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1.
Vascular ; : 17085381221075479, 2022 May 15.
Article in English | MEDLINE | ID: covidwho-1846743

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has significantly affected the 2021 match application cycle as in person sub-internships and interviews have been halted. Given the abrupt change, we aimed to characterize the utilization of social media and virtual open house platforms by integrated vascular surgery residency programs for outreach and networking during the pandemic for the 2021 cycle. METHODS: A list of accredited integrated vascular surgery residency programs was compiled using the Electronic Residency Application Service (ERAS) website provided by the Academic Medical Colleges (AMC). The social media platforms Twitter, Instagram, and Facebook were queried for accounts associated with the training programs or their associated institutional vascular surgery divisions. Each discovered account was surveyed for date of creation as well as posts outlining virtual interactive events such as open houses, meet-and-greets, and virtual sub-internship opportunities. Slopes of the curves representing total account numbers and account numbers on each platform were compared from pre-COVID to current day using linear regression and t-statistics. RESULTS: There were 64 integrated vascular surgery residency programs participating in the 2021 match cycle. 70.3% (N = 45) of programs had a social media presence on at least one of the three platforms. 54.7% (N = 35) of programs had an associated Twitter account. 43.9% (N = 28) of programs had an associated Instagram account. Six (9.4%) programs were found on Facebook. The number of social media accounts significantly increased from March 2020 (37 vs 69, p < .001) to March 2021. CONCLUSIONS: Vascular surgery residency programs have significantly increased use of social media platforms over a 12-month period beginning in March 2020, indicating adaptation to the restrictions prompted by the pandemic.

2.
Open forum infectious diseases ; 2022.
Article in English | EuropePMC | ID: covidwho-1824559

ABSTRACT

Anti-spike monoclonal antibody treatment of 180 B-cell-depleted patients with mild-to-moderate COVID-19 resulted in good outcomes overall, with only 12.2% progressing to severe disease, 9.4% requiring hospitalization, 0.6% requiring mechanical ventilation, no deaths within 30 days, and 1.8% developing persistent COVID-19. Anti-spike monoclonal antibodies appear effective in this immunocompromised population.

3.
Int J Environ Res Public Health ; 19(3)2022 01 25.
Article in English | MEDLINE | ID: covidwho-1648893

ABSTRACT

Critical temporal changes such as weekly fluctuations in surveillance systems often reflect changes in laboratory testing capacity, access to testing or healthcare facilities, or testing preferences. Many studies have noted but few have described day-of-the-week (DoW) effects in SARS-CoV-2 surveillance over the major waves of the novel coronavirus 2019 pandemic (COVID-19). We examined DoW effects by non-pharmaceutical intervention phases adjusting for wave-specific signatures using the John Hopkins University's (JHU's) Center for Systems Science and Engineering (CSSE) COVID-19 data repository from 2 March 2020 through 7 November 2021 in Middlesex County, Massachusetts, USA. We cross-referenced JHU's data with Massachusetts Department of Public Health (MDPH) COVID-19 records to reconcile inconsistent reporting. We created a calendar of statewide non-pharmaceutical intervention phases and defined the critical periods and timepoints of outbreak signatures for reported tests, cases, and deaths using Kolmogorov-Zurbenko adaptive filters. We determined that daily death counts had no DoW effects; tests were twice as likely to be reported on weekdays than weekends with decreasing effect sizes across intervention phases. Cases were also twice as likely to be reported on Tuesdays-Fridays (RR = 1.90-2.69 [95%CI: 1.38-4.08]) in the most stringent phases and half as likely to be reported on Mondays and Tuesdays (RR = 0.51-0.93 [0.44, 0.97]) in less stringent phases compared to Sundays; indicating temporal changes in laboratory testing practices and use of healthcare facilities. Understanding the DoW effects in daily surveillance records is valuable to better anticipate fluctuations in SARS-CoV-2 testing and manage appropriate workflow. We encourage health authorities to establish standardized reporting protocols.


