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1.
JMIR Human Factors ; 9(3):e37313, 2022.
Article in English | MEDLINE | ID: covidwho-2039592

ABSTRACT

BACKGROUND: Participation from clinician stakeholders can improve the design and implementation of health care interventions. Participatory design methods, especially co-design methods, comprise stakeholder-led design activities that are time-consuming. Competing work demands and increasing workloads make clinicians' commitments to typical participatory methods even harder. The COVID-19 pandemic further exacerbated barriers to clinician participation in such interventions. OBJECTIVE: The aim of this study was to explore a web-based participatory design approach to conduct economical, electronic co-design (ECO-design) workshops with primary care clinicians. METHODS: We adapted traditional in-person co-design workshops to web-based delivery and adapted co-design workshop series to fit within a single 1-hour session. We applied the ECO-design workshop approach to codevelop feedback interventions regarding abnormal test result follow-up in primary care. We conducted ECO-design workshops with primary care clinicians at a medical center in Southern Texas, using videoconferencing software. Each workshop focused on one of three types of feedback interventions: conversation guide, email template, and dashboard prototype. We paired electronic materials and software features to facilitate participant interactions, prototyping, and data collection. The workshop protocol included four main activities: problem identification, solution generation, prototyping, and debriefing. Two facilitators were assigned to each workshop and one researcher resolved technical problems. After the workshops, our research team met to debrief and evaluate workshops. RESULTS: A total of 28 primary care clinicians participated in our ECO-design workshops. We completed 4 parallel workshops, each with 5-10 participants. We conducted traditional analyses and generated a clinician persona (ie, representative description) and user interface prototypes. We also formulated recommendations for future ECO-design workshop recruitment, technology, facilitation, and data collection. Overall, our adapted workshops successfully enabled primary care clinicians to participate without increasing their workload, even during a pandemic. CONCLUSIONS: ECO-design workshops are viable, economical alternatives to traditional approaches. This approach fills a need for efficient methods to involve busy clinicians in the design of health care interventions.

2.
BMC Pediatr ; 22(1):496, 2022.
Article in English | PubMed | ID: covidwho-2002132

ABSTRACT

BACKGROUND: Descriptions of the COVID-19 pandemic's indirect consequences on children are emerging. We aimed to describe the impacts of the pandemic on children with medical complexity (CMC) and their families. METHODS: A one-time survey of Canadian paediatricians using the Canadian Paediatric Surveillance Program (CPSP) was conducted in Spring 2021. RESULTS: A total of 784 paediatricians responded to the survey, with 70% (n = 540) providing care to CMC. Sixty-seven (12.4%) reported an adverse health outcome due to a COVID-19 pandemic-related disruption in healthcare delivery. Disruption of the supply of medication and equipment was reported by 11.9% of respondents (n = 64). Respondents reported an interruption in family caregiving (47.5%, n = 252) and homecare delivery (40.8%, n = 218). Almost 47% of respondents (n = 253) observed a benefit to CMC due to COVID-19 related changes in healthcare delivery, including increased availability of virtual care and reduction in respiratory illness. Some (14.4%) reported that CMC were excluded from in-person learning when their peers without medical complexity were not. CONCLUSION: Canadian paediatricians reported that CMC experienced adverse health outcomes during the COVID-19 pandemic, including disruptions to family caregiving and community supports. They also describe benefits related to the pandemic including the expansion of virtual care. These results highlight the need for healthcare, community and education policymakers to collaborate with families to optimize their health.

