Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 6 de 6
Filter
1.
Critical Care Medicine ; 51(1 Supplement):537, 2023.
Article in English | EMBASE | ID: covidwho-2190661

ABSTRACT

INTRODUCTION: While COVID19 was initially thought to only affect the lungs, the virus also affects other organs including the kidneys. This has led to reports of renal function alterations including impairment and enhancement. The incidence of acute kidney injury (AKI) and augmented renal clearance (ARC) has been reported to be 25-35% and 25-75%, respectively. Several risk factors for AKI and ARC have been reported with many overlapping. This study sought to identify which patients might experience AKI vs ARC. METHOD(S): Hospitalized, adult patients with laboratory confirmed COVID19 from the National COVID Cohort Collaborative (N3C) database were included in this retrospective study. Patients who had all data to calculate creatinine clearance (CrCl) via Cockroft-Gault were screened and excluded for pregnancy, body mass index < 18kg/m2, history of end-stage renal disease on dialysis or nephrectomy, or lacking data to determine exclusion criteria. AKI and ARC were defined using AKIN criteria and CrCl >130mL/min, respectively. Potential demographic and biomarker predictors of AKI or ARC were considered in univariate and multivariate logistic regression models. RESULT(S): 11,274 patients were included in univariate and multivariate logistic regression analysis. 20.1% developed AKI and 34.2% experienced ARC. Significant variables associated with AKI included age, weight, height, white race, male sex, Hispanic ethnicity, and diabetes (OR 0.996, 1.01, 0.73, 0.969, 1.1, 1.11, and 1.06, respectively). Age, weight, black race, male sex, Hispanic ethnicity, and hypertension were all associated with experiencing ARC (OR 0.973 1.01, 0.753, 0.945, 1.15, 0.911, respectively). No biomarker variables were available from N3C database. CONCLUSION(S): While a significant proportion of patients with COVID19 experience alterations in renal function, there are many overlapping risk factors for the development of AKI or ARC including age, weight, and Hispanic ethnicity, with male sex as the only differentiating patients at risk for AKI vs ARC. Thus, determining which patient may be at risk for renal dysfunction or enhancement based on their demographic is still unknown. Further investigation is needed to identify patients who are at risk for each of these renal function alterations.

2.
JACCP Journal of the American College of Clinical Pharmacy ; 5(12):1399, 2022.
Article in English | EMBASE | ID: covidwho-2173042

ABSTRACT

Introduction: COVID19 was originally thought to be solely a respiratory disease, however, other organs, such as the kidneys, are often also affected. While acute kidney injury (AKI) and augmented renal clearance (ARC) have both been documented, the incidence, renal characteristics, and outcome of each derangement have not been fully elucidated. Research Question or Hypothesis: What are the incidences, characteristics, and outcomes of AKI, ARC, and no AKI/ARC in patients hospitalized with COVID19? Study Design: Retrospective, observational cohort study Methods: Inpatient data from the National COVID Cohort Collaborative database with laboratory confirmed COVID19 who were >18 years old were utilized. Patients who had all data to calculate creatinine clearance (CrCl) via Cockcroft-Gault equation were screened. Exclusion criteria were pregnancy, body mass index <18kg/m2, history of end-stage renal disease on dialysis or nephrectomy. Episodes of AKI and ARC were defined using AKIN criteria and CrCl >130mL/min, respectively. Renal function characteristics and outcomes included days with episode, hospital length of stay (LOS), and mortality. Descriptive statistics and Mann-Whitney U tests were used for statistical analysis where appropriate with p<0.05 indicating statistical significance. Result(s): 15,608 patients from 11 sites were included. Overall, 57.3% were male with median age 62.7[50.1-73.2] years. The incidence of No AKI/ARC, AKI, and ARC was 43.5%, 22.9%, and 33.6%, respectively. Episodes of ARC lasted longer than AKI (4[2-7] vs 3[1-6] days;p<0.0001) Patients with AKI and ARC both had longer LOS compared to no AKI/ARC (19[10-34] and 6[4-11] vs 6[4-10];p<0.001). Patients with AKI had the highest mortality followed by no AKI/ARC then ARC (41.7% vs 10.1% vs 5.4%;p<0.001). Conclusion(s): A significant proportion of patients with COVID19 exhibit altered renal function throughout hospitalization. Clinicians should be mindful of these alterations given their associations with increased LOS and mortality with AKI. Future research should explore the impact of ARC on medication therapy in patients with COVID19.