Subject(s)
COVID-19 , COVID-19 Testing , Humans , Massachusetts/epidemiology , Pandemics , SARS-CoV-2
4.
United European Gastroenterology Journal ; 9(SUPPL 8):317-318, 2021.
Article in English | EMBASE | ID: covidwho-1490991

ABSTRACT

Introduction: UBT is the most accurate non-invasive test for H.pylori infection. The orally given urea, labelled with C13, is hydrolysed by the enzyme urease of H.pylori and C13O2 is measured expired in breath. UBT was our gold standard diagnostic test for H.pylori. This practice changed abruptly in March 2020, when our first wave of coronavirus -2 (SARS-CoV-2) started. UBT carries the risk of contamination by SARS-CoV-2 in the aerosol droplets generated by exhaled air. The British Society of Gastroenterology guideline at that time graded UBT as Aerosol Generating Procedure and therefore at high risk for transmission. Only emergency gastroenterology high risk procedures were recommended during restrictions which effectively terminated our standard UBT service. To maintain a non-invasive diagnostic option we developed a novel virtual test. C13 UBT At Home, is performed by patients at home with step by step instructions involving live video conference interaction between the patients and technicians. Aims & Methods: To determine the acceptability and the accuracy of the novel C13 UBT At Home service. Patients on a UBT waiting list were contacted and invited to undergo the alternative virtual breath test. Willing participants were pre assessed over phone to explain the process. Technical aspects (internet, smart phone or laptop requirements), navigation through the video call system attendanywhere and routine clinical parameters including PPI and antibiotic use were discussed. Suitable patients collected a Home UBT kit (Patient information sheet, test documentation, pre and post collection tubes, collection straw, urea tablet and feedback questionnaire) from a drop off point up to a week prior to their scheduled appointment. The test was performed as standard by the patient at home with live interaction for all active steps. The 20 minute rest between samples 1 and 2 collection was offline which allowed technicians to do concurrent cases. Patients were requested to fill in a feedback questionnaire after the test and to return it with the samples to the drop off point within 48 hours for analysis. The questionnaire included 6 questions covering pre procedure, procedure and post procedure domains. In addition to patient satisfaction, positivity rate, sample error rate and activity numbers were compared between UBT at home and a standard UBT cohort which was reinstated in 2021. Results: 300 patients were enrolled, mean age 41 years (range 7-85), 177 female (59%). Overall response rate was 96% (288), 96% (285) rated the entire UBT at home process as either excellent or good. All other parameters except connection to the hospital video call system, which was subject to external factors were also rated excellent/good by >90%. Accuracy between UBT tests was similar: positivity rate 23% (69/299) versus 22% (74/326), sample error rate 0.33% (1/300) versus 0.6% (2/326) for the UBT at home and standard tests respectively. Currently 3 of every 4 UBT's is now virtual despite reduced restrictions. Conclusion: UBT at home is possible and acceptable to patients with equivalent accuracy to standard UBT and should be continued to improve patient choice and satisfaction.