3.
Journal of General Internal Medicine ; 37:S133, 2022.
Article in English | EMBASE | ID: covidwho-1995829

ABSTRACT

BACKGROUND: In-person clinic visits can be challenging for underserved populations due to social determinants of health such as transportation, time off work, and childcare responsibilities. These challenges were further compounded during the COVID-19 pandemic, which propelled primary care physicians to rapidly incorporate telehealth into their practice. The aim for this project was to assess our internal medicine residents' views on, preparation for, and comfort with telehealth. METHODS: With technical support from our local Area Health Education Center (AHEC) chapter, we created a telehealth training module specific to our residency continuity clinics. Upper-level Internal Medicine residents were surveyed regarding their experience and comfort level with the use of telehealth in their continuity clinics. First-year residents were excluded, as they were assigned to in-person clinic visits during the peak of the pandemic. Survey results were analyzed using descriptive statistics. Themes, areas of improvement, and next steps were identified. RESULTS: Approximately 57 percent of Wake Forest Internal Medicine residents (n=38) completed the newly developed telehealth online training module and associated survey assessing resident experience and comfort level with telehealth. Many respondents (71.9%) stated that they had not received prior training in telehealth. However, 65.7% of residents surveyed stated they felt comfortable managing patients through telehealth. Many of those surveyed believed telehealth benefits the health of patients (84.4%,) is an important learning opportunity during residency (93.8%,) and expect to use telehealth in their future career (97.1%.) A majority of residents felt telehealth could be a suitable alternative for routine follow-up and chronic disease management, but mentioned the lack of patient connectivity to video and need for access to objective data like vital signs and physical exam. CONCLUSIONS: Internal Medicine residents were eager to incorporate telehealth into their current training and future careers, despite most not having received prior telehealth training. Residents recognized the limitations of telehealth and frequently suggested home measurements of vital signs to improve management decisions. Thus, “Know Your Numbers” pilot project was created, which targets patients with poorly controlled diabetes and hypertension, was designed to provide residents with greater exposure to telehealth, as well as equip patients with the remote monitoring tools necessary to better inform treatment recommendations. Patients are scheduled for interval telehealth visits between their regularly scheduled in-person visits with their resident primary care physician. Residents will be surveyed again in July 2022 to assess changes in comfort level and experience with telehealth.

4.
International Journal of Health Sciences ; 6:2776-2784, 2022.
Article in English | Scopus | ID: covidwho-1989167

ABSTRACT

Introduction: Diabetes Mellitus is a chief reason for morbidity and mortality globally. It is also a major comorbidity contributory factor in COVID-19. Patients with diabetes have an increased susceptibility to viral and bacterial infections, including those affecting the respiratory tract. Numerous scoring systems have been developed to evaluate and stratify the risk of Communityacquired Pneumonia (CAP). CURB 65 scorings are one of the time tested and relatively easy methods. However, comparative CURB 65 SCORE data analysing its correlation between diabetes mellitus (DM) & non - diabetic mellitus (NDM) in hospitalized covid 19 patients is lacking. Therefore, this study aimed to evaluate and perform a comparative analysis of CURB 65 scores between diabetic & non- diabetic hospitalized COVID 19 confirmed patients. Methods: This cross-sectional single-centre research evaluated hundred and forty COVID 19 positive patients with and without diabetes from April to June 2021. Following the evaluation of the glycemic status of the patient, CURB 65 scores were calculated. Cohorts were grouped as mild, moderate and severe illnesses, based on the CURB 65 score. Duration of hospitalisation, the requirement of the ventilator, ICU admission and mortality were recorded. Patients were monitored until they were discharged or deceasement. Results: Of the sixty-nine patients who were diabetic, 65.2 % had a mild illness, 30.4% had moderate and 4.3 % had severe illness. Of the rest 71 patients who were non-diabetic 97.2 % had mild, 2.8% had moderate and none had severe illness. There is a significant association between patients with and without diabetes when compared with their CURB 65 score with a p-value <0.0001 and a chi-square value of 24. Seventeen DM patients were hospitalised in ICU and 13 required ventilation, whilst only 4 NDM patients were in ICU and 3 required ventilator support. The mean value of the duration of hospital stay for the DM group was 9.25 days with an SD of ± 5.0. In comparison mean value for NDM cohorts was 7.01 days with an SD of ± 4.30. The difference was statistically significant with a p-value of 0.005. No mortality was noted in NDM patients. In contrast, 17 DM patients succumbed. The difference in mortality was statistically significant with a p-value of <0.0001. Conclusion: CURB 65 was found to be of increased value for diabetic patients. The severity of illness is more in the diabetes population than in the non-diabetic population. © 2022 The authors.

