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1.
Drama Therapy Review ; JOUR(2):213-233, 8.
Article in English | Scopus | ID: covidwho-2098784

ABSTRACT

H.E.R.O. (Helping Essential workers Reclaim roles Online) Unmasking was a virtual drama therapy protocol designed to support frontline healthcare workers (re)connect to part of their humanity overshadowed by the role of the Healthcare Hero during the COVID-19 pandemic. The intervention, grounded in Role Theory, sought to provide immediate relief and meaning making through embodied storytelling. This pilot study utilized a quasi-experimental mixed methods design to measure the effect of the protocol. The Integration of Stressful Life Experiences Scale-Short Form was implemented. A dependent t-test did not yield statistical significance from pre-test (17.26) to post-test (20.47), although a medium effect size (0.64) was found. Post-test scores suggested that participants demonstrated more adaptive meaning making after the workshop. A small sample size (n = 19) likely impacted the ability to find statistical significance. Qualitative results produced prominent themes of transformation, connection and joy. Clinical implications and future directions are discussed. © 2022 Intellect Ltd Article. English language.

2.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1879971
3.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1879924
4.
Annals of Behavioral Medicine ; 56(SUPP 1):S411-S411, 2022.
Article in English | Web of Science | ID: covidwho-1848472
5.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-330674

ABSTRACT

Objective : To investigate the effect of interview format changes (in-person to virtual, one-to-one to multiple-to-one) necessitated by the COVID-19 travel restrictions on candidate ranking variabilities. Method : In 2018/2019, the glaucoma fellowship interviews were conducted in-person and one-to-one, whereas in 2020, interviews were virtual and multiple (interviewers)-to-one (candidate). We compared ranking ranges of interviewers within the same virtual room (WSR) and not within the same virtual room (NWSR) to assess the effect of this change on ranking variabilities. We also compared ranking categories ("accept," "alternate," and "pass") agreements between in-person and virtual interviews to assess the effect of this change on ranking variabilities. Results : NWSR and WSR mean rankings differed by 1.33 (95% confidence interval difference 0.61 to 2.04, p = 0.0003), with WSR interviewers having less variability than NWSR pairs. The variability of in-person interviews and later virtual interviews showed no differences (weighted Kappa statistic 0.086 for 2018, 0.158 for 2019, and 0.101 for 2020;p < 0.05 for all years). The overall least attractive candidate has the lowest variability;the most attractive candidate has the second lowest variability. Conclusion: Grouping interviewers decreased ranking variabilities, while a change from in-person to virtual interview format did not increase the ranking variabilities.

6.
Heart ; 107(SUPPL 1):A91, 2021.
Article in English | EMBASE | ID: covidwho-1325144

ABSTRACT

Background Limitation of activity and restriction of movement have been widely, and effectively, enforced to reduce COVID- 19 transmission. Physical activity is however a critical measure in the prevention of cardiovascular disease. Pulmonary arterial hypertension (PAH) is a devastating, disease driven by small vessel vascular remodeling, leading to right heart failure. Exercise capacity relates to clinical outcomes and exercise training improves key indicators of cardiopulmonary function. Here, we describe the temporal effects of UK government restriction measures on daily activity, heart rate and quality-of-life (QoL) in patients with PAH. Methods From November 2019 to March 2020 patients were enrolled into the arrhythmia sub-study of The UK National Cohort Study of Idiopathic and Heritable PAH (REC:13/EE/ 0203) and implanted with insertable cardiac monitors. Daily heart rate, heart rate variability and activity were transmitted remotely. Standard questionnaires were administered remotely to assess QoL (EmPHasis-10), anxiety (GAD-7) and depression (PHQ-9). Results Median age of the 26 patients implanted with insertable cardiac monitors was 49 years, 23(88%) were female and 5(19%) had heritable PAH with mutations in BMPR2. At enrolment 10(38.5%) patients were low risk (<5% 1-year mortality), 10(38.5%) were intermediate risk (5-10%) and 6 (23%) were high risk (>10%). The mean duration from insertion to census date was 21.1weeks±5.7. No complications were reported. Completeness of remote monitoring data was 100%. Following lockdown, mean activity was reduced (3.16vrs 2.68hours, -0.48 hours, 95%CI -0.27-0.69, 16%, p<0.0001). During the period April 14th to 23rd QoL was reduced (26(18-38)vrs 32 (17-47), p<0.01) and anxiety (1(0- 9)vrs 10 (5-18), p<0.001) and depression scores increased (3 (1-16)vrs 11 (3-17), p<0.001) compared to pre-lockdown levels. The observed increase in depression scores persisted to the census date (3(1-16)vrs 11(8-17), p<0.01). No change in day or night heart rate, or heart rate variability, was observed and no patients developed COVID-19. Conclusion In this cohort of patients with idiopathic and heritable PAH, UK protective health measures were effective in preventing COVID-19 in patients thought to be vulnerable. However, these protective measures resulted in reduced daily activity and QoL and were associated increased anxiety and depression indicators. Patients may decondition through periods of reduced activity. This may have implications for riskassessment and endpoint adjudication in clinical studies, both of which use measures of exercise capacity.

