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2.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009635

ABSTRACT

Background: Patients with SARS-CoV-2 with a diagnosis of cancer have increased risk of severe COVID-19 outcomes compared to patients without cancer. However, little is known regarding outcomes of patients with COVID-19 and cancer in the setting of human immunodeficiency virus (HIV). Given the unique risks of this population, we sought to understand COVID-19 outcomes using registry data. Methods: This is a descriptive research study utilizing the CCC19 registry, an international multi-institutional registry with healthcare provider-reported cases of patients with cancer and COVID-19. Between March 2020-December 2021, 116 persons with HIV (PWH) and 10,642 persons without HIV (PWOH) with laboratory-confirmed SARS-CoV-2 infection were identified as eligible for the analysis. Results: Median follow-up time for both groups was 90 days, with interquartile range (IQR) 30-180 days. Most PWH were actively receiving antiretroviral therapy (ART) at the time of COVID-19 diagnosis, with 71% (n = 82) having named drug information available;bictegravir/emtricitabine/tenofovir was the most common ART (n = 25). PWH were of younger age (median 57.5 yrs [IQR 46.5-63.25] vs 65 yrs [IQR 55-74]), male (81% vs 47%), and either non-Hispanic Black or Hispanic (71% vs 34%) compared to PWOH. 12% of PWH (n = 14) were current smokers compared to 6% of PWOH (n = 638), and more than half in each group were never smokers (51% of PWH and 53% of PWOH). The following comorbidities were identified in PWH vs PWOH: cardiovascular (16% vs 20%), pulmonary (16% vs 20%), renal (15% vs 14%), and diabetes mellitus (18% vs 27%). A higher proportion of PWH had hematologic malignancy compared to PWOH (33% vs 19%). More PWH had active cancer which was progressing at the time of SARS-CoV-2 infection compared to PWOH (24% vs 14%). 44% of PWH (n = 51) had received active systemic anticancer therapy within the 3 months preceding SARS-CoV-2 infection (including cytotoxic, targeted, endocrine therapies, and immunotherapy) compared to 51% of PWOH (n = 5,420). PWH had an increased rate of hospitalization (58% vs 55%) compared to PWOH. Although a lower proportion of PWH required supplemental oxygen during hospitalization compared to PWOH (34% vs 38%) and ICU admission rates were identical between the two groups (16% vs 16%), PWH had an increased rate of mechanical ventilation (14% vs 10%) and death (24% vs 18%) compared to PWOH. Conclusions: This is the first known study describing outcomes of patients with cancer and COVID-19 in the PWH population from a large multinational dataset. PWH have characteristics associated with adverse outcomes in prior analyses (male sex, non-Hispanic Black or Hispanic, hematologic malignancy, progressing cancer) but are notably younger and have fewer comorbidities. HIV infection may portend increased risk of severe COVID-19 and death;however, additional analyses, including multivariable regression, are warranted.

3.
Canadian Journal of Hospital Pharmacy ; 74(2):190, 2021.
Article in English | EMBASE | ID: covidwho-1589626

ABSTRACT

Background: During the first wave of the COVID-19 pandemic, an increased need for critical care pharmacist (CCP) coverage in the two medical/surgical intensive care units (ICUs) at the Queen Elizabeth II Health Sciences Centre (QEII HSC) in Halifax, Nova Scotia was identified. Description: CCP coverage was expanded in two medical/surgical ICUs from 8 hours per day, 5 days per week excluding holidays to 8 hours per day, 7 days per week including holidays. Action: Workflow within the pharmacy department was rearranged so that two CCPs, on a rotating schedule, provided dedicated clinical coverage to each ICU seven days a week. CCPs were not responsible for dispensary coverage during this time period. Evaluation: A 22 question survey was developed by the research team and distributed to all health care providers (HCP) who work in the medical/surgical ICUs. Survey questions solicited HCP perceptions and opinions on the impact of expanded CCP coverage;importance of 25 evidenceinformed CCP activities was assessed via 5-point Likert scale. Clinical pharmacist output, reported as the number of drug-therapy problems (DTPs) addressed over a 6-week period, was retrospectively evaluated. The majority of respondents agreed/strongly agreed with the following: CCP are integral members of the multidisciplinary healthcare team, CCP play an important role in improving patient outcomes, CCP presence in the unit and on patient care rounds allows HCP to concentrate on their own professional responsibilities, and that the expanded CCP coverage improved patient care. The majority of respondents categorized 23 of the 25 CCP activities as very important. During the 6-week time period, four CCPs addressed 798 DTPs for 140 discreet patients: an average of 5.7 DTPs per patient. Implications: HCPs felt that expanded CCP coverage improved patient care and that evidence-informed CCP activities were very important. Given the perceived impact of CCP in the ICU, novel staffing models are being explored to optimize CCP coverage.