5.
Circulation: Cardiovascular Quality and Outcomes ; 15, 2022.
Article in English | EMBASE | ID: covidwho-1938119

ABSTRACT

Background: Different arrhythmias have been reported in patients with COVID-19 due to the complication of the disease, and medications used in the management of COVID-19. Remdesivir was approved by FDA for the management of COVID-19 patients in October 2020. There are several case reports suggesting remdesivir causing bradyarrhythmia in COVID-19 patients. Objective: To increase the knowledge and awareness among healthcare professions (HCPs) about the risk of arrhythmias associated with the use of remdesivir. Methods: We used the FDA Adverse Events Reporting System (FAERS) database to find bradyarrhythmia as a reported adverse event (AE) due to remdesivir until October,2021. Total 6,504 events were reported, out of which 5,996 (92.2%) were reported by HCPs. These AEs were included and further analyzed. Results: Out of 5,996 AEs reported with remdesivir, total 537 (9.0%) events were bradyarrhythmia. There were 74 (1.27%) events reported for atrial fibrillation, and 24 (0.04%) for ventricular tachycardia attributed to the use of remdesivir. Reported events of bradyarrhythmia were further divided and analyzed into men vs women, and different age groups of years 18-64, 65-85, >85. Total events of bradyarrhythmia among men (238, 6.5%) vs women (141, 6.4%) were not significantly different. Among all the age groups, more events were reported in younger women in the age group of 18-64 (12.3%) vs 65-85 (7.9%) vs >85 (6.9%). Conclusion: Multiple studies have shown COVID-19 associated tachyarrhythmias, likely secondary to the myocardial damage due to hypoxia. Few studies have also suggested bradyarrhythmias in these patients. Our analysis of the FAERS database also showed many reported AEs of bradyarrhythmia attributed to the use of remdesivir. Postulated mechanisms include;medication side effects, damage to the SA node as a complication of the COVID-19 disease process, and electrolyte imbalance due to the renal failure. Close surveillance of these patients with early diagnosis can lead to prompt discontinuation of the medication, which can further decrease the mortality related to bradyarrhythmias. Further studies are required to identify the at-risk population and to better understand the risk of bradyarrhythmia associated with remdesivir.

6.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927834

ABSTRACT

A 27- year-old previously healthy man presented to the emergency department with a 3-day history of confusion, urinary retention, cough, slurred speech, intermittent vertigo, and unsteady gait after being started on outpatient abx for diagnosis of community acquired pneumonia at an outside facility. On presentation, his vital signs were significant for a Temp. of 102.4 F, a HR of 118 bpm, a RR of 22 bpm, a BP of 135/75 mmHg, O2 sats down to the 80s% with a new oxygen requirement of 3 L/min. His neurological exam was remarkable for dysarthria, a wide based and unsteady gait, forward drift on standing, bilateral dysmetria and was otherwise non-focal. Bilateral basilar rales were noted on lung exam. Initial workup was significant for a sodium level of 129, potassium 3.1, AST 178, ALT 31. His urine legionella antigen test was positive and COVID-19 PCR test was negative. CT of the chest demonstrated multifocal pneumonia. The predominant neurological picture on presentation warranted a lumbar puncture as well as an MRI of the brain, both of which came back negative. HIV test was negative as well. The spectrum of neurological manifestations of legionnaire's disease is quite wide ranging from simple headaches to acute disseminated encephalomyelitis (ADEM). While up to 40% of patients may present with headaches and some confusion, the specific cerebellar presentation is quite rare and has been described in case reports. According to Shelburne(1), there has been instances where the neurological manifestations have lasted up to 3 years after resolution of the pulmonary disease. In a review article detailing 29 cases of cerebellar dysfunction in Legionnaire's disease, a lumbar puncture performed in 16 of the cases showed that the majority had no abnormalities in CSF studies. The propensity for Legionella to specifically manifest as cerebellar Sx remains to be studied. Interestingly, another case report of two patients with neurological symptoms, showed hypoperfusion of the cerebellar and frontal lobes on single photon emission while CT and MRI imaging of the brain were normal. We add to the literature another 'cerebellar' presentation of Legionnaire's disease.

