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1.
J Hosp Infect ; 127: 59-68, 2022 Jun 07.
Article in English | MEDLINE | ID: covidwho-1936782

ABSTRACT

BACKGROUND: Personal protective equipment (PPE) is essential to protect healthcare workers (HCWs). The practice of reusing PPE poses high levels of risk for accidental contamination by HCWs. Scarce medical literature compares practical means or methods for safe reuse of PPE while actively caring for patients. METHODS: In this study, observations were made of 28 experienced clinical participants performing five donning and doffing encounters while performing simulated full evaluations of patients with coronavirus disease 2019. Participants' N95 respirators were coated with a fluorescent dye to evaluate any accidental fomite transfer that occurred during PPE donning and doffing. Participants were evaluated using blacklight after each doffing encounter to evaluate new contamination sites, and were assessed for the cumulative surface area that occurred due to PPE doffing. Additionally, participants' workstations were evaluated for contamination. RESULTS: All participants experienced some contamination on their upper extremities, neck and face. The highest cumulative area of fomite transfer risk was associated with the hook and paper bag storage methods, and the least contamination occurred with the tabletop storage method. Storing a reused N95 respirator on a tabletop was found to be a safer alternative than the current recommendation of the US Centers for Disease Control and Prevention to use a paper bag for storage. All participants donning and doffing PPE were contaminated. CONCLUSION: PPE reusage practices pose an unacceptably high level of risk of accidental cross-infection contamination to healthcare workers. The current design of PPE requires complete redesign with improved engineering and usability to protect healthcare workers.

2.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925453

ABSTRACT

Objective: Evaluate the role of virtual case-based discussions lead by neurology residents at supplementing the standard didactic series in the neurology clerkship. Background: COVID-19 created a new barrier to medical education by reducing trainee participation in patient care. Neurophobia is still present in up to 50% of medical students. To encourage critical thinking, we developed a series of virtual case-based resident-led discussions ('NeuroLytes'), simulating neurological cases. Design/Methods: Second and third year medical students were enrolled in NeuroLytes during their neurology clerkship. Each rotation was divided into two groups (one group participating earlier). Each group received a virtual case discussion weekly (migraine and multiple sclerosis (MS)). Both groups completed surveys regarding perception of the experience and a quiz of 10 questions regarding case knowledge, followed by 7 questions regarding confidence on clinical reasoning. Results: 108 students participated in NeuroLytes. Over 96% of students that discussed both cases had a score ≥7/10 in knowledge questions compared with 72.9% of students that did not attend any cases (p=0.005). Over 80% of students that participated in NeuroLytes felt confident in identifying clinical findings of neurological diseases compared to 52.2% of students who had not (p=0.026). Students who participated in NeuroLytes also felt more comfortable building a preliminary differential diagnosis after receiving an initial patient history (90.3% compared to 69.6%, p=0.052). Conclusions: Medical students participating in NeuroLytes reported perceived improvement in formulating differentials and identifying common neurological diseases. Virtual case-based discussions could be an effective supplemental learning tool for developing clinical reasoning.

3.
Age and Ageing ; 50:1, 2021.
Article in English | Web of Science | ID: covidwho-1852898
4.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-333587

