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1.
Front Pediatr ; 10:908337, 2022.
Article in English | PubMed | ID: covidwho-2022821

ABSTRACT

Prior to the COVID-19 pandemic, the development of hospital-based telemedicine services had been slow and circumscribed in scope due to insurance and licensure restrictions. As these restrictions were eased during the COVID-19 pandemic to facilitate ongoing patient care, the public health emergency facilitated a rapid expansion and utilization of telemedicine services across the ambulatory service sector. OBJECTIVES: The current quality improvement (QI) study utilized this unprecedented opportunity to evaluate the use of telemedicine services across a variety of clinical disciplines and patient groups. METHODS: Caregivers of patients (ages 0-21) who received care through an outpatient specialty center provided experience ratings of telemedicine services delivered during the initial pandemic months (March-June 2020;N = 1311) or during the national "winter surge" in late 2020 (November 2020-February 2021;N = 1395). Questionnaires were distributed electronically following the clinical visits, and ANCOVA was employed (with patient age as the covariate) to determine if caregiver responses differed based on patient demographic characteristics. RESULTS: Ratings of patient satisfaction with services were very strong at both time points;greater variability in scores was noted when caregivers were asked if they would use telemedicine services again. At both time points, younger patient age (i.e., age 0-5) was associated with decreased caregiver willingness to use telemedicine services in the future. Smaller effects were seen for certain "hands on" therapies (occupational, physical, and speech) during the initial months of the pandemic and for proximity to the hospital during the "winter surge." CONCLUSIONS: These data suggest a very positive overall caregiver response to telemedicine-based services during the COVID-19 pandemic. Several areas of potential improvement/innovation were identified, including the delivery of telemedicine therapies (e.g., occupational, physical, and speech) services to young patients (i.e., aged 0-5).

2.
PLoS Global Public Health ; 2(7), 2022.
Article in English | CAB Abstracts | ID: covidwho-2021475

ABSTRACT

This study uses two existing data sources to examine how patients' symptoms can be used to differentiate COVID-19 from other respiratory diseases. One dataset consisted of 839,288 laboratory-confirmed, symptomatic, COVID-19 positive cases reported to the Centers for Disease Control and Prevention (CDC) from March 1, 2019, to September 30, 2020. The second dataset provided the controls and included 1,814 laboratory-confirmed influenza positive, symptomatic cases, and 812 cases with symptomatic influenza-like-illnesses. The controls were reported to the Influenza Research Database of the National Institute of Allergy and Infectious Diseases (NIAID) between January 1, 2000, and December 30, 2018. Data were analyzed using case-control study design. The comparisons were done using 45 scenarios, with each scenario making different assumptions regarding prevalence of COVID-19 (2%, 4%, and 6%), influenza (0.01%, 3%, 6%, 9%, 12%) and influenza-like-illnesses (1%, 3.5% and 7%). For each scenario, a logistic regression model was used to predict COVID-19 from 2 demographic variables (age, gender) and 10 symptoms (cough, fever, chills, diarrhea, nausea and vomiting, shortness of breath, runny nose, sore throat, myalgia, and headache). The 5-fold cross-validated Area under the Receiver Operating Curves (AROC) was used to report the accuracy of these regression models. The value of various symptoms in differentiating COVID-19 from influenza depended on a variety of factors, including (1) prevalence of pathogens that cause COVID-19, influenza, and influenza-like-illness;(2) age of the patient, and (3) presence of other symptoms. The model that relied on 5-way combination of symptoms and demographic variables, age and gender, had a cross-validated AROC of 90%, suggesting that it could accurately differentiate influenza from COVID-19. This model, however, is too complex to be used in clinical practice without relying on computer-based decision aid. Study results encourage development of web-based, stand-alone, artificial Intelligence model that can interview patients and help clinicians make quarantine and triage decisions.

