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1.
Critical Care Medicine ; 51(1 Supplement):190, 2023.
Article in English | EMBASE | ID: covidwho-2190533

##### ABSTRACT

INTRODUCTION: The current CDC guidelines recommend COVID-19 vaccine boosters for all eligible individuals to enhance protection. Resources have been allocated to research done regarding the COVID-19 vaccine, and we speculate that there is a correlation between COVID booster rates and number of COVID patients in the ICU. We hypothesize that the states with a higher percentage of the population that received the booster shot will have decreased COVID ICU bed utilization and vice versa. METHOD(S): The percentage of people who received the COVID-19 booster vaccine and the number of ICU beds occupied by patients with COVID-19 per 10,000 population, both stratified by states, were reviewed to determine the pattern of correlation. The data for both the variables was sourced from Becker's Healthcare as it used information from the CDC's data tracker to rank states by their booster rates. The rankings were last updated based on data from July 20th, 2022. The state of Idaho was excluded because the data was not available. Limitations of the study included reporting lags between the states and CDC, the emergence of numerous variants of the virus, and a lack of a standardized timeline across the states. RESULT(S): Pearson Correlation Coefficient was used to determine the pattern of correlation between COVID booster rates and the number of COVID patients in the ICU for all US states. Booster rates was set as x and ICU patients was set as y. The data was analyzed while using the formula r = SIGMA((X - My)(Y - Mx)) / ((SSx)(SSy)). X Values were calculated with SIGMA = 2407.7, Mean = 48.154 and SIGMA(X - Mx)2 = SSx = 2308.544. Y Values were calculated with SIGMA = 5112, Mean = 102.24 and SIGMA(Y - My)2 = SSy = 835103.12. The coefficient of determination, R2, was 0.0611. Our obtained R was -0.25 which means no strong correlation was found. The data was analyzed independently by two statisticians and the same results were obtained. The results failed to confirm our hypothesis and suggested that there was no correlation between COVID booster rates and the number of COVID patients in the ICU. CONCLUSION(S): Based on our results, no correlation was found between the states' COVID booster rates and ICU bed occupancy. Further studies are needed to quantify this association if any as highly virulent COVID strains pose a threat to humanity.

2.
Critical Care Medicine ; 51(1 Supplement):181, 2023.
Article in English | EMBASE | ID: covidwho-2190525

##### ABSTRACT

INTRODUCTION: As of July 26th, 2022, 3,591 confirmed cases of Monkeypox have been reported in the United States (US). Globally, the number of cases exceeded 17,000. As a result, the World Health Organization (WHO) declared this outbreak a global health emergency. The Center for Disease Control (CDC) is currently working with states and local health officials to track the spread of the virus, monitor the health of infected individuals, and control the outbreak. We hypothesized that global travel may be a factor that facilitated the spread of monkeypox. METHOD(S): To test our hypothesis, we used the CDC data for the number of monkeypox cases in each state in the US. In addition, we obtained the U.S. Department of Transportation Bureau of Transportation Statistics for the busiest airports in the US (last updated - 2021). We compared the statereported Monkeypox cases to the volume of international travelers at the airports. We included 26 states in our analysis as data for both the variables, i.e. Monkeypox cases and busiest airports statistics were accessible. RESULT(S): As these data variables are not normally distributed, and outliers were expected, we used Spearman's Rho Calculator instead of the Pearson Correlation Coefficient. In addition, the scale of measurement was in the form of matched pairs, and the association was monotonic, Spearman's Rho Calculator was found to be more appropriate. Rs value was 0.63786 with two-tailed p-value= 0.00034 (statistically significant). The data was analyzed independently by two statisticians and the same results were obtained. Our study was limited by various factors including nascent and scant data on the recent global outbreak, variability of population diversity in states with busy international airports, and possible underreporting due to social stigma associated with the disease. CONCLUSION(S): Relaxed COVID masking guidelines along with arecent surge in air travel, may have played a role in the spread of monkeypox. Healthcare systems in highly populated states, particularly with busy international airports should stay vigilant and prepare themselves for the management of high volumes of cases.

