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1.
Aust Crit Care ; 2022.
Article in English | ScienceDirect | ID: covidwho-2031142

ABSTRACT

BACKGROUND: Intensive care units (ICUs) are emotionally demanding workplaces. Exposure to stress can negatively impact ICU staff members' emotional resilience, health, and capacity to provide care. Despite recognition of the benefits of promoting "healthy workplaces", there are limited interventional studies aimed at improving the well-being of ICU staff. AIM: The aim of this study was to assess the effectiveness of a multifaceted intervention for improving well-being of staff working in a tertiary ICU. METHODS: A before-and-after interventional study was conducted over a 2-year period, between 2019 and 2021. Interventions included social activities, fitness, nutrition, and emotional support. An electronic version of the PERMA-Profiler questionnaire was used to assess the well-being of a convenience sample of ICU staff before (n = 96) and after (n = 137) the intervention. Ten focus groups (each involving 12-18 nurses) were held to explore nurses' perceptions of the intervention's effectiveness. RESULTS: After the intervention, a significantly greater proportion of participants described their work week as draining (32% vs 19%, chi(2) = 4.4 df + 1, P = 0.03) and at least a bit harder than normal (38% vs 22%, chi(2) = 6.4 df + 1, p = 0.01) compared to baseline surveys. However, well-being scores after the intervention (mean = 6.95, standard deviation = 1.28) were not statistically different (p = 0.68) from baseline scores (mean = 7.02, standard deviation = 1.29). Analysis of focus groups data revealed three key categories: boosting morale and fostering togetherness, supporting staff, and barriers to well-being. CONCLUSIONS: After the intervention, there was a preserved level of well-being from baseline despite a statistically significant increase in staff reporting the work week as draining and at least a little bit harder than normal. These findings must be considered in light of the COVID-19 pandemic, which started after baseline data collection and continues to impact the community, including staff workload and pressures in intensive care. The study findings may inform strategies for improving ICU staff members' well-being.

3.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003297

ABSTRACT

Background: The COVID-19 pandemic presented a variety of challenges to learners at all levels of training. The fall and winter seasons are when Pediatric trainees are exposed to a high volume of respiratory illnesses such as bronchiolitis, croup and asthma. However the advent of social distancing and use of face masks showed a significant decrease in the burden of infectious diseases. A multi-center study using the Pediatric Health Information System (PHIS) showed that ED visit rates decreased by 45.7% during the pandemic as compared to the three years prior(1). At our institution we saw a 90% reduction in bronchiolitis cases after the stay-at-home order went into effect March 30, 2020 compared to 2019 data for the same time period. With less hands-on experience, trainees are struggling to identify, triage and manage respiratory distress. Methods: Given the missed learning opportunities associated with COVID-19 and a low volume respiratory season, interns requested an expansion of the simulation curriculum to include specific content review for respiratory distress. The session started with a brief fifteen minute overview in the Just-in-Time-Teaching (JiTT) style(2). Learning objectives included recognizing the signs and symptoms of respiratory distress, reviewing the differential diagnoses, initiating treatment for the various differentials and escalating care in a timely fashion. Interns then moved on to the simulated cases. We used a high-fidelity baby mannequin for a bronchiolitis case and pediatric mannequin for an asthma case. Cases were debriefed in the Advocacy-Inquiry Method and interns were asked to share one piece of practice changing knowledge. Results: Interns (n=17) were anonymously surveyed before and after the session with responses measured on the 5- point Likert scale(3). 80% of interns reported that the COVID-19 pandemic impacted their medical education and, following the completion of cases, 94% strongly agreed that simulations were a helpful way to supplement their medical training. Two interns completed a post-survey but did not complete a pre-survey. Before the simulation, 13% of interns reported not feeling adequately prepared to identify respiratory distress and only 6% felt adequately prepared to manage it. After the simulation, 82% of interns felt adequately prepared to identify respiratory distress and 82% felt prepared to manage it. Conclusion: Public health mandates during the COVID-19 pandemic proved effective for controlling disease spread, but created a knowledge gap for Pediatric trainees regarding commonly encountered respiratory diseases. We addressed this gap in real time by modifying our simulation curriculum to include a content review of respiratory distress. Interns showed improved self-reported confidence in their diagnostic and treatment abilities. Continued use of JiTT in the simulation setting could be a helpful way to bridge resident-identified knowledge gaps on a more routine basis. Further work needs to be done to establish the long-term effectiveness of this flexible, learner-specific curriculum.