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, gay and other men who have sex with men (MSM) in the United States (US) report similar or fewer sexual partners and reduced HIV testing and care access. Pre-exposure prophylaxis (PrEP) use has declined. We estimated the potential impact of COVID-19 on HIV incidence and mortality among US MSM. METHODS: We used a calibrated HIV transmission model for MSM in Baltimore, Maryland, and available data on COVID-19-related disruptions to predict impacts of data-driven reductions in sexual partners(0%,25%,50%), condom use(5%), HIV testing(20%), viral suppression(10%), PrEP initiations(72%), PrEP use(9%) and ART initiations(50%), exploring different disruption durations and magnitudes. We estimated the median (95% credible interval) change in cumulative new HIV infections and deaths among MSM over one and five years, compared with a scenario without COVID-19-related disruptions. FINDINGS: A six-month 25% reduction in sexual partners among Baltimore MSM, without HIV service changes, could reduce new HIV infections by 12.2%(11.7,12.8%) and 3.0%(2.6,3.4%) over one and five years, respectively. In the absence of changes in sexual behaviour, the six-month data-driven disruptions to condom use, testing, viral suppression, PrEP initiations, PrEP use and ART initiations combined were predicted to increase new HIV infections by 10.5%(5.8,16.5%) over one year, and by 3.5%(2.1,5.4%) over five years. A 25% reduction in partnerships offsets the negative impact of these combined service disruptions on new HIV infections (overall reduction 3.9%(-1.0,7.4%), 0.0%(-1.4,0.9%) over one, five years, respectively), but not on HIV deaths (corresponding increases 11.0%(6.2,17.7%), 2.6%(1.5,4.3%)). The predicted impacts of reductions in partnerships or viral suppression doubled if they lasted 12 months or if disruptions were twice as large. INTERPRETATION: Maintaining access to ART and adherence support is of the utmost importance to minimise excess HIV-related mortality due to COVID-19 restrictions in the US, even if accompanied by reductions in sexual partnerships. Funding: Nih. RESEARCH IN CONTEXT: Evidence before this study: The COVID-19 pandemic and responses to it have disrupted HIV prevention and treatment services and led to changes in sexual risk behaviour in the United States, but the overall potential impact on HIV transmission and HIV-related mortality is not known. We searched PubMed for articles documenting COVID-related disruptions to HIV prevention and treatment and changes in sexual risk behaviour in the United States, published between 1 st January and 7 th October 2020, with no language restrictions, using the terms COVID* AND (HIV OR AIDS) AND ("United States" OR US). We identified three cross-sectional surveys assessing changes in sexual risk behaviour among men who have sex with men (MSM) in the United States, one finding a reduction, one a slight increase, and one no change in partner numbers during COVID-19 restrictions. Two of these studies also found reductions in reported HIV testing, HIV care and/or access to pre-exposure prophylaxis (PrEP) among MSM due to COVID-19. A separate study from a San Francisco clinic found declines in viral suppression among its clients during lockdown. We searched PubMed for articles estimating the impact of COVID-related disruptions on HIV transmission and mortality published between 1 st January 2020 and 12 th October 2020, with no language restrictions, using the following terms: COVID* AND model* AND (HIV OR AIDS). We identified two published studies which had used mathematical modelling to estimate the impact of hypothetical COVID-19-related disruptions to HIV programmes on HIV-related deaths and/or new HIV infections in Africa, another published study using modelling to estimate the impact of COVID-19-related disruptions and linked HIV and SARS-CoV-2 testing on new HIV infections in six cities in the United States, and a pre-print reporting modelling of the impact of COVID-19-related disruptions on HIV incidence among men who have sex with men in Atlanta, United States. None of these studies were informed by data on the size of these disruptions. The two African studies and the Atlanta study assessed the impact of disruptions to different healthcare disruptions separately, and all found that the greatest negative impacts on new HIV infections and/or deaths would arise from interruptions to antiretroviral therapy. They all found smaller effects on HIV-related mortality and/or incidence from other healthcare disruptions, including HIV testing, PrEP use and condom supplies. The United States study assessing the impact of linked HIV and SARS-CoV-2 testing estimated that this could substantially reduce HIV incidence. Added value of this study: We used mathematical modelling to derive estimates of the potential impact of the COVID-19 pandemic and associated restrictions on HIV incidence and mortality among MSM in the United States, directly informed by data from the United States on disruptions to HIV testing, antiretroviral therapy and pre-exposure prophylaxis services and reported changes in sexual risk behaviour during the COVID-19 pandemic. We also assessed the impact of an HIV testing campaign during COVID-19 lockdown. Implications of all the available evidence: In the United States, maintaining access to antiretroviral therapy and adherence support for both existing and new users will be crucial to minimize excess HIV-related deaths arising from the COVID-19 pandemic among men who have sex with men. While reductions in sexual risk behaviour may offset increases in new HIV infections arising from disruptions to HIV prevention and treatment services, this will not offset the additional HIV-related deaths which are also predicted to occur. There are mixed findings on the impact of an HIV testing campaign among US MSM during COVID-19 lockdown. Together, these studies highlight the importance of maintaining effective HIV treatment provision during the COVID-19 pandemic.