7.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927819

ABSTRACT

Post-intubation tracheal stenosis (PiTS) is a complication that occurs in 10-22% of patients after prolonged intubation or tracheostomy. Predisposing factors include localized infection, soft tissue trauma, granulation at the site of stoma, hypotension, tracheal cartilage damage, and metabolic disorders. Despite advances in the design of endotracheal tubes and cuffs, PiTS continues to remain an undesired consequence that warrants increased attention, especially in the COVID pandemic, which has led to increased number of tracheostomies and intubations. Consequently, prompt diagnosis and management is imperative to improve patient survival and quality of life. Herein, we present a 52-year-old male with history of tracheostomy in the setting of prolonged intubation from intraparenchymal hemorrhage with subsequent decannulation who was admitted for the management of pulmonary embolism. His course was complicated by encephalopathy and acute hypercapnic respiratory failure requiring intubation. In the intensive care unit, the patient was extubated after improvement in his respiratory and mental status, however developed shortness of breath and the feeling of impending doom a few hours after extubation. Chest radiograph was obtained and suggested tracheal stenosis (Image-1A). Given this finding, follow-up urgent chest computed tomography demonstrated severe lateral collapse of the subglottic space with critical tracheal stenosis (Image-1B). There was >90% cross sectional area reduction at the site of greatest stenosis (Image-1C). The measured area at the site of greatest stenosis was noted at 0.32 cm2 (average tracheal area is 2.8-3.4 cm2). His tracheal stenosis was suspected to be secondary to his history of tracheostomy. Given these findings, patient was reintubated for airway protection and urgently underwent rigid bronchoscopy. Initially, argon plasma coagulation was used in between stenotic areas, however there was minimal improvement in the airway, requiring a silicone 18 x 14 x 14 cm Y-stent to be placed. Since stent placement, patient has required frequent bronchoscopies to assist with mucus and secretion clearing. The remainder of his hospital course was benign. PiTS is an infrequent yet important complication that clinicians must consider in individuals with a history of prolonged intubation who have sudden difficulty breathing postextubation. Prompt recognition is required to manage these patients effectively. Factors considered in the management include location, length, and the severity of the stenosis. Therefore, if 1) critical stenosis is suspected, 2) the facility is capable of resection and reconstruction, and 3) the patient has minimal comorbidities, surgery should be considered. Otherwise, bronchoscopy with stent placement can be performed.

8.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925433

ABSTRACT

Objective: To present a patient with acute-onset of multiple cranial neuropathies associated with recent COVID-19 vaccination. Background: Vaccine-associated neurologic adverse effects have been well-described over the decades;the influenza vaccine as well as others have been thought to precede Guillain-BarréSyndrome (GBS), Miller-Fisher Syndrome (MFS), and similar processes. Hyper-inflammatory responses have been frequently reported with SARS-CoV-2 infection and immunization, along with various neurologic pathologies. In this case report we describe a cranial polyneuropathy (3, 6, 7 and 12) associated with the COVID-19 vaccine. Design/Methods: Case Report with Video/Photos Results: A 52-year-old R-handed female presented with acute-onset, rapidly progressive deficits including left upper lid ptosis, left eye ophthalmoplegia, leftward tongue deviation, left facial paresis and dysarthria. History includes congenital left eye cataract s/p lens exchange, remote strabismus surgery and slight ptosis at baseline. She denied recent illness or injuries, though had completed single-dose vaccination for SARSCoV-2 11 days prior to symptom onset. Exam revealed new L eye esotropia with restriction in abduction and supraduction. Also noted was worsening of baseline ptosis, weak tongue protrusion with right-sided fasciculations and leftward deviation. Patient endorsed dysphagia and dysarthria. Workup consisted of three unexplanatory MRIs during week of symptom onset, lumbar puncture, evaluation by ENT and neuro-ophthalmology as well as other serum and CSF studies to investigate other autoimmune causes. Consent-obtained videos and photographs were taken for documentation/educational purposes. Follow-up visits revealed slow improvement starting three months after symptom onset. Conclusions: We outline a case of a female patient who presented with progressive, multiple cranial neuropathies with onset 11 days after single-dose SARS-CoV-2 vaccination. This constellation of symptoms in the setting of COVID-19 vaccination suggests propensity towards autoimmune neurologic processes. Further investigation is needed to determine the true incidence of similar polyneuropathies with the COVID-19 vaccine and to guide providers and patients to make informed decisions.