5.
Annals of Oncology ; 32:S1146, 2021.
Article in English | EMBASE | ID: covidwho-1432889

ABSTRACT

Background: Early data suggested a higher risk of COVID-19 in oncology patients, in particular those with co-morbidities or on systemic anticancer therapy (SACT). Immunisation strategies are likely to be critical in risk-reduction patient management. We examined patients' attitudes towards COVID-19 vaccines, studying factors affecting uptake such as demographics, socioeconomics, cancer diagnoses and treatments, and previous influenza vaccination. Methods: An anonymised questionnaire was distributed among oncology patients attending for SACT from November to December 2020. Statistical analyses were performed using SPSS v23 (IBM, Armonk, NY, USA). Results: In total 115 patients completed the survey. Of these, 30 (26%) were aged > 65, 65 (56%) were female and 54 (47%) were treated for metastatic disease. Overall 68 (59%) were receiving cytotoxic chemotherapy, and 15 (13%) were receiving immunotherapy. The most common cancer was breast (29%), followed by colorectal (18%) and lung (10%). Most patients (72%) had received or were intending to receive the influenza vaccine. Of patients surveyed 19 (17%) had friends or family who had been diagnosed with COVID-19, while only 3 (2.6%) had had COVID-19. The majority (81%) were in favour of receiving a COVID-19 vaccine if it was recommended for them. A small number however (5.2%) were against receiving a vaccine. Similar numbers of patients worried (30%) and did not worry (33%) that a COVID-19 vaccine could be unsafe. Interestingly 42% stated they if a COVID-19 vaccine were to be made available they would prefer to wait rather than to get it immediately. Patients who had received or intended to receive the influenza vaccine were less likely to want to delay receiving a COVID-19 vaccine (p=0.018). Age group, education level and palliative treatment was not associated with a significant difference in vaccine acceptance. Conclusions: The majority of patients surveyed were agreeable to COVID-19 vaccination, particularly those with prior influenza vaccination. An interesting finding was that though 42% of patients would prefer not to be first to receive the vaccine the majority welcomed vaccination. This finding, especially within a cohort regarded as being "highly vulnerable” to COVID, may have implications for the vaccine program in the general population. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

6.
Annals of Oncology ; 32:S1272, 2021.
Article in English | EMBASE | ID: covidwho-1432827

ABSTRACT

Background: The COVID-19 pandemic has impacted many aspects of the practice of oncology around the world. COVID was first detected in Ireland on 29/2/20. Many oncology units saw dramatic changes in activity in the face of rising infection rates. We aim to assess compare pharmacy activity, day unit systemic therapy adminstration and nursing staffing levels during the pre- and COVID periods. Methods: Hospital information systems were used to retrieve numbers of patients attending, numbers and types of items dispensed by pharmacy, and available nurses to deliver the systemic therapies from March 2019 to Feb. 2021. The data was analysed to identify trends in prescribing and dispensing practices for this period. Supportive medications such as anti-emetics, bisphosphosphonates were not included. Subgroup analysis on numbers of chemotherapy, immunotherapy, monoclonal antibody drugs dispensed per month was performed. A paired t-test was used to compare means. Results: 9410 non-clinical trials and 411 clinical trials items were dispensed from March 2019 until February 2020 (pre-COVID) for 11,606 patient attendances. From March 2020 until February 2021 (COVID period), 8931 non-clinical trials and 826 clinical trials items were dispensed for 10818 patient attendances. The mean number of non-clinical trials items dispensed per month were 784 and 744 respectively, with no statistical difference being found (p=0.11). There was a doubling in the number of clinical trials agents dispensed. The mean number of nurses available to administer therapies per day was 5.7 (SD=0.78) compared to the projected 7.8 WTE (whole time equivalents) ideally required. [Formula presented] Conclusions: Despite COVID restrictions it was possible to administer comparable numbers of cancer treatments throughout the COVID period, when compared to the previous year despite modest nursing staff numbers due to the dedication and selflessness of nursing, oncologists and oncology pharmacy staff. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

7.
Diabetologia ; 64(SUPPL 1):362-362, 2021.
Article in English | Web of Science | ID: covidwho-1431597
8.
Biophysical Journal ; 120(3):34a-34a, 2021.
Article in English | PMC | ID: covidwho-1385144
9.
Retina ; 41(12): 2456-2461, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1348074