5.
Open Forum Infectious Diseases ; 8(SUPPL 1):S343-S344, 2021.
Article in English | EMBASE | ID: covidwho-1746513

ABSTRACT

Background. Multi-system inflammatory syndrome in children (MIS-C) is a rare consequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). MIS-C shares features with common infectious and inflammatory syndromes and differentiation early in the course is difficult. Identification of early features specific to MIS-C may lead to faster diagnosis and treatment. We aimed to determine clinical, laboratory, and cardiac features distinguishing MIS-C patients within the first 24 hours of admission to the hospital from those who present with similar features but ultimately diagnosed with an alternative etiology. Methods. We performed retrospective chart reviews of children (0-20 years) who were admitted to Vanderbilt Children's Hospital and evaluated under our institutional MIS-C algorithm between June 10, 2020-April 8, 2021. Subjects were identified by review of infectious disease (ID) consults during the study period as all children with possible MIS-C require an ID consult per our institutional algorithm. Clinical, lab, and cardiac characteristics were compared between children with and without MIS-C. The diagnosis of MIS-C was determined by the treating team and available consultants. P-values were calculated using two-sample t-tests allowing unequal variances for continuous and Pearson's chi-squared test for categorical variables, alpha set at < 0.05. Results. There were 128 children admitted with concern for MIS-C. Of these, 45 (35.2%) were diagnosed with MIS-C and 83 (64.8%) were not. Patients with MIS-C had significantly higher rates of SARS-CoV-2 exposure, hypotension, conjunctival injection, abdominal pain, and abnormal cardiac exam (Table 1). Laboratory evaluation showed that patients with MIS-C had lower platelet count, lymphocyte count and sodium level, with higher c-reactive protein, fibrinogen, B-type natriuretic peptide, and neutrophil percentage (Table 2). Patients with MIS-C also had lower ejection fraction and were more likely to have abnormal electrocardiogram. Conclusion. We identified early features that differed between patients with MIS-C from those without. Development of a diagnostic prediction model based on these early distinguishing features is currently in progress.

6.
Age and Ageing ; 50(SUPPL 3), 2021.
Article in English | EMBASE | ID: covidwho-1665884

ABSTRACT

Background: COVID-19 has proved devastating in older persons. Previous studies reveal a mortality rate of 31% for hospitalised patients over 70.1 We examine outcomes for older COVID patients in our hospital. Methods: We conducted a Hospital In Patient Enquiry Scheme review for patients coded as COVID-19 between 19/03/2020-19/02/2021 (n=674). Older adults were defined as those aged over 65 years at time of admission. Age, sex, length of stay and survival were collected. Data was collated by 'wave': (Wave 1 n=294, 2 n=105, 3 n=275). We reviewed whether patients had a CT pulmonary angiogram (CTPA) on the National Integrated Medical Imaging System. Results: 42.3% of COVID patients in our hospital were older persons (n=285). This remained stable throughout the pandemic (Wave 1 44.2%,Wave 2 44.7%,Wave 3 39.3%). Mean length of stay was 19.7 days for older adults vs 7.4 for those under 65. Older persons had a higher mortality rate at 30.9% vs 3.6%. Overall incidence of PE was low at 1.9% (1.1% in older persons). However, the likelihood of a CTPA being positive for those over 65 was much higher at 42.9% vs 17.9%. While there was improvement in mortality rates in older persons from Wave 1 (31.5%) to 2 (19.1%), our data showed a significant rise in mortality inWave 3 (35.2%). This compares to a different pattern in younger people, with mortality rates by wave at 6.7%, 0% and 1.7%. Conclusion: In a large Irish cohort of patients hospitalised with COVID-19, 42.3% were older adults. Length of hospital stay was 3 times longer and mortality was 10 times higher than patients under 65.Older adults were alsomore likely to have a positive CTPA. Further study is needed to evaluate the long term effects of COVID-19 in our older population.