3.
Alcoholism-Clinical and Experimental Research ; 46:123A-123A, 2022.
Article in English | Web of Science | ID: covidwho-1894169
5.
American Journal of Respiratory and Critical Care Medicine ; 203(9):2, 2021.
Article in English | Web of Science | ID: covidwho-1407392
6.
American Journal of Respiratory and Critical Care Medicine ; 203(9):2, 2021.
Article in English | Web of Science | ID: covidwho-1407134
8.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277371

ABSTRACT

RATIONALE: The COVID-19 pandemic has rapidly become the most significant worldwide public health crisis in the modern era. Like other states around the country, the state of Colorado instituted a statewide lockdown to combat increasing case and hospitalization rates for COVID-19 throughout the state. The impact of this mandate on the ICU admission rates and outcomes of other medical problems has never been investigated. Our study aimed to determine the effects of stay-at-home orders on outcomes for other diagnoses by analyzing ICU admission rates and outcomes of patients presenting to the ICU for non-COVID related issues before, during, and after the statewide mandate. METHODS: We performed a retrospective analysis of all ICU admissions in three phases: before (2 months prior), during, and 1.5 months after the statewide lockdown (March 26 to April 27, 2020). We included all patients admitted to the University of Colorado Health System hospitals ICUs within this defined time period. A time-to-event analysis was performed with the date of index ICU stay set as time zero. Baseline characteristics were obtained. Primary outcome measures were 28-day mortality and all-time mortality. Kaplan-Meier curves were used to estimate survival probabilities, while Cox regression and multivariable logistic regression were utilized to model phase-specific mortality controlling for comorbidities, demographics, and admission diagnoses. Counts of typical ICU admission diagnoses were also analyzed to determine any changes across lockdown periods. RESULTS: 9201 total ICU admissions occurred, of which 8154 (88.6%) were non-COVID-19 related. Approximately 57.4% were male with a mean age of 60.4 years. 28-day mortality rates for non-COVID-19 ICU admissions were 475 (11.0%), 127 (13.8%), and 306 (10.5%) before, during, and after the lockdown, respectively. The increased mortality during lockdown persisted after adjustment for comorbidities and demographics (HR=1.23, 95% CI, 1.007 to 1.512, p = 0.043). Acute respiratory failure was the most common diagnosis in each time period, and increased during lockdown (p<0.001). Admissions for sepsis increased during lockdown and decreased after (p = 0.001);myocardial infarction (MI) admission decreased during lockdown but increased after (p = 0.014);and alcohol withdrawal (AW) admission increased both during and after lockdown (p < 0.001). CONCLUSIONS: For non-COVID-19 related ICU admissions, the mortality rate increased during the state-wide shutdown but decreased after shutdown, although this difference became insignificant after controlling for patient admission diagnoses. Admission diagnoses also differed with more admissions for sepsis and AW during lockdown and more admissions for MI and AW after lockdown.

9.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277306

ABSTRACT

Background: Previous studies have suggested that the use of heated high-flow nasal canula (HHFNC) may reduce intubation rates in severely hypoxemic patients (PaO2/FiO2 <200). Early in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, HHFNC was underutilized due to concern for viral aerosolization. Studies have since shown that HHFNC has a similar aerosolization risk as a standard oxygen mask prompting increased usage of HHFNC in patients with SARS-CoV-2. We sought to determine if the usage of HHFNC reduced the odds of intubation or the number of ventilator days for patients with acute hypoxemic respiratory failure due to SARS-CoV-2 pneumonia (COVID-19). Methods: We conducted a retrospective cohort study utilizing electronic health record data from the University of Colorado Health System. We included all adult patients admitted to intensive care units between February 1st, 2020 and May 3rd, 2020 with a diagnosis of acute hypoxemic respiratory failure and COVID-19. We divided patients into two groups: patients who received HHFNC and patients who did not receive HHFNC. Patient demographics, clinical characteristics and clinical outcomes were compared. Results: A total of 193 patients were included, of which 41 (21.2%) received HHFNC support. Age, sex, ethnicity, BMI, and comorbidities were similar between both groups. CRP was slightly higher and creatinine lower in the HHFNC group. We found that patients who used HHFNC were 76.5% less likely to receive mechanical ventilation (p<0.001). Patients who were supported with HHFNC spent an average of 5.1 more days on mechanical ventilation (p=0.025). The odds of death were estimated to be 39.4% lower for those who used HHFNC after adjusting for confounders (age, sex, BMI, ethnicity, smoking, alcohol use, prone positioning, corticosteroid use and Remdesivir use) however this effect estimate was not statistically significant. Conclusions: We found that patients with COVID-19 who received HHFNC were less likely to be intubated, which is consistent with previously published data. Those who did require intubation remained on mechanical ventilation for a longer duration. Our study did not detect any differences in mortality between the HHFNC group and the non-HHFNC group. These findings suggest HHFNC may be a useful modality for treatment of acute hypoxemic respiratory failure due to SARS-CoV-2 that may reduce the need for mechanical ventilators during local shortages.