3.
Chest ; 162(4):A2241, 2022.
Article in English | EMBASE | ID: covidwho-2060916

ABSTRACT

SESSION TITLE: Pulmonary Manifestations of Infections SESSION TYPE: Case Reports PRESENTED ON: 10/17/2022 03:15 pm - 04:15 pm INTRODUCTION: Diffuse alveolar hemorrhage (DAH) due to an undiagnosed autoimmune condition is rare and can be life-threatening. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been described as a viable rescue therapy in severe cases, providing time to establish a diagnosis and begin remission induction therapy (1). We report a patient who presented during the Omicron surge with hypoxemic respiratory failure due to pulmonary hemorrhage ultimately diagnosed with antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) who was supported with VV-ECMO without systemic anticoagulation. CASE PRESENTATION: A 46-year-old woman presented with subacute fatigue and two days of cough and brown sputum. She was found to have normocytic anemia (hemoglobin 3.5 g/dL), renal failure (serum creatinine 17.4 µmol/L), and bilateral pulmonary infiltrates on chest roentgenogram. Though vaccinated, nasal molecular testing detected SARS-CoV-2. She was intubated for progressive hypoxic respiratory failure and bronchoalveolar lavage fluid was consistent with DAH. She received empiric antibiotics, remdesivir, and pulse dose intravenous methylprednisolone as well as continuous renal replacement therapy and plasma exchange. Due to refractory hypoxemia she was cannulated for VV-ECMO. Systemic anticoagulation was deferred due to concerns that it may exacerbate her underlying pathology and due to a small subcortical bleed seen on computed tomography of the head. Perinuclear ANCA (titer >1:1280) was confirmed by immunofluorescence analysis with elevated myeloperoxidase serologies and cyclophosphamide was initiated. Glomeruli with cellular crescent formation consistent with AAV was later identified on renal biopsy. Her course was complicated by recurrent DAH while tapering steroids and an iliac vein thrombus, extracted during decannulation. Her respiratory failure resolved and she was discharged to rehab. DISCUSSION: Traditionally, VV-ECMO obligates systemic anticoagulation to prevent circuit thrombosis, however this may be viewed as a barrier to its use in patients with prohibitive bleeding risk and may contribute to the therapy's overall morbidity. Some institutions have begun to demonstrate the safety of ECMO with low- or prophylactic doses of anticoagulation (2), but this practice remains controversial. Detection of SARS-CoV-2 posed diagnostic and management challenges and its significance to this case remains uncertain. There are many past examples of infectious triggers for both DAH and AAV, and there is emerging evidence for an association between SARS-CoV-2 and ANCA (3). Concerns regarding the risk of B-cell depletion influenced the selection of remission induction therapy. CONCLUSIONS: In the case described, a patient with severe DAH was successfully supported with VV-ECMO. Withholding systemic anticoagulation did not prevent recurrent bleeding and may have contributed to a deep vein thrombosis. Reference #1: Arnold S, Deja M, Nitschke M, Bohnet S, Wallis S, Humrich JY, Riemekasten G, Steinhoff J, Lamprecht P. Extracorporeal membrane oxygenation in ANCA-associated vasculitis. Autoimmun Rev. 2021 Jan;20(1):102702. doi: 10.1016/j.autrev.2020.102702. Epub 2020 Nov 11. PMID: 33188916. Reference #2: Kurihara C, Walter JM, Karim A, et al. Feasibility of Venovenous Extracorporeal Membrane Oxygenation Without Systemic Anticoagulation. Ann Thorac Surg. 2020;110(4):1209-1215. doi:10.1016/j.athoracsur.2020.02.011 Reference #3: Kadkhoda, K., Laurita, K. Antineutrophil cytoplasmic antibodies and their association with clinical outcomes in hospitalized COVID-19 patients. Cell Death Discov. 7, 277 (2021). DISCLOSURES: No relevant relationships by Nathaniel Nelson No relevant relationships by Radu Postelnicu no disclosure on file for Antonio Velez;