7.
International Journal of Sport and Exercise Psychology ; : 18, 2022.
Article in English | Web of Science | ID: covidwho-1635928

ABSTRACT

The dual pandemic of 2020 - COVID-19 and systemic racism - continues to reshape society. The current study examines how this dual pandemic contributes to the psychological distress of college student-athletes, with attention to college student-athletes who identify as Black, Indigenous, or people of colour (BIPOC). A total of 222 student-athletes from nine universities completed the online survey. Student-athletes reported COVID-19 had a moderate impact on daily life. The direct effect of COVID-19 on psychological distress was found to be positive and significant but did riot differ for BIPOC and White participants. Additionally, nearly all BIPOC student-athletes reported experiencing systemic racism;yet the level of systemic racism did not predict psychological distress. Findings provide insight related to the importance of mental health among college student-athletes.

8.
Infectious Microbes & Diseases ; 3(1):1-3, 2021.
Article in English | Web of Science | ID: covidwho-1584003
9.
Open forum infectious diseases ; 8(Suppl 1):S343-S344, 2021.
Article in English | EuropePMC | ID: covidwho-1564002

ABSTRACT

Background Multi-system inflammatory syndrome in children (MIS-C) is a rare consequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). MIS-C shares features with common infectious and inflammatory syndromes and differentiation early in the course is difficult. Identification of early features specific to MIS-C may lead to faster diagnosis and treatment. We aimed to determine clinical, laboratory, and cardiac features distinguishing MIS-C patients within the first 24 hours of admission to the hospital from those who present with similar features but ultimately diagnosed with an alternative etiology. Methods We performed retrospective chart reviews of children (0-20 years) who were admitted to Vanderbilt Children’s Hospital and evaluated under our institutional MIS-C algorithm between June 10, 2020-April 8, 2021. Subjects were identified by review of infectious disease (ID) consults during the study period as all children with possible MIS-C require an ID consult per our institutional algorithm. Clinical, lab, and cardiac characteristics were compared between children with and without MIS-C. The diagnosis of MIS-C was determined by the treating team and available consultants. P-values were calculated using two-sample t-tests allowing unequal variances for continuous and Pearson’s chi-squared test for categorical variables, alpha set at < 0.05. Results There were 128 children admitted with concern for MIS-C. Of these, 45 (35.2%) were diagnosed with MIS-C and 83 (64.8%) were not. Patients with MIS-C had significantly higher rates of SARS-CoV-2 exposure, hypotension, conjunctival injection, abdominal pain, and abnormal cardiac exam (Table 1). Laboratory evaluation showed that patients with MIS-C had lower platelet count, lymphocyte count and sodium level, with higher c-reactive protein, fibrinogen, B-type natriuretic peptide, and neutrophil percentage (Table 2). Patients with MIS-C also had lower ejection fraction and were more likely to have abnormal electrocardiogram. Conclusion We identified early features that differed between patients with MIS-C from those without. Development of a diagnostic prediction model based on these early distinguishing features is currently in progress. Disclosures Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Quidel (Grant/Research Support, Other Financial or Material Support, Donation of supplies/kits)Sanofi (Grant/Research Support, Other Financial or Material Support, HAI/NAI testing) Natasha B. Halasa, MD, MPH, Genentech (Individual(s) Involved: Self): I receive an honorarium for lectures - it’s a education grant, supported by genetech, Other Financial or Material Support, Other Financial or Material Support;Sanofi (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support James A. Connelly, MD, Horizon Therapeutics (Advisor or Review Panel member)X4 Pharmaceuticals (Advisor or Review Panel member)

10.
Biology ; 10(9), 2021.
Article in English | CAB Abstracts | ID: covidwho-1523857

ABSTRACT

Human-to-animal and animal-to-animal transmission of SARS-CoV-2 has been documented;however, investigations into SARS-CoV-2 transmission in congregate animal settings are lacking. We investigated four animal shelters in the United States that had identified animals with exposure to shelter employees with laboratory-confirmed COVID-19. Of the 96 cats and dogs with specimens collected, only one dog had detectable SARS-CoV-2 neutralizing antibodies;no animal specimens had detectable viral RNA. These data indicate a low probability of human-to-animal transmission events in cats and dogs in shelter settings with early implementation of infection prevention interventions.