4.
Nat Nanotechnol ; 2022.
Article in English | PubMed | ID: covidwho-1991611

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already infected more than 500 million people globally (as of May 2022), creating the coronavirus disease 2019 (COVID-19) pandemic. Nanotechnology has played a pivotal role in the fight against SARS-CoV-2 in various aspects, with the successful development of the two highly effective nanotechnology-based messenger RNA vaccines being the most profound. Despite the remarkable efficacy of mRNA vaccines against the original SARS-CoV-2 strain, hopes for quickly ending this pandemic have been dampened by the emerging SARS-CoV-2 variants, which have brought several new pandemic waves. Thus, novel strategies should be proposed to tackle the crisis presented by existing and emerging SARS-CoV-2 variants. Here, we discuss the SARS-CoV-2 variants from biological and immunological perspectives, and the rational design and development of novel and potential nanotechnology-based strategies to combat existing and possible future SARS-CoV-2 variants. The lessons learnt and design strategies developed from this battle against SARS-CoV-2 variants could also inspire innovation in the development of nanotechnology-based strategies for tackling other global infectious diseases and their future variants.

5.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927854

ABSTRACT

Rationale: Patients with chronic lung disease experience dyspnea and other symptoms that significantly affect quality of life and can result in elevated rates of depression and anxiety. Concomitant anxiety and depression can often result in poorer outcomes in these patients and can hinder their confidence in self-management of their disease. Mindfulness involves non-judgmental attention to a person's surroundings and experiences cultivates the ability to be aware of the present moment. A formal mindfulness-based intervention developed at Ohio State University called Mindfulness in Motion offered within the established structure of a pulmonary rehabilitation program was implemented in both virtual and in-person format to promote disease self-efficacy, reduce stress and improve symptoms of anxiety and depression that often accompany chronic symptomatic lung disease. Methods: This is a prospective feasibility/pilot study pre/post-test design with an intervention and control wait list groups. All new adult patients enrolling in pulmonary rehabilitation were eligible. Mindfulness in Motion (MIM) is a Mindfulness Based Intervention that is offered in a group format for 1hr/week/8 weeks combined with 10-20 online audio and video programs to facilitate individual mindfulness practice. The Mindfulness in Motion program relaced one of the usual 1 hour pulmonary rehabilitation education sessions. One round of the intervention was done virtually via Microsoft Teams due to the restrictions of the Covid-19 pandemic and an additional in-person round of this program is currently ongoing. The primary outcome is the PROMIS Self-Efficacy for Managing Chronic Conditions-Symptoms. Breath counts pre and post intervention are of interest as well. Secondary outcomes are: PROMIS Percieved Stress Scale, PROMIS Anxiety Short Form, PROMIS Depression short form and Respiratory Rate. These measures were collected pre-intervention, post-intervention, 6 months and 1 year. Results: Data collection and analysis of primary and secondary endpoints is currently ongoing. However, early analysis shows a decrease in respiratory rate immediately post-intervention. In initial 4 subjects in which respiratory rate data was recorded, 3 out of 4 patients showed significant consistent reduction in respiratory rate from the beginning to the end of each session in the 7 weeks of the intervention already completed (see Table 1). Conclusion: Mindfulness in Motion is a mindfulness intervention that is implementable within the existing structure of pulmonary rehabilitation. Further, it may be effective at slowing breathing rate in these patients prior to exercising which may be beneficial to participation. Further investigation with a larger randomized control trial would be feasible and warranted for further study. (Table Presented).

