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1.
Annals of Emergency Medicine ; 78(4):S116, 2021.
Article in English | EMBASE | ID: covidwho-1748249

ABSTRACT

Study Objectives: The COVID-19 pandemic imposed both constraints and opportunities for innovation in emergency care delivery. Visits to the emergency department (ED) plunged by as much as 42% in the US, resulting in excess morbidity and mortality due to patients deferring or avoiding emergency care. With the declaration of a public health emergency, payors such as Medicare authorized emergency physicians (EPs) to bill for evaluation and management services delivered through telehealth—potentially allowing EPs to project emergency care beyond the four walls of the physical ED. If adopted, the provision of emergency care via telehealth could expand the reach of emergency medicine, not only during a pandemic but also more broadly, and especially as aging populations choose to receive more care at home. Such expansion of emergency care could benefit from perspectives of EPs in terms of the motivations, barriers, and necessary capabilities. Thus, our objectives were to survey and profile EPs to better understand the potential for telehealth in emergency care delivery. Methods: In collaboration with ACEP and the Emergency Medicine Practice Resource Network (EMPRN), we designed a survey instrument comprising of 5 main questions that provided ranked choice selections. The survey was sent electronically to a group of EMPRN volunteers representing EPs from diverse geographic, age, and practice levels. Results: The survey was sent to a total number of 765 participants, of which a total of 140 (18%) responded. In terms of motivations, respondents identified early engagement with the option to escalate care to the ED if necessary (77% ranked as very important or somewhat important). Respondents also identified the opportunity to quickly address non-life-threatening complaints that may not have needed an ED visit (76% ranked as very important or somewhat important). The top two identified barriers ranked as very significant or somewhat significant were the inability to obtain an adequate evaluation of the patient (76%) and a lack of support personnel in patients’ homes to assist with virtual visits (64%). A related series of responses ranked the needed capabilities necessary for supportive personnel to address barriers to telehealth use. (Table 1). Conclusions: This survey is a mechanism to begin understanding EPs’ perceptions and what they would need to feel comfortable to safely provide telehealth services in the ED. The results revealed that EPs recognize certain opportunities in terms of the potential future of telehealth in emergency care delivery. However, specific barriers were identified. This survey suggests that the ability to escalate care and obtain adequate telehealth exams with presenters and diagnostic support will be important for EPs to feel safe delivering telehealth services. [Formula presented]

2.
Open Forum Infectious Diseases ; 8(SUPPL 1):S22-S23, 2021.
Article in English | EMBASE | ID: covidwho-1746807

ABSTRACT

Background. Accurately identifying COVID-19 patients at-risk to deteriorate remains challenging. Dysregulated immune responses impact disease progression and development of life-threatening complications. Tools integrating host immune-protein expression have proven useful in determining infection etiology and hold potential for prognosticating disease severity. Methods. Adults with COVID-19 were enrolled at medical centers in Israel, Germany, and the United States (Figure 1). Severe outcome was defined as intensive care unit admission, non-invasive or invasive ventilation, or death. Tumor necrosis factor related apoptosis inducing ligand (TRAIL), interferon gamma inducible protein-10 (IP-10) and C-reactive protein (CRP) were measured using an analyzer providing values within 15 minutes (MeMed Key®). A signature indicating the likelihood of severe outcome was derived generating a score (0-100). Description of derivation cohort RT-PCR, reverse transcription polymerase chain reaction. Results. Between March and November 2020, 518 COVID-19 patients were enrolled, of whom 394 were eligible, 29% meeting a severe outcome. Age ranged between 19-98 (median 61.5), with 59.1% male. Patients meeting severe outcomes exhibited higher levels of CRP and IP-10 and lower levels of TRAIL (Figure 2;p < 0.001). Likelihood of severe outcome increased significantly (p < 0.001) with higher scores. The signature's area under the receiver operating characteristic curve (AUC) was 0.86 (95% confidence interval: 0.81-0.91). Performance was not confounded by age, sex, or comorbidities and was superior to IL-6 (AUC 0.77;p = 0.033) and CRP (AUC 0.78;p < 0.001). Clinical deterioration proximal to blood draw was associated with higher signature score. Scores of patients meeting a first outcome over 3 days after blood draw were significantly (p < 0.001) higher than scores of non-severe patients (Figure 3). Moreover, the signature differentiated patients who further deteriorated after meeting a severe outcome from those who improved (p = 0.004) and projected 14-day survival probabilities (p < 0.001;Figure 4). TRAIL, IP-10, CRP and the severity signature score are differentially expressed in severe and non-severe COVID-19 infection Dots represent patients and boxes denote median and interquartile range (IQR) The signature score of patients meeting a severe outcome on or after the day of blood draw is significantly (p < 0.001) higher than the signature score of non-severe patients. Dots represents patients and boxes denote median and IQR Kaplan-Meier survival estimates for signature score bins Conclusion. The derived signature combined with a rapid measurement platform has potential to serve as an accurate predictive tool for early detection of COVID-19 patients at risk for severe outcome, facilitating timely care escalation and de-escalation and appropriate resource allocation.