11.
BJS Open ; 5(SUPPL 1):i45, 2021.
Article in English | EMBASE | ID: covidwho-1493750

ABSTRACT

Background: Haematuria often requires investigation with an imaging test and flexible cystoscopy to rule out urinary tract cancers. With a reduction in diagnostic services due to the COVID-19 pandemic there is a risk of compromise in the care of patients referred with haematuria. We aimed to provide a pragmatic strategy that optimises the use of scarce resources by reducing patient visits to hospital and allocating the appropriate diagnostic tests according to risk of bladder cancer. Methods: The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of newly suspected urinary tract cancer. Patients underwent cystoscopy, imaging tests, urine cytology and transurethral resection of bladder tumour (TURBT), where indicated. We developed strategies using combinations of imaging and cytology as triage tests to flexible cystoscopy. These strategies aimed to maximise cancer detection within a pragmatic pathway in a resource-limited environment. Findings: 8112 patients (74 4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70 7%) patients had visible haematuria (VH) and 2375 (29 3%) had non-visible haematuria (NVH). Amongst all patients, 1474 (18 2%) had bladder cancer;1333 (23 2%) in VH group and 141 (5 94%) in NVH group. Diagnostic test performance was used to determine optimal age cut-offs for each proposed strategy. We recommended proceeding directly to TURBT for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients (threshold of 60-years-old with VH, or 70-years-old with NVH) to capture high risk bladder cancer. Interpretation: We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.

12.
Neurology ; 96(15 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1407896

ABSTRACT

Objective: To demonstrate that interactive virtual case-based discussions contribute to the education and satisfaction of medical students as an adjunct to standard educational practices. Background: Due to the COVID-19 pandemic, medical students have had their time engaging with patients dramatically decreased. In an attempt to compensate for this deficit in education, many novel teaching methods have been utilized such as the use of interactive virtual case discussions. Design/Methods: We designed four interactive case discussions (NeuroLytes), each focusing on a particular neurologic disorder. These discussions were held weekly, led by neurology residents, and targeted at medical students during their neurology clerkship. Satisfaction surveys were distributed to medical students who participated in NeuroLytes in order to assess their subjective perception of these sessions as well as their overall perspective on how education was impacted by COVID-19. Results: Seventy-six medical students participated in NeuroLytes and responded to the perception survey. Students identified that their learning experience after the pandemic was most affected by decreased interaction with patients (85.5%), other students (73.6%), residents (46.1%), attendings (53.9%), as well as decreased motivation to study (52.6%). Students also felt their ability to learn the neurological exam, take a history, and reason clinically would be most affected (51.5%, 69.7%, and 42.4% respectively). Satisfaction with NeuroLytes has been reported as high-86% strongly agreed or agreed that NeuroLytes should continue. Additionally, there was a significant increase in student rating of teaching sessions prior (median of 4/5) and after (median of 4.3/5) NeuroLytes (p=0.01). Similarly, there was a significant increase in student rating of overall educational experience on the clerkship as a median of 3.5 before and 3.9 after (p=0.02). Conclusions: Interactive virtual case-based discussions (NeuroLytes) appear to be a successful educational method and may be implemented in neurology clerkships as an add-on to standard teaching, especially during the COVID-19 pandemic.