6.
Sleep ; 45(SUPPL 1):A163, 2022.
Article in English | EMBASE | ID: covidwho-1927405

ABSTRACT

Introduction: Telehealth has been widely integrated into healthcare systems during the COVID-19 pandemic and is likely to remain a part of routine clinical care. At the VA Greater Los Angeles Healthcare System (VAGLAHS), positive airway pressure (PAP) set-up visits transitioned from in person to telehealth for newly diagnosed sleep apnea patients during the pandemic. The telehealth pathway included mailing of PAP machines to patients with follow-up video/phone education by respiratory therapists (RTs). As part of a larger study examining the clinical outcomes resulting from telehealth versus in-person PAP initiation, we performed a cost analysis of these two treatment pathways within VAGLAHS. Methods: We examined the total variable direct cost of telehealth versus in-person PAP initiation for patients newly diagnosed with sleep apnea at VAGLAHS between March and October 2021 (n = 2,662 PAP set-ups) using a bottom-up analysis. There was an average of 16 PAP set-ups per day with 11 set-ups (68.7%) via telehealth and 5 set-ups (31.3%) in person. Results: The total variable direct cost of telehealth PAP initiation was $98.87 per patient. The total variable direct cost of in-person PAP initiation was $50.58 per patient. For telehealth, there was an additional cost of mailing the PAP machine and 31.2% more RT time spent on educating patients compared to the in-person pathway. After the initial PAP set-up visit, a larger subset of patients required additional troubleshooting help from RTs about proper PAP use after telehealth compared to in-person set-ups (5% versus 1%). Conclusion: The telehealth PAP initiation pathway was nearly two times the cost of in-person PAP initiation. This resulted from the additional cost of mailing the PAP machine, more RT time spent on education, and a greater need for troubleshooting after the visit. Telehealth visits may need to be supplemented by written educational materials or web-based resources to reduce the need for additional support after the initial visit.

7.
SSM Popul Health ; 19: 101133, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1895448

ABSTRACT

Introduction: Approaches to COVID-19 mitigation can be more efficiently delivered with a more detailed understanding of where the severe cases occur. Our objective was to assess which demographic, housing and neighborhood characteristics were independently and collectively associated with differing rates of severe COVID-19. Methods: A cohort of patients with SARS-CoV-2 in a single health system from March 1, 2020 to February 15, 2021 was reviewed to determine whether demographic, housing, or neighborhood characteristics are associated with higher rates of severe COVID-19 infections and to create a novel scoring index. Characteristics included proportion of multifamily homes, essential workers, and ages of the homes within neighborhoods. Results: There were 735 COVID-19 ICU admissions in the study interval which accounted for 61 percent of the state's ICU admissions for COVID-19. Compared to the general population of the state those admitted to the ICU with COVID-19 were disproportionately older, male sex, and were more often Black, Indigenous, People of Color. Patients disproportionately resided in neighborhoods with three plus unit multifamily homes, homes built before 1940, homes with more than one person to a room, homes of lower average value, and in neighborhoods with a greater proportion of essential workers. From this our COVID-19 Neighborhood Index value was comparatively higher for the ICU patients (61.1) relative to the population of Rhode Island (49.4). Conclusion: COVID-19-related ICU admissions are highly related to demographic, housing and neighborhood-level factors. This may guide more nuanced and targeted vaccine distribution plans and public health measures for future pandemics.

8.
Preprint in English | bioRxiv | ID: ppbiorxiv-498206

ABSTRACT

Variants of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) continue to cause disease and impair the effectiveness of treatments. The therapeutic potential of convergent neutralizing antibodies (NAbs) from fully recovered patients has been explored in several early stages of novel drugs. Here, we identified initially elicited NAbs (Ig Heavy, Ig lambda, Ig kappa) in response to COVID-19 infection in patients admitted to the intensive care unit at a single center with deep RNA sequencing (>100 million reads) of peripheral blood as a diagnostic tool for predicting the severity of the disease and as a means to pinpoint specific compensatory NAb treatments. Clinical data were prospectively collected at multiple time points during ICU admission, and amino acid sequences for the NAb CDR3 segments were identified. Patients who survived severe COVID-19 had significantly more of a Class 3 antibody (C135) to SARS-CoV-2 compared to non-survivors (16,315 reads vs 1,412 reads, p=0.02). In addition to highlighting the utility of RNA sequencing in revealing unique NAb profiles in COVID-19 patients with different outcomes, we provided a physical basis for our findings via atomistic modeling combined with molecular dynamics simulations. We established the interactions of the Class 3 NAb C135 with the SARS-CoV-2 spike protein, proposing a mechanistic basis for inhibition via multiple conformations that can effectively prevent ACE2 from binding to the spike protein, despite C135 not directly blocking the ACE2 binding motif. Overall, we demonstrate that deep RNA sequencing combined with structural modeling offers the new potential to identify and understand novel therapeutic(s) NAbs in individuals lacking certain immune responses due to their poor endogenous production. Our results suggest a possible window of opportunity for administration of such NAbs when their full sequence becomes available. A method involving rapid deep RNA sequencing of patients infected with SARS-CoV-2 or its variants at the earliest infection time could help to develop personalized treatments using the identified specific NAbs.