ABSTRACT

PURPOSE: To evaluate the outcomes of delay in care secondary to the coronavirus pandemic in patients requiring intravitreal anti-vascular endothelial growth factor therapy. METHODS: A retrospective review was performed, and subjects were divided into two groups: 1) a study group of patients who experienced a treatment delay of ≥6 weeks from the intended follow-up during the coronavirus pandemic and resumed treatment with ≥2 anti-vascular endothelial growth factor injections over 6 months following treatment delay, and 2) a control group of patients who received regular care throughout the coronavirus pandemic. RESULTS: Totally, 234 subjects were analyzed. The mean treatment delay from the intended follow-up in the study group was 11.8 (±4.0) weeks. Visual acuity and central macular thickness worsened from baseline to 6 months after resuming anti-vascular endothelial growth factor therapy in the study group (P < 0.0001 and P = 0.001, respectively). Visual acuity and central macular thickness were better in the control group compared with the study group at the end of the 6-month study period (P < 0.0001 for both). CONCLUSION: Treatment delay in subjects undergoing anti-vascular endothelial growth factor therapy for retina disease during the coronavirus pandemic had worse visual and anatomical outcomes despite reinitiating treatment over 6 months compared with a control group, suggesting irreversibility and permanence of outcomes.


Subject(s)
Angiogenesis Inhibitors/therapeutic use , COVID-19/epidemiology , Retinal Diseases/drug therapy , SARS-CoV-2 , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Aged , Bevacizumab/therapeutic use , Choroidal Neovascularization/drug therapy , Choroidal Neovascularization/physiopathology , Continuity of Patient Care , Diabetic Retinopathy/drug therapy , Diabetic Retinopathy/physiopathology , Female , Humans , Intravitreal Injections , Macular Edema/drug therapy , Macular Edema/physiopathology , Male , Outcome Assessment, Health Care , Ranibizumab/therapeutic use , Retinal Diseases/physiopathology , Retinal Vein Occlusion/drug therapy , Retinal Vein Occlusion/physiopathology , Retrospective Studies , Time-to-Treatment , United States/epidemiology , Visual Acuity/physiology , Wet Macular Degeneration/drug therapy , Wet Macular Degeneration/physiopathology
10.
Int J Environ Res Public Health ; 18(14)2021 07 12.
Article in English | MEDLINE | ID: covidwho-1308353

ABSTRACT

Military field hospitals typically provide essential medical care in combat zones. In recent years, the United States (US) Army has deployed these facilities to assist domestic humanitarian emergency and natural disaster response efforts. As part of the nation's whole-of-government approach to the coronavirus disease (COVID-19) pandemic, directed by the Federal Emergency Management Agency and the Department of Health and Human Services, during New York City's (NYC) initial surge of COVID-19, from 26 March to 1 May 2020, the US Army erected the Javits New York Medical Station (JNYMS) field hospital to support the city's overwhelmed healthcare system. The JNYMS tasked a nutrition operations team (NuOp) to provide patient meals and clinical nutrition evaluations to convalescent COVID-19 patients. However, few guidelines were available for conducting emergency nutrition and dietary response efforts prior to the field hospital's opening. In this case study, we summarize the experiences of the NuOp at the JNYMS field hospital, to disseminate the best practices for future field hospital deployments. We then explain the challenges in service performance, due to information, personnel, supply, and equipment shortages. We conclude by describing the nutrition service protocols that have been implemented to overcome these challenges, including creating a standardized recordkeeping system for patient nutrition information, developing a meal tracking system to forecast meal requirements with food service contractors, and establishing a training and staffing model for military-to-civilian command transition. We highlight the need for a standardized humanitarian emergency nutrition service response framework and propose a Nutrition Response Toolkit for Humanitarian Crises, which offers low-cost, easily adaptable operational protocols for implementation in future field hospital deployments.