13.
Investigative Ophthalmology and Visual Science ; 62(8), 2021.
Article in English | EMBASE | ID: covidwho-1378790

ABSTRACT

Purpose : To evaluate the risks and impact of COVID-19, SARS-CoV-2, on a private ophthalmology practice in Ohio and analyze the fluctuation in patient visits and surgeries before and during the COVID-19 pandemic. Methods : A retrospective analysis was performed using outpatient clinic logs for patients seen during the first 10 weeks of 2020 and compared to outpatient clinic logs for 10 weeks during the COVID-19 pandemic. During the twenty-week period, the number of appointments, intravitreal injections, and surgeries, most commonly retinal detachments, epiretinal membrane (ERM), and vitreous hemorrhages, were compared. Additionally, consideration was given to potential measures to reduce the spread and maintain prepandemic clinical care levels. The number of appointments, injections administered, and surgeries completed or postponed were analyzed before and during the COVID-19 pandemic. The practice implemented additional precautions for patients and staff. These included, but were not limited to, temperature checks, hand sanitizer availability, required use of face masks, and asking patients to come alone to appointments;with the exception of patients that were wheelchair bound, suffered from dementia, were under the age of 18, or required a translator. Results : During the first 10 weeks of 2020, the practice saw an average of 2,205 visits a week. In week one of the pandemic, the average was 1,147 patients per week, a 54% drop. An overall 40% drop was seen in surgical cases;vitreous hemorrhage surgeries decreased by 35%, retinal detachment surgeries decreased 25%, and ERM peels reduced by 60%. The drop in ERM's were mostly due to rescheduling. Intravitreal injections during the first 10 weeks averaged 1,025 (SD±112) per week. During the start of the 10 COVID-19 weeks, intravitreal injections averaged 852 (SD±122) per week and by the last weeks injections averaged 972 (SD±142) per week. Conclusions : In the early stages, the initial number of outpatient visits declined by 54%, the average number of intravitreal injections did not change in a similar pattern. This represents the importance of patients' triage and prioritizing urgent cases.

14.
Morbidity and Mortality Weekly Report ; 69(46):1725-1729, 2020.
Article in English | GIM | ID: covidwho-1342749

ABSTRACT

This article used supplementary information sources and relied on direct data importation and matching of patient identifiers for data on hospitalisation status, the occurrence of death, race/ethnicity, and presence of underlying medical conditions. The highest rates of cases, hospitalisations, and deaths were concentrated in communities of color, high poverty areas, and among persons aged 75 years or with underlying conditions. The crude fatality rate was 9.2% overall and 32.1% among hospitalised patients. Using these data to prevent additional infections among NYC residents during subsequent waves of the pandemic, particularly among those at highest risk for hospitalisation and death, is critical. Mitigating COVID-19 transmission among vulnerable groups at high risk for hospitalisation and death is an urgent priority. Similar to NYC, other jurisdictions might find the use of supplementary information sources valuable in their efforts to prevent COVID-19 infections. This report describes cases of laboratory-confirmed COVID-19 among NYC residents diagnosed during 29 February 29 to 1 June, 2020, that were reported to DOHMH. DOHMH began COVID-19 surveillance in January 2020 when testing capacity for SARS-CoV-2 (the virus that causes COVID-19) using real time reverse transcription polymerase chain reaction (RT-PCR) was limited by strict testing criteria because of limited test availability only through CDC. The NYC and New York State public health laboratories began testing hospitalised patients at the end of February and early March. DOHMH encouraged patients with mild symptoms to remain at home rather than seek health care because of shortages of personal protective equipment and laboratory tests at hospitals and clinics. Commercial laboratories began testing for SARS-CoV-2 in mid to late March. During 29 February 29 to 15 March, patients with laboratory confirmed COVID-19 were interviewed by DOHMH, and close contacts were identified for monitoring. The rapid rise in laboratory-confirmed cases (cases) quickly made interviewing all patients, as well as contact tracing, unsustainable. Subsequent case investigations first included medical chart review for patients who were hospitalised or who had died, but then progressed to chart review only for patients who had died, and then finally only for deaths in patients aged <65 years. Mitigating COVID-19 transmission among vulnerable groups at high risk for hospitalisation and death is an urgent priority.