3.
Chest ; 162(4):A1485-A1486, 2022.
Article in English | EMBASE | ID: covidwho-2060829

##### ABSTRACT

4.
Chest ; 162(4):A1458, 2022.
Article in English | EMBASE | ID: covidwho-2060819

##### ABSTRACT

SESSION TITLE: Quality Improvement SESSION TYPE: Original Investigations PRESENTED ON: 10/17/22 1:30 pm - 2:30 pm PURPOSE: Organ transplant is the ultimate necessity in managing many end-stage organ pathologies. As per the health resource and service administration, 17 people die every day while waiting for an organ transplant. In the year 2020, 169 million Americans registered as organ donors, but due to the limitations of organ donation such as cause of death and condition of the organ at the time of death, only about 3 in 1000 people die in such a way that their organs are in an optimum condition for transplantation 1. The role of nurses in organ donation is critical in both acute and critical care settings 2. Educating nurses on certain aspects of organ donation, such as approaching the families and counseling regarding moral and legal considerations, will acclererate the process of organs retrieval from the interested donors. We hypothesized that in addition to Best Practice Alert (BPA) on Electronic Medical Record (EMR), educating nurses can optimize organ donation by timely referring the organs for transplantation. METHODS: ICU-wide nursing education sessions were conducted elucidating that when a ventilated patient qualifies for Life Gift notification and a BPA does not pop up in EMR, Nurses should immediately call the Houston Methodist organ donation service, Life Gift within one hour of the following two triggers: 1) Loss of one or more brainstem reflex(es), 2) Glasgow Coma Scale (GCS) ≤ 5. Nurses were also educated to start a timely discussion with the family proposing Life Gift prior to discussing the withdrawal of life-sustaining treatments, popularly known as terminal extubation. The data for timely organ referral from the preceding six months (January 2021 to June 2021) was compared to the four months (July 2021 to October 2021) following the nursing education sessions. RESULTS: The total number of timely referrals in the pre- and post-education period were n=23/33 Vs. n=29/31. The overall timely referral of the organ for transplantation increased from 69.2% to 95%. Out of four months post-education, two months record the compliance of 100%. Our chi-square statistic was 5.969 with a p-value of 0.01456. We performed Yates continuity correction due to small sample size and to compensate for deviations from the theoretical (smooth) probability distribution. Our chi-square statistic with Yates correction was 4.506, and the p-value was 0.034 (Significant at p < 0.05). Our study was limited by the small sample size, high nursing turnover due to the COVID-19 pandemic, and logistic restrictions due to the pandemic. CONCLUSIONS: The overall referring time for organs improved after nursing education sessions, including targeted triggers. CLINICAL IMPLICATIONS: Nursing education plays a crucial role in organ donation programs. Further studies are needed to better understand the issues that nurses face and develop new strategies that can be implemented to improve the organ and tissue referrals for organ donation. DISCLOSURES: No relevant relationships by Muhammad Mohsin Abid No relevant relationships by Sana Jogezai No relevant relationships by Iqbal Ratnani No relevant relationships by Salim Surani No relevant relationships by Muhammad Hassan Virk

5.
Chest ; 162(4):A1454, 2022.
Article in English | EMBASE | ID: covidwho-2060818

##### ABSTRACT

6.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927738

##### ABSTRACT

Background - Among all the specialties, Critical Care Medicine physicians have reported the highest rate of burnout in the year 2021[Medscape National Physician Burnout & Suicide Report 2021]. Likewise, all Intensive Care Unit (ICU) staff such as nurses, respiratory therapists and patient care assistants as frontline workers have been experiencing stress during g the past 18 months of the COVID-19 pandemic. Here we present an initiative of Center for Performing Arts (CPAM) department at a tertiary care academic medical center to help reduce fatigue and burnout among ICU staff through splatter painting. Methods - This study was conducted in a 36-bed Cardiovascular ICU at a tertiary care hospital. Permission was obtained from the relative departments for the use of data. CPAM planned a 3-day splatter tent event in the ICU. This event was mainly for the ICU staff but was open to all the hospital staff. The event was advertised using colorful flyers. Each participant was led to a quiet room where they would drape, pick their favorite music selection, and color prop. Participants were then left alone to unwind and release all the feels in the form of creating art and could stay as long as they wanted. Pre- and post-completion surveys were recorded and, data was analyzed. Results - A total of 49 staff participated. 32 out of 49 participants returned their surveys. Overwhelmingly majority of the comments were positive. The most popular music genre was rap/hip hop. Average stress levels 1(low) to 5(high) were 4.19 - before to 2.56 - after. The average score (1-least) to 5-most) for if the intervention helped with compassion fatigue (F) and mental exhaustion (ME) was 4.22 and 4.44 respectively. The average score for if the intervention helped them feel more engaged at work (EW) and instilled positive attitude (PA) towards organization was 4.34 and 4.77 respectively. We did Pearson's correlation for the four components of the activity i.e., F, ME, EW and PA. Our R was strongly positive with value of 0.9913, using formula r = Σ((X - My)(Y - Mx)) / √((SSx)(SSy)). We also cross checked meta-numerics. Our value of R2 (the coefficient of determination) was 0.9827. Our P-Value was .001199, with significance at p < .05. Conclusions - The level of burnout amongst healthcare workers is at a critical level globally. Healthcare administrations need to find ways to mitigate feelings of burnout and fatigue amongst staff. (Figure Presented).