3.
Jaids-Journal of Acquired Immune Deficiency Syndromes ; 87(2):E182-E187, 2021.
Article in English | Web of Science | ID: covidwho-1688416

ABSTRACT

Background: During the COVID-19 outbreak, facility capacity for HIV testing has been limited. Furthermore, people may have opted against HIV testing during this period to avoid COVID-19 exposure. We investigated the influence of the COVID-19 pandemic on HIV testing and the number of reported HIV cases in Japan. Methods: We analyzed quarterly HIV/AIDS-related data from 2015 to the second quarter of 2020 using an anomaly detection approach. The data included the number of consultations, the number of HIV tests performed by public health centers or municipalities, and the number of newly reported HIV cases with and without an AIDS diagnosis. We further performed the same analysis for 2 subgroups: men who have sex with men (MSM) and non-Japanese persons. Results: The number of HIV tests (9,584 vs. 35,908 in the yearbefore period) and consultations (11,689 vs. 32,565) performed by public health centers significantly declined in the second quarter of 2020, whereas the proportion of new HIV cases with an AIDS diagnosis (36.2% vs. 26.4%) significantly increased after removing the trend and seasonality effects. HIV cases without an AIDS diagnosis decreased (166 vs. 217), but the reduction was not significant. We confirmed similar trends for the men who have sex with men and non-Japanese subgroups. Conclusions: During the COVID-19 pandemic, the current HIV testing system in Japan seems to have missed more cases of HIV before developing AIDS. Continuously monitoring the situation and securing sufficient test resources by use of self-testing is essential to understand the clear epidemiological picture of HIV incidence during the COVID-19 pandemic.

4.
Encyclopedia of Dairy Sciences (Third Edition) ; : 477-488, 2022.
Article in English | ScienceDirect | ID: covidwho-1439810

ABSTRACT

UHT processing of milk consists of treating the milk at 138–145°C for 2–10s. The process allows attaining commercial sterility with a very minimal impact on the product's nutritional value. The quality, stability, acceptability, and sensorial properties of the products are affected by the combined influence of the quality of the raw milk, processing details, and storage conditions. Detailed information about the mechanisms that govern the evolution and severity of physicochemical instabilities in the final product, such as enzymatic- and non-enzymatic age gelation, sedimentation, and creaming has been established. This understanding highlights the adverse effects of residual activities of heat-stable proteases from psychrotrophic bacteria and plasmin on the quality and stability of UHT milk. These activities, along with the effects of heat treatment and storage temperature on the physicochemical properties, composition, and distribution of milk proteins, as well as the influence of pH and ionic composition, govern the manifestation of the afore-stated instabilities in UHT milk. Ensuring the quality and stability of UHT milk calls for utilizing milk with as low as possible somatic cell counts, maintaining the psychrotrophic bacteria counts of milk as low as possible as well as understanding the effects of the stage in lactation and seasonality of the properties of the raw milk. The sensorial quality of UHT milk reflects the accumulation of different volatile and non-volatile flavor and aroma impacting compounds that originate from the effects of heat treatment and storage conditions on the proteins, carbohydrates, and lipid constituents of milk. It can be also argued that the availability of high-quality and stable UHT milk products is of special importance during the time of disrupted supply chain, such as that during the COVID-19 pandemic of 2020.

5.
Medizinische Klinik-Intensivmedizin Und Notfallmedizin ; 116(SUPPL 2):54-55, 2021.
Article in German | Web of Science | ID: covidwho-1260320
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