9.
Journal of Paediatrics and Child Health ; 58(SUPPL 2):97-98, 2022.
Article in English | EMBASE | ID: covidwho-1916250

ABSTRACT

Background: COVID-19 trials took <1 year to identify therapies reducing death in >30,000 patients but the Australian Placental Transfusion Study took >12 years to show that delaying cord clamping reduced death or major disability (cerebral palsy, severe visual loss, deafness, or cognitive delay) in 1,531 preterm infants. What can this teach us? Further, as composite outcomes of death or major disability can be inconclusive if each is unequally affected (as in the NeOProM Collaboration1) 2 important aims are (i) global co-operation (https://www.alphacollaboration.com/) to identify core Participant-Intervention-Comparator-Outcome questions for trials assessing mortality, a key outcome, and (ii) to answer those questions in much larger, faster trials. Such trials will also yield much more precise estimates of disability in survivors than was previously typical - a major benefit. Method: To inform these aims we compared enrolment in 2 COVID-19 trials and in 10 trials by IMPACT collaborators with samples >1,500 in high- or low-or-middle-income countries (HIC/LMIC). Results: The COVID-19 trials took 3-9 months, enrolling 13 - 219 per-site-per-year. Perinatal trials took 16-86 months, enrolling 5 - 1,700 per site per year. Trials in pregnant women or LMIC (n = 53,092) enrolled 5 times more than trials in newborns or restricted to HIC (n = 9,014). (Table) Conclusions: Greater international collaboration could resolve questions of shared relevance and priority more rapidly. Megatrials addressing mortality may benefit from highly streamlined processes for enrolment and minimal data collection, e.g., RECOVERY's one-page outcome form.

10.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880479
11.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880478
12.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880101
13.
7th International Conference on Wireless Communications, Signal Processing and Networking, WiSPNET 2022 ; : 105-109, 2022.
Article in English | Scopus | ID: covidwho-1874361

ABSTRACT

Nowadays, in this COVID era, work from home is quietly more preferred than work from the office. Due to this, the need for a firewall has been increased day by day. Every organization uses the firewall to secure their network and create VPN servers to allow their employees to work from home. Due to this, the security of the firewall plays a crucial role. In this paper, we have compared the two most popular open-source firewalls named pfSense and OPNSense. We have examined the security they provide by default without any other attachment. To do this, we performed four different attacks on the firewalls and compared the results. As a result, we have observed that both provide the same security still pfSense has a slight edge when an attacker tries to perform a Brute force attack over OPNSense. © 2022 IEEE.

14.
Multiple Sclerosis Journal ; 28(1_SUPPL):181-181, 2022.
Article in English | Web of Science | ID: covidwho-1866073
15.
Age and Ageing ; 51(SUPPL 1):i3-i4, 2022.
Article in English | EMBASE | ID: covidwho-1815985