7.
Open Respiratory Medicine Journal ; 16(1), 2022.
Article in English | EMBASE | ID: covidwho-1779849

##### ABSTRACT

The emergence of SARS-CoV-2 in late December 2019 has taken the world by storm. In March 2020, the World Health Organization (WHO) named this virus COVID-19. To date, it has infected approximately 186 million people worldwide and is attributed as the cause of death of more than 5 million people (and this number is only increasing.) The global effort to develop vaccines and therapeutics occurred at the fastest pace yet, with several vaccines' approval under emergency authorization use. There are also several post-marketing side effects, including myocarditis, cerebral venous embolism, and Guillain Barre Syndrome. Global vaccine disparity complicates the control of pandemic challenges. Several highly infectious variants have emerged, and more variants are feared to emerge if global vaccination plans are not developed soon.

8.
Chest ; 160(4):A1278, 2021.
Article in English | EMBASE | ID: covidwho-1466142

##### ABSTRACT

9.
American Journal of Respiratory and Critical Care Medicine ; 203(9):1, 2021.
Article in English | Web of Science | ID: covidwho-1407247
10.
Critical Care Medicine ; 49(1):43-43, 2021.
Article in English | Web of Science | ID: covidwho-1326443
11.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277179

##### ABSTRACT

Introduction: Thoracic endometriosis syndrome (TES) is a rare phenomenon that affects 6-10% of women of reproductive age. It is characterized by presence of ectopic endometrial tissue within the thoracic cavity, mainly the lung parenchyma and pleura. TES presents as catamenial pneumothorax (CP), catamenial hemothorax (CH), pulmonary nodules or hemoptysis. Hormonal therapy is considered first line treatment followed by operative thoracoscopy for removal of ectopic endometrial implants. Our case highlights the limited number of treatment options in a young patient with recurrent catamenial disease.Description: A 37-year-old G4P0040 female presented to the emergency department (ED) with worsening shortness of breath (SOB) for 5 days. Her SOB was sudden in onset, progressively worsening, and associated with cough and right-sided chest pain. Patient was admitted 5 months ago for similar symptoms. She has a past medical history significant for hypertension, obesity, iron deficiency anemia, severe endometriosis and TES manifesting as recurrent, right sided pleural effusions, CPs and CHs requiring surgical treatment. Previous biopsies of the ectopic endometrial tissue revealed dense fibroconnective tissue with focal endometriosis and no indication for malignancy. In the ED, she appeared in distress and had a BP of 166/102. Physical examination revealed tachypnea, accessory muscle usage, respiratory distress and retractions. Breath sounds were decreased in the right lung. EKG revealed normal sinus rhythm, and a COVID-19 test yielded negative results. Chest x-ray and CT were consistent with findings for right tension hemothorax. She was started on BiPAP initially and thoracic surgery was consulted. A tube thoracostomy was performed in the ED and a chest tube was placed. Moreover, a CBC revealed Hb of 5.7g/dl. She was transfused 4 units pRBC and admitted to the ICU for further monitoring. Ob/gyn was consulted and leuprolide was administered to prevent recurrence of a hemothorax. She remained in the hospital for 3 days and was subsequently discharged after resolution of symptoms confirmed by imaging.Conclusion: Catamenial hemothoraces are a late finding of TES. There is mixed data regarding the effectiveness of GnRH agonists on recurrence rates of CH, however subsequent surgery has shown to be preventative in resistant cases. This unique case illustrates the insufficiency in both mainstay treatments. Despite the fact the patient had previous lobectomies using VATS, lysis of adhesions and hormonal therapy, she continued to have recurrent manifestations of TES. Novel treatments in conjunction with a multidisciplinary team approach should be used to effectively treat TES and prevent disease relapse.