7.
Annals of Behavioral Medicine ; 55:S206-S206, 2021.
Article in English | Web of Science | ID: covidwho-1250846
8.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-8842

ABSTRACT

Objective : To investigate the effect of interview format changes (in-person to virtual, one-to-one to multiple-to-one) necessitated by the COVID-19 travel restrictions on candidate ranking variabilities. Method : In 2018/2019, the glaucoma fellowship interviews were conducted in-person and one-to-one, whereas in 2020, interviews were virtual and multiple (interviewers)-to-one (candidate). We compared ranking ranges of interviewers within the same virtual room (WSR) and not within the same virtual room (NWSR) to assess the effect of this change on ranking variabilities. We also compared ranking categories ("accept," "alternate," and "pass") agreements between in-person and virtual interviews to assess the effect of this change on ranking variabilities. Results : NWSR and WSR mean rankings differed by 1.33 (95% confidence interval difference 0.61 to 2.04, p = 0.0003), with WSR interviewers having less variability than NWSR pairs. The variability of in-person interviews and later virtual interviews showed no differences (weighted Kappa statistic 0.086 for 2018, 0.158 for 2019, and 0.101 for 2020;p < 0.05 for all years). The overall least attractive candidate has the lowest variability;the most attractive candidate has the second lowest variability. Conclusion: Grouping interviewers decreased ranking variabilities, while a change from in-person to virtual interview format did not increase the ranking variabilities.

10.
Chest ; 158(4):A2455-A2456, 2020.
Article in English | EMBASE | ID: covidwho-871898

ABSTRACT

SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Evaluate patients with pneumomediastinum (PTM) as a complication of coronavirus 2019 (Covid-19) infection and their outcomes. METHODS: Data was obtained by retrospective analysis of a database of Covid-19 patients, admitted to two New York hospitals from March 25th to April 26th, 2020. Identified 13 patients with PTM as a complication of Covid-19. RESULTS: Median age of patients was 67 years, 7 (54%) were men, and 1 patient had pre-existing emphysema. Presenting symptoms included dyspnea (13/13, 100%), fever (10/13, 77%), and cough (9/13, 69%);none had chest pain. Median presenting SaO2/FiO2 ratio was 359. Pneumomediastinum was diagnosed on presentation in 2 patients (15%), during hospitalization but prior to invasive mechanical ventilation in 4 patients (31%), and after invasive mechanical ventilation in 7 patients (54%). Six patients had CT scans confirming the diagnosis of PTM. Twelve of the 13 patients were initiated on mechanical ventilation at median 5.5 days. Four patients (31%) developed pneumothoraces and 1 patient required bilateral chest tube drainage. Tension pneumothorax, tension pneumopericardium, and chest wall compartment syndrome were not observed in our cohort. Pneumomediastinum self-resolved in 5 patients (38%) while on mechanical ventilation. (Fig. 1) Seven out of 12 intubated patients (58%) underwent prone ventilation without worsening of PTM. One patient was discharged home, 10 patients expired, and 2 patients remain hospitalized. CONCLUSIONS: Pneumomediastinum is a known sequelae of noncompliant lungs in severe acute respiratory distress syndrome (ARDS), typically in the setting of positive pressure delivered with invasive mechanical ventilation. Our cohort had a low prevalence of predisposing risk factors such as emphysema, and a high mortality. Pneumomediastinum was not strongly associated with mechanical ventilation, as nearly half (6/13) of the patients developed PTM prior to intubation. CLINICAL IMPLICATIONS: In our cohort, findings of PTM may be attributed to two main etiologies converging: damage from Covid-19 and self-inflicted increases in transpulmonary pressures. We postulate that impaired surfactant production from type II pneumocytes may predispose to atelectrauma leading to diffuse alveolar injury and risk of rupture, unlike in typical ARDS where barotrauma occurs in the context of poorly compliant lungs. Moreover, the increased work of breathing and pronounced cough seen in Covid-19 pneumonia may lead to increased transpulmonary pressures resulting in PTM. Reductions in transpulmonary pressures after intubation with initiation of sedation and neuromuscular blockade may explain the resolution of PTM in spite of invasive ventilation. Given the high mortality we observed, early identification and initiation of methods to reduce transpulmonary pressures is imperative to reduce risk of further complications. DISCLOSURES: No relevant relationships by Young Im Lee, source=Web Response No relevant relationships by Nan Li, source=Web Response No relevant relationships by Joseph Mathew, source=Web Response No relevant relationships by Lina Miyakawa, source=Web Response No relevant relationships by Paru Patrawalla, source=Web Response No relevant relationships by Paru Patrawalla, source=Web Response No relevant relationships by Adam Rothman, source=Web Response No relevant relationships by Vishad Sheth, source=Web Response No relevant relationships by David Steiger, source=Web Response No relevant relationships by Jigna Zatakia, source=Web Response