4.
JACCP Journal of the American College of Clinical Pharmacy ; 4(12):1668-1669, 2021.
Article in English | EMBASE | ID: covidwho-1616005

ABSTRACT

Introduction: Clinical reasoning skills are arguably the most important skill set a healthcare professional can possess. Anecdotally, students in the latter half of pharmacotherapy course series were underachieving in developing medication-centric patient assessments and goals from collected patient data. Scaffolding is a pedagogy used to progressively advance students toward stronger understanding, skill acquisition, and independence in learning process. A clinical reasoning scaffolding tool (CRST) was designed to improve students' ability to collect pertinent information, assess patient medication therapy problems, and develop appropriate goals of therapy with specific monitoring parameters. Research Question or Hypothesis: Can a CRST improve student clinical reasoning performance? Study Design: Prospective observational cohort Methods: The CRST was implemented in Fall 2020. To assess its impact, student performance on pharmacotherapy clinical reasoning think-alouds (CRTA) in Spring 2021 were compared to historical 2020 CRTAs not exposed to CRST. Students were evaluated using entrustable professional activity-like (EPA) ratings on five CRTA sections (Findings, Assessment/Goals, Recommendations, Monitoring, Rationale) and a Percent Grade calculated. Median EPA ratings and Percent Grade were compared between 2020 and 2021 cohorts using Mann-Whitney U or Kruskal-Wallis test which were also conducted, when appropriate, to assess impact of covariates including experiential education and case progression. CRTA cases during the beginning of COVID19 were excluded from analysis. Results: Twenty-six CRTA from 2020 and 56 from 2021 were analyzed. To minimize the effect of case progression only the first two CRTAs were included. The CRST cohort had significantly higher Assessment/Goals (2[2-2.5] vs. 2[1.5-2],p=0.001) and Monitoring (2[2-2.5] vs 1.5[1.5-1.75],p<0.001) EPA-ratings, but there was no difference in Findings. Additionally, there was a significant improvement in Percent Grade in the CRST cohort (86% vs 83%, p<0.001). Conclusion: The implementation of a CRST in an early course significantly improved future student clinical reasoning performance in assessing MTPs, developing goals of therapy, and patient monitoring.

5.
WHO Regional Office for Europe. WHO Health Evidence Network Synthesis Reports ; 2021.
Article in English | MEDLINE | ID: covidwho-1279208

ABSTRACT

Physical distancing measures have been implemented worldwide to contain the transmission of COVID-19, but how best to communicate with the public to promote acceptance, uptake and adherence to these measures is less clear. This rapid review analysed evidence regarding communication with individuals and communities within the wider structural and sociopolitical context of the pandemic to support public health decision-makers when planning and implementing physical distancing measures. Findings indicated the critical role played by public communication and information in the pandemic response. Consistent features of effective communication included clear, consistent and actionable content;attention to the timing and currency of messages;consideration of the audiences for communication within and across populations;and deliberate considerations of tailoring and equity to ensure diverse population groups are reached and existing inequalities addressed. Comprehensive practical support, including access to essential services and financial support, was also critical to promote acceptance, uptake and adherence to required measures. Findings also emphasized the importance of building and maintaining public trust in authorities and of engaging communities when planning and delivering messages related to physical distancing measures.

6.
JACCP Journal of the American College of Clinical Pharmacy ; 2021.
Article in English | EMBASE | ID: covidwho-1146594

ABSTRACT

In pharmacy education, we are experiencing the “new normal” after an “inflection point” along with a host of other overused phrases. Yet, without doubt, there is pressing need to reconsider what was once standard operating procedure. When an inflection point is viewed as opportunity, it sparks a strategic boom. Indeed, the confluence of threats and opportunities caused—or revealed—by the COVID-19 pandemic is setting the stage for an acceleration of change in professional education. In this paper, we investigate the motivations and approaches to accelerate needed change in pharmacy education. Though prompted by the demand for rapid restructuring in response to the COVID-19 pandemic, these ideas transcend any one driver. We argue that now is the time to disrupt current practices through innovation leading to new educational models and present sample solutions. We consider academic, social, technological, economic, and political (ASTEP) forces driving the imperative to educational change.

SELECTION OF CITATIONS
SEARCH DETAIL