12.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277086

##### ABSTRACT

Introduction: COVID-19 changed normal routines across the world. During the beginning of the pandemic, everyone wanted to learn more about the virus. After 4 months, with death-tolls rising and isolation not being over anytime soon, psychological fatigue may have set in. To what degree has this psychological fatigue, with perspective of age groups along with the factor of personally knowing someone affected by COVID-19, impacted people's interest in the virus? Methods: We conducted an online survey using a Likert Scale from 1-5 to rate interest in hearing about COVID-19 related news when the pandemic started, around early March, and then to rate their interest in hearing about COVID-19 related news at the end of June. We divided respondents between two age groups, 25 and younger or older than 25, and whether or not they knew someone that has been affected by the virus. The survey was done online and was open to everyone who could access the survey online. Each participant answered the same two questions assessing their interest in March and then in June. Results: We received 410 survey responses which were divided into two groups according to age limit i.e., Younger Group (YG) with age ≤ 25 (n =133), and Older Group (OG) with age > 25 (n = 277). We found that both groups were interested (level 4/5 at a scale of 1-5) at the beginning of the pandemic (around the end of March) with a frequency of 65.4% (87/133) and 77.2% (214/277). In the span of 12 weeks, both groups' interest dropped drastically to 32.3% (43/133) and 41.5% (115/277) respectively with no statistically significant difference between the two groups when calculated with 2x2 Fischer exact test (P=0.7). When a variable of a loved one or an acquaintance known to have COVID-19 is applied, both groups behaved differently with a frequency of 26.2% (n= 20 vs 23 /87) and 41.1% (n= 27 vs 88/214) within the group with chi-square statistic of 7.8983, and p-value =.02 (significant at p < .05 with two-tailed analysis). Conclusions: Our results indicate fatigue from pandemic news all throughout our tested population. This fatigue persisted in the younger age group despite knowing someone with COVID-19, indicating either apathy or lack of awareness towards the pandemic. This needs to be further investigated as due to their asymptomatic carrier state accompanied by persistently low interest may result in a higher spread rate within the community.

13.
Critical Care Medicine ; 49(1 SUPPL 1):520, 2021.
Article in English | EMBASE | ID: covidwho-1194045

##### ABSTRACT

INTRODUCTION: 17 million cases & 0.6 million deaths are attributed to the novel Coronavirus disease (COVID 19). After decades of reluctance to implement pathogenreporting systems, the current pandemic has resulted in the formulation of comprehensive national reporting systems. We hypothesized that despite all efforts to improve reporting, fewer number of deaths are reported on weekends when compared to weekdays due to closure of health offices or lack of staffing on weekends, as reporting being highly dynamic. METHODS: Worldometer, a reliable database that reports real-time statistics on COVID-19 was used to retrieve the number of COVID-19 related deaths. We selected 9 worsthit countries from across the globe where reporting systems assumed to be robust. We observed the number of daily deaths over the course of 9 weeks, 4 weeks prior to their peak week, and 4 weeks afterwards. The average number of deaths/day on weekdays (WDs) and weekends (WEs) were recorded and compared. RESULTS: The WDs/WEs deaths/day for the USA, Sweden, Canada, Germany Spain, Italy, UK, Belgium and Netherlands were 1748/1142, 84/27, 150/113, 149/76, 445/386, 452/387, 594/441, 150/127 and 87/70. All countries showed data leaning towards fewer deaths on weekends. Data was first confirmed with the Kolmogorov-Smirnov Test of Normality. The test statistic (D) for Both Weekdays (WDs) and Weekends (WDs) was 0.27 & 0.26 with p values of 0.46 & 0.48 respectively, confirming that our data does not differ significantly from that which is normally distributed. T-value was calculated using the formula t = (M - μ)/SM. T-Test for two dependent means while comparing WDs and WEs deaths were significant at p < .05 (Two-tailed) for all countries except Canada and Spain. Our study was limited by data collection from a single-site though reliable, continuous updating of death counts by some countries, and limited number of countries though supposed to have proper reporting. CONCLUSIONS: Our review showed a statistically significant less number of deaths being reported on Weekends in all countries other than Spain and Canada, which may be due to the closure of administrative offices and the continuous mounting of high death counts. More research is warranted to quantify the extent of under-reporting of weekend deaths to effectively rectify the problem.

14.
Critical Care Medicine ; 49(1 SUPPL 1):43, 2021.
Article in English | EMBASE | ID: covidwho-1193805