4.
Canadian Journal of Hospital Pharmacy ; 74(2):189, 2021.
Article in English | EMBASE | ID: covidwho-1589481

ABSTRACT

Background: At the beginning of the COVID-19 pandemic, it was predicted that hospitals would accommodate both a high volume of COVID-19-related patient admissions as well as frequent patient transitions of care, including discharge. Effective communication between healthcare providers during transitions of care is crucial for promoting patient safety and continuity of care. Description: A mnemonic-based electronic handover tool was created to facilitate streamlined communication between clinical pharmacists caring for patients hospitalized with COVID-19. Action: The COVID Handover Tool was developed, refined, and implemented by clinical pharmacists working in COVID-19 care areas in early 2020. The tool provided a standardized template to communicate basic patient information and pharmaceutical care issues. The patient-specific handover tools were stored centrally using OneNote™, and shared for updating amongst pharmacists as patients transitioned between COVID-19 care areas (e.g., intensive to acute care). Evaluation: Pharmacists were surveyed to assess the tool's ease of use, perceived usefulness, and other subthemes. All eight clinical pharmacists working in COVID-19 care areas responded to the survey (100% response rate). The majority of respondents agreed or strongly agreed it was easy to learn to use the tool, and that the content was relevant and organized. Half agreed or strongly agreed that the tool made handover easier, quicker, and more effective. Responses trended towards neutrality regarding the tool being useful in respondents' jobs. Most pharmacists continued using previous handover methods in addition to or instead of the tool. Implications: Survey responses suggest the COVID Handover Tool is intuitive, and facilitated organized and efficient patient handover between clinical pharmacists. Pharmacist perceived usefulness during the study period was mixed, and the tool has been updated further based on feedback. The tool is adaptable to any patient care area or population, and may be useful to other institutions for patient handover between clinical pharmacists.

5.
To Improve the Academy ; 39(3):65-83, 2021.
Article in English | ProQuest Central | ID: covidwho-1463891

ABSTRACT

The COVID-19 pandemic challenged educational developers, like instructors across the world, to pivot their traditionally face-to-face faculty development programs to online formats. At the Stearns Center for Teaching and Learning at George Mason University (classified as research-intensive and the largest public institution in Virginia, U.S.), we faced the challenge of reimagining our annual pedagogy conference that scaled from 497 registered in 2019 when it was face-to-face to over 800 in 2020 as it was moved online. Under pressures of limited resources and increased uncertainty, leaders can find it difficult to imagine pathways toward innovation rather than just daily responses to crises, yet centers for teaching and learning (CTLs) need to take and maintain leadership roles in our institutions. Here we outline our programmatic goals, our guiding user-centered principles (from user experience frameworks;i.e., Zarour & Alharbi, 2017), and the user-centered iterative design process from learning engineering (Kessler, 2019) that enabled our evidence-based decision-making processes to select conference support technology platforms and create the conference infrastructure and workflows. We discuss a variety of data sources that informed our decision-making processes throughout the conference planning and actual event. We share assessment results and lessons learned that guide innovation in CTLs and can be applied to a range of educational development programs from large conferences like ours to small workshops and even one-to-one consultations.

7.
Canadian Journal of Hospital Pharmacy ; 74(2):190-190, 2021.
Article in English | Web of Science | ID: covidwho-1210420
8.
Canadian Journal of Hospital Pharmacy ; 74(2):189-189, 2021.
Article in English | Web of Science | ID: covidwho-1210405
9.
BMJ Leader ; 2020.
Article in English | Scopus | ID: covidwho-916306

ABSTRACT

Background: The COVID-19 pandemic has exposed front-line healthcare workers to unprecedented risks and stressors threatening both physical and mental health. Prior work in the military has found that team identification, or the sense that one was a part of a team, can help reduce stress and prevent burnout during prolonged stress. Methods: We conducted repeated cross-sectional surveys embedded within emergency department workflow to understand whether team identification was associated with reduced reports of stress and burnout among front-line workers. Results: During the 10-week study which spanned the first wave of COVID-19, 327 of 431 (76%) front-line healthcare workers responded to at least one round of the survey. Higher team identification was associated with significantly less work stress (B=-0.60, 95% CI -0.84 to to -0.40, p<0.001) and burnout (B=-12.87, 95% CI -17.73 to -8.02, p<0.001) in cross-sectional analyses. Further evidence of the protective effect of team identification for work stress (B=-0.36, 95% CI -0.76 to 0.05, p=0.09) and burnout (B=-13.25, 95% CI -17.77 to -8.73, p<0.001) was also found in prospective longitudinal evidence. Conclusion: This work suggests work team identification is a key buffering factor against feelings of stress and burnout. Efforts to promote team identification may offer a promising way for leaders to support front-line healthcare workers' well-being during the COVID-19 pandemic. These results can inform ongoing COVID-19 operational and quality improvement initiatives. © 2020 Author(s) (or their employer(s)). No commercial re-use. See rights and permissions. Published by BMJ.

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