9.
Journal of Oncology Pharmacy Practice ; 28(2 SUPPL):29-30, 2022.
Article in English | EMBASE | ID: covidwho-1868952

ABSTRACT

Background: Patient satisfaction with non-medical prescriber (NMP) clinics at the Churchill Cancer Centre (Oxford University Hospitals NHS Foundation Trust) has been reported previously.1 Patient consultations, (face to face or telephone) by prescribing pharmacists in uro-oncology clinics (mostly prostate cancer) have increased significantly and the scope of the role is expanding from cycle 2+clinical reviews to treatment initiation, consent and cycle 1 prescribing. Objectives • To quantify the increase in patient numbers seen or telephoned in prescribing pharmacist clinics, both as whole numbers and as a proportion of the Uro-oncology service (medical oncology). • To identify how the role of the prescribing pharmacist role is expanding to patient care at earlier stages in the treatment pathway. Method: Contribution to the uro-oncology service has been measured using the following parameters (see Table 1). • Number of patient consultations in prescribing pharmacist clinics over the past 12 months, using data from the Trust's Electronic Prescribing and Medicines Administration system. • Proportion of these patient contacts as a percentage of the overall uro-oncology service. • And compared to prior year. Results: In the 12 months to June 2021:- • Uro-oncology prescribing pharmacists have seen or telephoned 61% more patients than the previous 12 months. • 78% of the 889 patient contacts were telemedicine consultations, compared to 20% in the prior 12 months. This is due to the covid pandemic. • The contribution of prescribing pharmacist consultations to the overall uro-oncology service has increased by 7%. Discussion: At the Churchill Cancer Centre two prescribing pharmacists see or telephone an average of 21-24 patients per week. Current scope of the prescribing pharmacist role comprises clinical review of metastatic prostate cancer patients being treated with: luteinizing hormone-releasing hormone (LHRH) agonists, with or without bicalutamide, enzalutamide, abiraterone, docetaxel, cabazitaxel. Clinical consultations typically include: assessment of treatment efficacy and tolerability, prescribing continued treatment, or referral to Consultant, addition of bicalutamide (PSA relapse) or stopping bicalutamide (for PSA withdrawal response), ordering CT or MRI scan if appropriate, managing symptoms e.g. medroxyprogesterone / cyproterone for hot flushes, requesting GP to initiate bone protection (bisphosphonate). The expanding scope of the role includes: liaison with MDT / Consultant for diagnosis and treatment, consenting patient for treatment, cycle 1 prescribing, oral education session prior to starting treatment (patient counselling including safety netting, clinical checks, drug interactions, drug supply). Adherence to treatment pathway (e.g. enzalutamide) to ensure correct blood tests ordered and timing of next clinic review. Conclusion: Prescribing pharmacist clinics enable follow up and treatment of large numbers of uro-oncology patients. The covid pandemic has driven trends for oral systemic anticancer treatment (e.g. enzalutamide) and telemedicine consultations. Expanding the role of the prescribing pharmacist to treatment initiation, patient consent, and cycle 1 prescribing can improve the efficiency of the clinical service and bring opportunities for enhanced skills and development.

10.
11.
Annals of Behavioral Medicine ; 56(SUPP 1):S640-S640, 2022.
Article in English | Web of Science | ID: covidwho-1848729
12.
J Breath Res ; 16(3)2022 05 26.
Article in English | MEDLINE | ID: covidwho-1830923

ABSTRACT

Exhaled breath vapor contains hundreds of volatile organic compounds (VOCs), which are the byproducts of health and disease metabolism, and they have clinical and diagnostic potential. Simultaneous collection of breath VOCs and background environmental VOCs is important to ensure analyses eliminate exogenous compounds from clinical studies. We present a mobile sampling system to extract gaseous VOCs onto commercially available sorbent-packed thermal desorption tubes. The sampler can be connected to a number of commonly available disposable and reusable sampling bags, in the case of this study, a Tedlar bag containing a breath sample. Alternatively, the inlet can be left open to directly sample room or environmental air when obtaining a background VOC sample. The system contains a screen for the operator to input a desired sample volume. A needle valve allows the operator to control the sample flow rate, which operates with an accuracy of -1.52 ± 0.63% of the desired rate, and consistently generated that rate with 0.12 ± 0.06% error across repeated measures. A flow pump, flow sensor and microcontroller allow volumetric sampling, as opposed to timed sampling, with 0.06 ± 0.06% accuracy in the volume extracted. Four samplers were compared by sampling a standard chemical mixture, which resulted in 6.4 ± 4.7% error across all four replicate modular samplers to extract a given VOC. The samplers were deployed in a clinical setting to collect breath and background/environmental samples, including patients with active SARS-CoV-2 infections, and the device could easily move between rooms and can undergo required disinfection protocols to prevent transmission of pathogens on the case exterior. All components required for assembly are detailed and are made publicly available for non-commercial use, including the microcontroller software. We demonstrate the device collects volatile compounds, including use of chemical standards, and background and breath samples in real use conditions.


