge disposition, and a composite variable of postoperative complications. RESULTS: Overall, 16 068 hip fractures were observed in 2019 compared with 7498 in 2020. Patients with hip fractures in 2020 (compared with 2019) experienced earlier hospital discharge and were less likely to be admitted to ICU, but more likely to be admitted to home. Amongst 83 patients with hip fractures with concomitant COVID-19 diagnosis, we specifically observed more non-surgical treatments, almost doubled LOS, a more than 10-fold increased mortality rate, and higher complication rates compared with COVID-19-negative patients. CONCLUSIONS: The COVID-19 pandemic significantly impacted not only volume of hip fractures, but also patterns in care and outcomes. These results may inform policymakers in future outbreaks and how this may affect vulnerable patient populations, such as those experiencing a hip fracture.


Subject(s)
COVID-19/epidemiology , Databases, Factual/trends , Hip Fractures/epidemiology , Hip Fractures/surgery , Aged , Aged, 80 and over , COVID-19/prevention & control , Cohort Studies , Female , Humans , Length of Stay/trends , Male , Patient Discharge/trends , Retrospective Studies , Treatment Outcome , United States/epidemiology
6.
J Prim Care Community Health ; 12: 21501327211005906, 2021.
Article in English | MEDLINE | ID: covidwho-1172822

ABSTRACT

BACKGROUND: As the COVID-19 pandemic continues into flu season, it is critical to minimize hospitalizations to maximize capacity and preserve critical care resources. We sought to identify risk factors for influenza-related hospitalization, specifically the role of immunization and oseltamivir prescriptions. METHODS: Patients with influenza diagnoses were identified from the MarketScan database (2014-2018). Primary risk factors of interest were an influenza vaccination within 6 months prior to infection and oseltamivir prescriptions (filled on the day diagnosis, the following day, or 2-5 days). A multivariable logistic regression model was run to identify risk factors for influenza-related hospitalizations within 30 days of diagnosis. RESULTS: Among 2 395 498 influenza infections, 0.27% were hospitalized. Of those prescribed oseltamivir the day of diagnosis, 0.13% were later hospitalized, compared to 0.67% among those who filled prescriptions the following day and 11.8% when filled within 2 to 5 days. Upon adjustment, oseltamivir prescriptions filled on the day of diagnosis were associated with significantly decreased odds of hospitalization (OR 0.51 CI 0.48-0.55). Prescriptions filled within 1 to 5 days of diagnosis were associated with significantly increased odds of hospitalization (1 day OR 2.01 CI 1.81-2.24; 2-5 days OR 34.1 CI 31.7-36.6). Flu vaccination was associated with a lower odds for hospitalization (OR 0.84 CI 0.74-0.95). CONCLUSIONS: We recommend oseltamivir be prescribed to patients when they first present with influenza-like symptoms to reduce the burden on the healthcare system. We also identified reduced odds of hospitalization associated with influenza vaccination, which is already well established, but particularly important this coming flu season.


Subject(s)
Antiviral Agents/therapeutic use , Hospitalization/statistics & numerical data , Influenza, Human/drug therapy , Influenza, Human/prevention & control , Oseltamivir/therapeutic use , Vaccination , Adolescent , Adult , Child , Child, Preschool , Cohort Studies , Female , Humans , Infant , Male , Middle Aged , Odds Ratio , Retrospective Studies , Risk Factors , Time Factors , United States/epidemiology
9.
Anesth Analg ; 131(5): 1337-1341, 2020 11.
Article in English | MEDLINE | ID: covidwho-983117

ABSTRACT

BACKGROUND: In response to the coronavirus disease 2019 (COVID-19) pandemic, New York State ordered the suspension of all elective surgeries to increase intensive care unit (ICU) bed capacity. Yet the potential impact of suspending elective surgery on ICU bed capacity is unclear. METHODS: We retrospectively reviewed 5 years of New York State data on ICU usage. Descriptions of ICU utilization and mechanical ventilation were stratified by admission type (elective surgery, emergent/urgent/trauma surgery, and medical admissions) and by geographic location (New York metropolitan region versus the rest of New York State). Data are presented as absolute numbers and percentages and all adult and pediatric ICU patients were included. RESULTS: Overall, ICU admissions in New York State were seen in 10.1% of all hospitalizations (n = 1,232,986/n = 12,251,617) and remained stable over a 5-year period from 2011 to 2015. Among n = 1,232,986 ICU stays, sources of ICU admission included elective surgery (13.4%, n = 165,365), emergent/urgent admissions/trauma surgery (28.0%, n = 345,094), and medical admissions (58.6%, n = 722,527). Ventilator utilization was seen in 26.3% (n = 323,789/n = 1232,986) of all ICU patients of which 6.4% (n = 20,652), 32.8% (n = 106,186), and 60.8% (n = 196,951) was for patients from elective, emergent, and medical admissions, respectively. New York City holds the majority of ICU bed capacity (70.0%; n = 2496/n = 3566) in New York State. CONCLUSIONS: Patients undergoing elective surgery comprised a small fraction of ICU bed and mechanical ventilation use in New York State. Suspension of elective surgeries in response to the COVID-19 pandemic may thus have a minor impact on ICU capacity when compared to other sources of ICU admission such as emergent/urgent admissions/trauma surgery and medical admissions. More study is needed to better understand how best to maximize ICU capacity for pandemics requiring heavy use of critical care resources.


Subject(s)
Appointments and Schedules , Coronavirus Infections/therapy , Critical Care , Delivery of Health Care, Integrated , Elective Surgical Procedures , Intensive Care Units/supply & distribution , Patient Admission , Pneumonia, Viral/therapy , Surge Capacity , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Databases, Factual , Health Services Needs and Demand , Humans , Needs Assessment , New York/epidemiology , Operating Room Information Systems , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Respiration, Artificial , Time Factors , Ventilators, Mechanical/supply & distribution
11.
Gerontol Geriatr Med ; 6: 2333721420956766, 2020.
Article in English | MEDLINE | ID: covidwho-796950

ABSTRACT

Elderly patients undergoing hip fracture surgery represent a myriad of perioperative challenges and risks. The arrival of the global pandemic of novel coronavirus disease 2019 (COVID-19) adds an unprecedented challenge to the management of hip fracture patients. We describe the unique experience and favorable outcome of a 100-year-old COVID-positive hip fracture patient that underwent spinal anesthesia for hemiarthroplasty and subsequent hydroxychloroquine (HCQ) therapy. Multiple factors of varying known benefit may have contributed to our outcome, including preoperative medical consultation and assessment, early surgical intervention, regional anesthesia with little to no sedation, early mobilization and HCQ therapy.

SELECTION OF CITATIONS
SEARCH DETAIL