ABSTRACT

Introduction: TEP detail appropriate ceilings of care and guide treatment of patients based on shared decision making. TEP documentation was not standard within our trust up to 2018.We aimed to design and introduce a standardised TEP proforma and evaluate its use in older persons aged ≥80. Methods: Data was obtained from patient notes and questionnaires within the Medicine for Older Persons department (MOP) from four PDSA cycles between 2018-2020. Cycle 1 was a service evaluation. Based on this data, a TEP form was created and approved for use in all adult patients. Cycles 2, 3 and 4 evaluated TEP after Introduction: of the proforma. Results: There was a 239% increase in TEP after Introduction: of the proforma, compared to baseline (cycle 1: n = 14/47 [29.8%], cycle 2: n = 17/112 [15.2%], cycle 3: n = 30/97 [30.9%], cycle 4: n = 42/59 [71.2%]).Theincrease in TEP between cycles 3 and 4 coincided with the COVID-19 epidemic. Clinicians were more confident in actioning TEP based on the proforma, compared to those written in the notes (cycle 2: 83% confidence vs 54%, cycle 3: 100% vs 35%, Cycle 4: 98% vs none written in the notes). An improvement in understanding the purpose, comprehensiveness and location of TEP forms was observed. Feedback suggested TEP provided clear guidance for 1. ceilings of care;especially useful out of hours 2. discussions with critical care and 3. patient handover between staff and successive shifts. Conclusion: TEP forms offer clear guidance on ceilings of care. Introduction: of the TEP proforma has led tomore frequent and proactive discussions with patients on ceilings of care and have facilitated a culture change in the management of older persons. Use of the forms increased during the COVID-19 pandemic but are now viewed as an essential component of patient safety and have been successfully implemented trustwide.

16.
Indian Journal of Transplantation ; 16(1):107-112, 2022.
Article in English | EMBASE | ID: covidwho-1798825

ABSTRACT

Introduction: Telemedicine represents an innovative but untested approach to maintain patient care and reduce the risk of COVID-19 exposure to patients, health-care workers, and the public. In this study, we evaluated the applicability and efficacy of telemedicine in a kidney transplant recipient (KTR) cohort in COVID 19 era. Materials and Methods: An observational cohort study was conducted at a tertiary-care public-sector kidney disease institute in western India between March and September 2020. We evaluated the reasons, modes, and outcomes of patient contacts by telemedicine in the KTR cohort. We also evaluated the utility of telemedicine across three age groups. Results: Of 840 participants, whose mean age was 38.78 ± 12.39 years, male to female ratio was 4:1. The most common mode of communication was WhatsApp (653, 77.7%) followed by in-person surrogates (126, 15%). Acceptability of telemedicine was significantly better in younger and middle-age groups (P < 0.00001) compared to the elderly. Request for drug delivery (n = 756) was the most common reason for contact overall and managed through postal parcels. KTRs (n = 200) and donors (n = 75) were evaluated for medical illnesses. The most common medical reasons for contact were for febrile illness (n = 120) and graft dysfunction (n = 60). COVID-19-related disease was diagnosed and managed in 80 KTRs and 2 donors. COVID-19 updates were given to all contacts. Conclusion: Telemedicine is underutilized in the care of the KTR cohort. Telemedicine can be used across all ages although it's best suited for young and middle age groups. The impact of telemedicine on short- and long-term patient outcomes is unclear and warrants further study.

17.
3rd International Conference on Advances in Computing, Communication Control and Networking, ICAC3N 2021 ; : 2021-2026, 2021.
Article in English | Scopus | ID: covidwho-1774599

ABSTRACT

Computer based intelligence innovations and apparatuses assume a key job in each part of the COVID-19 emergency reaction. Understanding the infection and quickening clinical exploration on medications and medicines is one of the factor. Recognizing and diagnosing the infection, and anticipating its advancement helping with forestalling or easing back the infection's spread through reconnaissance and contact following reacting to the wellbeing emergency through customized data and learning checking the recuperation and improving early admonition instruments. To help encourage the utilization of AI all through the emergency, strategy creators ought to energize the sharing of clinical, sub-atomic, and logical datasets and models on synergistic stages to help AI specialists assemble successful instruments for the clinical network, and ought to guarantee that scientists approach the essential processing limit. To understand the full guarantee of AI to battle COVID-19, arrangement producers must guarantee that AI frameworks are reliable and lined up with the OECD AI Principles: they should regard human rights and protection;be straightforward, logical, vigorous, secure and safe;and on-screen characters engaged with their turn of events and utilize ought to stay responsible. Before the world was even mindful of the danger presented by the coronavirus (COVID-19), manmade reasoning (AI) frameworks had distinguished the episode of an obscure kind of pneumonia in the People's Republic of China (in the future "China"). By analyzing different aspects, the intelligent system plays the vital role to generate COVID-19 awareness and which ultimately reduce the infection to others. Proposed paper focus on awareness. © 2021 IEEE.