15.
Journal of Burn Care and Research ; 42(SUPPL 1):S149, 2021.
Article in English | EMBASE | ID: covidwho-1288071

ABSTRACT

Introduction: Globally, medical centers have faced unprecedented times with the onset of the Novel Coronavirus pandemic. Emergency departments (ED) and burn units have had to adapt to uncertainty and new challenges. At our institution, we had to alter our daily burn practice, physically moving our burn unit to our surgical intensive care unit to accommodate staff cohorting. While some hospitals have seen patient surges, most have endured dramatic decreases in productivity. A UK burn unit documented lower ED presentations and reduced referrals from other centers, with 50% fewer patients admitted to their burns ward (Farroha). In Israel, a 66% decrease in adult burn patients was noted (Kruchevska et al.). We sought to identify the impact of COVID-19 on burn injury epidemiology in our burn unit based in a large, urban, academic medical center. Methods: We conducted a retrospective review of our burn database for ED visits and admissions related to burn injuries between March 1st and June 30th in the years 2017, 2018, 2019, and 2020. We looked at the age and sex of patient, type of visit, length of stay (LOS), the mechanism of injury, the setting in which injury occurred, and the details of the injury. We compare annual trends, with emphasis on comparison of 2020 to previous years. Results: From admissions and ED data records, 215 patient encounters were reviewed. We saw a yearly rise in total burn patients seen in the ED or admitted to our burn unit 2017-2020 (39, 43, 63, and 70 respectively) with the highest volume of patients in 2020. Mean patient age ranged from 45 (2020) to 51 (2017). More males were burned in all years (male:female ratio 3.9 in 2017, 2.1 in 2018, 2.5 in 2019, 1.9 in 2020). Median LOS in 2020 was 2.5 days, consistent with 2017-2019 values (2, 3, 3, respectively). Between 2017 and 2019, 10%, 2%, and 8% respectively of patients evaluated were treated on an outpatient basis, while in 2020, 20% were outpatient. Rates of flash, scald, flame, chemical, electrical, and contact burns were stable over the period. Of those patients who were admitted, 1.8% sustained workrelated burns in 2020 versus 8.9% over 2017-2019. In 2020, 23% of burns were cooking related versus 18% over the prior 3 years. Conclusions: Despite documented decreased burn admissions in some units, our unit saw an increase in burn injuries presenting for evaluation in the first 3 months of the COVID-19 pandemic as compared to the analogous period in the three years prior. Burns were less often tied to workrelated incidents and more frequently related to cooking injuries. Even with more patients treated and released from the ED, inpatient admission numbers were maintained. These findings support the importance of protecting our staffing and burn unit resources in a pandemic setting in order to appropriately treat regional patients and an increase in home-based injuries.

16.
Lancet Planetary Health ; 5(6):E336-E336, 2021.
Article in English | Web of Science | ID: covidwho-1282972
17.
British Journal of Surgery ; 108(SUPPL 2):ii7-ii8, 2021.
Article in English | EMBASE | ID: covidwho-1254597

ABSTRACT

Introduction: Diagnostic haematuria services have been reduced due to the COVID-19 pandemic, compromising patient care, and necessitating a more pragmatic pathway. Method: The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of haematuria. Using this data, we developed strategies using combinations of imaging and cytology as triage tests to maximise cancer detection within a pragmatic pathway. Results: 8112 patients (74 4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70 7%) patients had visible haematuria (VH) and 2375 (29 3%) had non-visible haematuria (NVH). Diagnostic test performance was used to determine optimal age cut-offs for four proposed strategies. We recommended proceeding directly to transurethral resection of bladder tumour for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients to capture high risk bladder cancer. Conclusions: We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.