10.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277106

ABSTRACT

Introduction: Before the COVID-19 pandemic, 20-30% of family members had symptoms of Post-Traumatic Stress Disorder (PTSD) or anxiety, while 15-30% had symptoms of depression. Interventions supporting family members have reduced burden of these symptoms. COVID-19 has resulted in prolonged ICU stays, high morbidity/mortality, and hospital policies severely limiting family presence at the bedside. We hypothesized the combination of prolonged critical illness and the necessary reduction of family presence would lead to high rates of PTSD, anxiety, and depression;likely higher than observed in previous studies. Methods: This was a multicenter study including 12 US hospitals, 8 academic and 4 community-based hospitals. A consecutive sample of family members of all patients with COVID-19 receiving ICU admission during the spring US peak in 2020 were called 3-4 months after the patients' ICU admission, except for New York City hospitals where a random sample was generated given the large number of hospitalizations. Consented participants completed the Impact-of- Events Scale-6 (IES-6;scored 0-30, higher scores indicate more symptoms of PTSD), Hospital-Anxiety- Depression Score (HADS, scored 0-20 for anxiety and 0-20 for depression, higher scores indicate more symptoms), and a subset of questions from Family-Satisfaction in the ICU-27 (FS-ICU27;scored on a Likert scale 1 to 5, with higher scores indicating more positive responses) selected as most likely impacted by restrictive family presence.Results: There were 945 eligible family members during the study period. Of those, 594 were contacted and 269 (45.3%) consented and completed surveys. The mean IES-6 score was 12.6 (95% CI 11.8- 13.4) with 65.4% having a score of 10 or greater, consistent with high levels of symptoms of PTSD. The mean score on the HADS-anxiety was 9.4 (95% CI 8.8-10.1) with 59.5% having a score of 8 or greater, consistent with high levels of symptoms of anxiety. Finally, the mean score for the HADS-depression was 8.0 (95% CI 7.3-8.7) with 47.6% having scores of 8 or greater, consistent with high level of symptoms of depression. The mean response for the FSICU27 questions of “I felt I had control” was 3.5 (95% CI 3.3-3.6), “I felt supported” was 3.8 (95% CI 3.6-4.0), and “I felt included” was 4.3 (95% CI 4.2-4.4).Conclusion: The consequences of a family member admitted to the ICU with COVID-19 infection are significant. We identify rates of PTSD, anxiety, and depression higher than recorded in non-COVID population. Further analysis is warranted to understand modifiable risk factors for developing these symptoms.

11.
Annals of the American Thoracic Society ; 17(12):1645-1648, 2020.
Article in English | Web of Science | ID: covidwho-1001051
12.
AJNR Am J Neuroradiol ; 41(11): 2017-2019, 2020 11.
Article in English | MEDLINE | ID: covidwho-724937

ABSTRACT

Multisystem inflammatory syndrome in children is a recently described complication in the late phase of Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection involving systemic hyperinflammation and multiorgan dysfunction. The extent of its clinical picture is actively evolving and has yet to be fully elucidated. While neurologic manifestations of SARS-CoV-2 are well-described in the adult population, reports of neurologic complications in pediatric patients with SARS-CoV-2 infection are limited. We present a pediatric patient with SARS-CoV-2 infection with development of multisystem inflammatory syndrome and acute encephalopathy causing delirium who was found to have a cytotoxic lesion of the corpus callosum on neuroimaging. Cytotoxic lesions of the corpus callosum are a well-known, typically reversible entity that can occur in a wide range of conditions, including infection, seizure, toxins, nutritional deficiencies, and Kawasaki disease. We hypothesized that the cytotoxic lesion of the corpus callosum, in the index case, was secondary to the systemic inflammation from SARS-CoV-2 infection, resulting in multisystem inflammatory syndrome in children.


Subject(s)
Coronavirus Infections/complications , Corpus Callosum/pathology , Pneumonia, Viral/complications , Systemic Inflammatory Response Syndrome/pathology , Adolescent , Betacoronavirus , COVID-19 , Female , Humans , Pandemics , SARS-CoV-2
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