18.
Journal of the American College of Cardiology ; 79(9):911, 2022.
Article in English | EMBASE | ID: covidwho-1768625

ABSTRACT

Background: The cardiac catheterization lab (CCL) is a dynamic environment with high acuity patients, however little is known about burnout syndrome among healthcare workers in the CLL. Methods: This is a multi-center cross-sectional study assessing burnout syndrome using the Maslach Burnout Inventory (MBI) among registered nurses (RN) and registered cardiac invasive specialists (RCIS) working in the CCL, electrophysiology lab (EPL) and cardiac observation unit (COU). The MBI and a sociodemographic survey were administered electronically, responses were collected anonymously. Validated cut off values were used to define a positive burnout score. Results: We received completed surveys from 48 of 87 staff (55%). The overall prevalence of burnout syndrome was 33.3% (16). Higher burnout was seen in males than females and in the CCL/EPL compared to COU (Fig. 1). Burned out participants showed a trend of working more day shifts, STEMI call shifts, and extended day shifts per month compared to non-burned out participants, without meeting statistical significance (Fig. 1). 69% (33) of all participants reported experiencing increased stress during the COVID 19 pandemic. Conclusion: RNs and RCIS working in the CCL/EPL experience elevated levels of burnout. Our results are similar to the prevalence of burnout among RNs in the emergency department and intensive care units. Greater attention should be given to identifying and optimizing workplace variables which contribute to burnout among this population. [Formula presented]

19.
Open Forum Infectious Diseases ; 8(SUPPL 1):S326, 2021.
Article in English | EMBASE | ID: covidwho-1746545

ABSTRACT

Background. Virus-specific antibodies help to understand the prevalence of infections and the course of the immune response. Humans produce antibodies against the spike and nucleocapsid proteins of SARS-COV-2 virus. Patients with COVID-19 who recover from the infections have higher levels of antibodies to spike proteins. Our study aimed to find the levels of antibodies to spike and nucleocapsid proteins in severe COVID-19. Methods. A single center prospective study was done at Ascension St John Hospital, Detroit, MI. We included COVID-19 cases diagnosed by reverse-transcriptase polymerase-chain-reaction (RT-PCR). Quantitative measurements of plasma or serum antibodies to nucleocapsid and spike proteins were done in hospitalized patients with acute COVID-19. Using the electronic medical record, we collected data on demographic and clinical information. Results. A total 24 patients were studied. Of which, 15 patients were suffering from severe and critical COVID 19 and 9 patients were suffering from mild to moderate COVID 19. The mean age (standard deviation) of our cohort was 69 ± 10 years and 60% were males. Common comorbid conditions were hypertension, obesity, and type 2 diabetes. We also noted that severe to critical COVID 19 expressed higher level of antibody to nucleocapsid. Conclusion. These results display the seroconversion in COVID 19 patients. Our study shows antibody level remain high in severe COVID 19 patients but those are against nucleocapsid protein instead of spike protein.

20.
MEDLINE;
Preprint in English | MEDLINE | ID: ppcovidwho-328547

ABSTRACT

Patients with cancer have higher COVID-19 morbidity and mortality. Here we present the prospective CAPTURE study (NCT03226886) integrating longitudinal immune profiling with clinical annotation. Of 357 patients with cancer, 118 were SARS-CoV-2-positive, 94 were symptomatic and 2 patients died of COVID-19. In this cohort, 83% patients had S1-reactive antibodies, 82% had neutralizing antibodies against WT, whereas neutralizing antibody titers (NAbT) against the Alpha, Beta, and Delta variants were substantially reduced. Whereas S1-reactive antibody levels decreased in 13% of patients, NAbT remained stable up to 329 days. Patients also had detectable SARS-CoV-2-specific T cells and CD4+ responses correlating with S1-reactive antibody levels, although patients with hematological malignancies had impaired immune responses that were disease and treatment-specific, but presented compensatory cellular responses, further supported by clinical. Overall, these findings advance the understanding of the nature and duration of immune response to SARS-CoV-2 in patients with cancer.

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