18.
Topics in Antiviral Medicine ; 29(1):287, 2021.
Article in English | EMBASE | ID: covidwho-1250490

ABSTRACT

Background: During the COVID-19 pandemic, gay, bisexual and other men who have sex with men (MSM) in the United States (US) have reported similar or fewer sexual partners and reduced access to HIV testing and care. Pre-exposure prophylaxis (PrEP) use has declined. We estimated the potential impact of COVID-19 on HIV incidence and HIV-related mortality among US MSM. Methods: We used a calibrated HIV transmission model for MSM in Baltimore, Maryland, and available data on COVID-19-related disruptions (from national online surveys of US MSM and from a Boston clinic with extensive PrEP experience) to predict impacts of data-driven reductions in sexual partners (0% or 25% - based on different surveys), condom use (5%), HIV testing (20%), viral suppression (VS;10%), PrEP initiations (72%), PrEP use (9%) and ART initiations (50%), exploring different disruption durations. We estimated the median (95% credible interval) relative change in cumulative new HIV infections and HIV-related deaths among MSM over 1 and 5 years from the start of COVID- 19-related disruptions, compared with a scenario without COVID-19-related disruptions. Results: A 6-month 25% reduction in sexual partners among Baltimore MSM, without HIV service changes, could reduce new HIV infections by 12 2%(11 7,12 8%) and 3 0%(2 6,3 4%) over 1 and 5 years, respectively. In the absence of changes in sexual behaviour, the 6-month data-driven disruptions to condom use, testing, VS, PrEP initiations, PrEP use and ART initiations combined were predicted to increase new HIV infections by 10 5%(5 8,16 5%) over 1 year, and by 3 5%(2 1,5 4%) over 5 years. A 25% reduction in partnerships offsets the negative impact of these combined service disruptions on new HIV infections (overall reduction 3 9%(-1 0,7 4%) and 0 0%(-1 4,0 9%) over 1 and 5 years, respectively), but not on HIV-related deaths (corresponding increases 11 0%(6 2,17 7%), 2 6%(1 5,4 3%)). Of the different service disruptions, a 6-month 10% reduction in VS was predicted to have the greatest impact, increasing new infections by 6 4%(2 6,11 9%) and HIV-related deaths by 9 5%(5 2,15 9%) over 1 year, without changes in sexual behaviour. The predicted impacts of reductions in partnerships or VS doubled if they lasted 12 months or if disruptions were twice as large. Conclusion: Maintaining access to ART and adherence support is of the utmost importance to minimise excess HIV-related mortality due to COVID-19 restrictions in the US, even if accompanied by reductions in sexual partnerships.

19.
Open Forum Infectious Diseases ; 7(SUPPL 1):S161, 2020.
Article in English | EMBASE | ID: covidwho-1185691

ABSTRACT

Background: While hospitalized COVID-19 patients are well described in the literature, studies of the natural history and ambulatory cases are limited. We aim to describe the symptoms and clinical course of COVID-19 among ambulatory patients seen at the Emory University multidisciplinary Acute Respiratory Clinic (ARC) developed to care for patients with confirmed or suspected COVID-19. Methods: PCR-confirmed COVID-19 cases seen at ARC from 4/3-5/16/2020 were included in a retrospective chart review. Encounters were classified as acute, subacute, or convalescent depending on the duration since illness onset (< 1, 1-4, or >4 weeks, respectively). Demographic, clinical, physical exam, diagnostic test, and disposition data were abstracted and analyzed with standard descriptive statistics. Results: Among 404 visits at ARC, 127 (31.4%) were for confirmed COVID-19 illness (107 unique patients with 1-4 visits). The majority (75.7%) of patients were female, and the median age was 55 years (range 24-89). Patients presented during acute, subacute, and convalescent phases of illness (15.7%, 58.3%, and 26.0%, respectively;Table). Prevalent co-morbidities included hypertension (39.3%), obesity (27.1%), diabetes (20.6%), and asthma (21.5%). While measured or subjective fever was reported in the majority of acute visits (60.0%), it was less common in subacute and convalescent encounters (27.0% and 30.3%). Cough was commonly reported in acute, subacute, and convalescent visits (70.0%, 79.7%, 66.7%), as were dyspnea on exertion (45.0%, 70.3%, 66.7%) and chest tightness (40.0%, 40.5%, 60.6%). Although smell or taste alteration was present in almost half of acute and subacute patients, it was only reported in a quarter of convalescent patients. Among the three stages of illness, transfers from ARC to the ED or direct hospitalizations occurred in 15.0%, 23.0%, and 12.1% of acute, subacute and convalescent visits, respectively. Conclusion: Following acute illness, COVID-19 patients can experience persistent symptoms, primarily respiratory symptoms, which can be severe enough to warrant hospitalization. Clinics evaluating recovering patients should prepare to manage these symptoms. Further study of the pathophysiology and treatment of persistent pulmonary symptoms in COVID-19 is needed. (Table Presented).

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