Subject(s)
Breath Tests , Environmental Monitoring , Volatile Organic Compounds , Breath Tests/methods , COVID-19/prevention & control , Environmental Monitoring/methods , Exhalation , Humans , SARS-CoV-2/isolation & purification , Volatile Organic Compounds/analysis
14.
Crit Care Med ; 50(3): e335-e336, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1758879
15.
Open Forum Infectious Diseases ; 8(SUPPL 1):S257-S258, 2021.
Article in English | EMBASE | ID: covidwho-1746690

ABSTRACT

Background. The management of COVID-19 poses diagnostic challenges with regard to concomitant bacterial pneumonia. This may result in unnecessary antibiotic therapy. This analysis described the experience of an urban academic medical center's management of non-ICU patients diagnosed with COVID-19 during the initial months of the pandemic and assessed the rate of concomitant bacterial pneumonia in this population. Methods. This retrospective analysis evaluated patients 18 years and older admitted to Thomas Jefferson University Hospital (TJUH) between March 1, 2020 and July 31, 2020 who had a positive COVID-19 test, were symptomatic, and received at least one dose of antibiotics. Antibiotic therapy was considered appropriate if there was objective evidence of bacterial pneumonia. Per the TJUH COVID-19 guidelines, objective diagnostic criteria assessed included the following: MRSA nasopharyngeal swab, urine Legionella pneumophilia or Streptococcus pneumoniae antigen test, respiratory pathogen panel, and sputum culture. If patients did not have evidence of bacterial pneumonia, the threshold for appropriate discontinuation of antibiotics was 48 hours. Results. 50 patients were included in the final analysis. Upon admission, 7 (14%) patients had clear chest radiographs, and 9 (25%) of the 36 patients with a procalcitonin drawn had a level ≥ 0.25, indicating a potential bacterial infection. 15 (30%) patients were known to be COVID-19 positive prior to being administered antibiotics. Additionally, 22 (44%) patients had an infectious diseases service consult during their admission. 25 (50%) patients were continued on antibiotics > 48 hours. The mean duration of antibiotic therapy in the entire population was 3.4 days (82 hours). The monthly average duration of antibiotic therapy trended downward as the pandemic progressed. The most common empiric antibiotic regimen was ceftriaxone and azithromycin, received by 28 (56%) patients. Only 2 (4%) patients were diagnosed with bacterial pneumonia. Conclusion. In a sample of 50 COVID patients the overall rate of concomitant bacterial pneumonia was 4%. Given this finding, it is vital to remain judicious with the use of antibiotics and to employ the assistance of antimicrobial stewardship colleagues when managing patients diagnosed with COVID-19.

16.
The Sport Journal ; 24(28), 2021.
Article in English | CAB Abstracts | ID: covidwho-1743692

ABSTRACT

Athletic conferences worked to lower the cost of delivering athletic programs while operating during the COVID-19 global pandemic. One strategy was the use of concentrated schedules for competitions. For example, the Sun Belt Conference focused on divisional play and a concentrated schedule for women's volleyball for the 2020 season. Schools played three matches in a two-day period against the same team. This practice lowered travel costs and isolated player contact in the event of needed contact tracing as part of player safety protocols. This study evaluates the impact of this scheduling format on player performance and the overall quality of competition. Gathering data from the box scores from all Sun Belt Conference volleyball matches, the impact of player fatigue (daily and cumulative) is not present in the team statistics. Player performance and the overall quality of team play did not decline, even when playing three matches in a two-day period. Conference personnel and university athletic administrators may take comfort that their efforts to lower costs and ensure player safety during a global pandemic did not affect player performance and the overall quality of competition. It remains to be seen if this new scheduling approach will be used in the post-COVID period in women's volleyball and possibly expanded to other sports. The need to control/lower operating costs will not disappear. This constraint may lead to the adoption of new conference scheduling formats in the future.

17.
Non-conventional in English | International HTA Db, Grey literature | ID: grc-751182
19.
Non-conventional in English | International HTA Db, Grey literature | ID: grc-751180
20.
Non-conventional in English | International HTA Db, Grey literature | ID: grc-751160
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