11.
Chest ; 158(4):A2043, 2020.
Article in English | EMBASE | ID: covidwho-871876

ABSTRACT

SESSION TITLE: Medical Student/Resident Pulmonary Manifestations of Systemic Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: New York has been the epicenter of the COVID-19 pandemic in the United States. As potential treatment options are investigated, discussion revolves around the thrombotic nature of this novel virus. We present two COVID-19 positive patients in an NYC hospital, whose recoveries were complicated by pulmonary emboli despite receiving anticoagulation. CASE PRESENTATION: Patient 1: A 66-year-old female with coronary artery disease presented with dyspnea, cough, and fever. She was hypoxic, with labwork notable for elevated D-dimer of 1.83. She was initiated on hydroxychloroquine, dexamethasone, and prophylactic-dose enoxaparin. Initial CT angiogram (CTA) of the chest was negative for PE. Her symptoms improved, inflammatory markers down-trended, and she was discharged. Three days later, she returned with worsened dyspnea, tachycardia, hypoxia to 70%, and increased D-dimer, now greater than 20. Repeat CTA demonstrated a new saddle pulmonary embolus extending to lobar, segmental, and subsegmental branches bilaterally with evidence of right heart strain. She was treated with therapeutic enoxaparin, with gradual improvement in symptoms. Patient 2: A 48-year-old female with obesity presented with dyspnea, non-productive cough, and fever. She was hypoxic, with initial CTA showing bilateral ground-glass opacities and no evidence of PE. Labs revealed elevated inflammatory markers, including D-dimer of 2.2. She was started on hydroxychloroquine, azithromycin, dexamethasone, tocilizumab, and prophylactic-dose enoxaparin. Inflammatory markers continued to rise, so she was switched to therapeutic-dose enoxaparin and high-flow nasal cannula. Two days later, she developed heavy bleeding due to menses and was switched back to prophylactic enoxaparin. She subsequently developed worsening hypoxia requiring BiPAP. Repeat CTA now demonstrated central emboli in the left pulmonary artery. She was given alteplase and started on therapeutic unfractionated heparin with transition to coumadin. CTA three weeks after admission demonstrated resolution of pulmonary emboli, but the patient’s diffuse ground-glass opacities and hypoxia persisted. DISCUSSION: These patients raise concerns about the thrombotic nature of COVID-19 and suggest that prophylactic doses of anticoagulation may not be enough to prevent thrombotic events. Trending D-dimers in combination with monitoring changes in oxygen requirements may be useful tools when suspecting new PEs and deciding when to start therapeutic anticoagulation. CONCLUSIONS: While more data is needed on the thrombotic nature of COVID-19, therapeutic doses of anticoagulation may be necessary to prevent major thrombotic events in COVID-19 patients at low risk of bleeding. Reference #1: Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020;7(6) DISCLOSURES: No relevant relationships by Tiffany Chen, source=Web Response No relevant relationships by Justin Gasper, source=Web Response No relevant relationships by Adam Rothman, source=Web Response No relevant relationships by Frederick Rozenshteyn, source=Web Response

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