Subject(s)
COVID-19 , Humans , New York , New York City , Pandemics , SARS-CoV-2 , United States , Workforce
11.
Endoscopy ; 53(SUPPL 1):S133-S134, 2021.
Article in English | EMBASE | ID: covidwho-1254051

ABSTRACT

Aims The UK JAG on GI Endoscopy's minimum standard for polyp detection rates (PDR) in colonoscopy is 15 %. TheCOVID-19 pandemic precipitated the use of restrictive personal protective equipment (PPE) which might reduce dexterityand decrease PDRs. We audited our polyp excision rates both prior to and post the COVID-19 pandemic in order to assesswhether restrictive PPE led to a diminution therein. Methods Our endoscopy database was queried for all colonoscopies performed between 01/01/2014 and 29/02/2020 (Pre-COVID-19, n = 18,231) and between 01/03/2020 and 02/09/2020 (Post-COVID-19, n = 825) and subsequently irrevocablyanonymised. A polyp excision rate (PER) was calculated for each period as a proxy for PDR. A comparative odds ratio was calculated. An ordinary least squares (OLS) regression, using number of polyps excised as the dependent variable and procedure in thepost-COVID-19 period as a primary explanatory variable, was performed. The regression was controlled for age, malegender and procedure coded as therapeutic (as opposed to diagnostic). Results 4,346 and 209 patients had at least one polyp excised in the pre-COVID-19 (PER 23.8 %) and post-COVID-19 (PER25.3 %) periods respectively. Odds ratio 1.08 (95 %CIs: 0.92, 1.27). OLS regression established positive relationships between number of polyps excised and age (0.004, 95 %CIs: 0.003,0.005), male gender (0.10, 95 %CIs: 0.07, 0.13) and procedure coded as therapeutic (1.75, 95 %CIs: 1.71, 1.78). Itdemonstrated no significant relationship between procedure in the post-COVID-19 period (-0.003, 95 %CIs:-0.07, 0.07)and number of polyps excised. Conclusions Odds ratios comparing PERs and an OLS regression analysing number of polyps excised failed to demonstrateany significant difference between the pre-COVID-19 and post-COVID-19 eras.

12.
Cureus ; 13(3): e13642, 2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1171606

ABSTRACT

Mass casualty incidents such as those that are being experienced during the novel coronavirus disease (COVID-19) pandemic can overwhelm local healthcare systems, where the number of casualties exceeds local resources and capabilities in a short period of time. The influx of patients with lung function deterioration as a result of COVID-19 has strained traditional ventilator supplies. To bridge the gap during ventilator shortages and to help clinicians triage patients, manual resuscitator devices can be used to deliver respirations to a patient requiring breathing support. Bag-valve mask (BVM) devices are ubiquitous in ambulances and healthcare environments, however require a medical professional to be present and constantly applying compression to provide the patient with respirations. We developed an automated manual resuscitator-based emergency ventilator-alternative (AMREV) that provides automated compressions of a BVM in a repetitive manner and is broadly compatible with commercially-available BVM devices approximately 5 inches (128 mm) in diameter. The AMREV device relieves the medical professional from providing manual breathing support and allows for hands-free operation of the BVM. The AMREV supports the following treatment parameters: 1) adjustable tidal volume (V T ), 2) positive end-expiratory pressure (PEEP) (intrinsic and/or external), 3) 1:1 inspiratory: expiratory ratio, and 4) a controllable respiratory rate between 10-30 breaths per minute. The relationship between the inherent resistance and compliance of the lung and the delivered breaths was assessed for the AMREV device. Adjustable V T of 110-700 ml was achieved within the range of simulated lung states. A linear increase in mean airway pressure (P aw ), from 10-40 cmH2O was observed, as the resistance and compliance on the lung model moved from normal to severe simulated disease states. The AMREV functioned continuously for seven days with less than 3.2% variation in delivered V T and P aw . Additionally, the AMREV device was compatible with seven commercially-available BVM setups and delivered consistent V T and P aw within 10% between models. This automated BVM-based emergency-use resuscitator can provide consistent positive pressure, volume-controlled ventilation over an extended duration when a traditional ventilator is not available. True ventilator shortages may lead to manual resuscitators devices such as the AMREV being the only option for some healthcare systems during the COVID-19 pandemic.

13.
J Infect Dev Ctries ; 15(2): 237-241, 2021 03 07.
Article in English | MEDLINE | ID: covidwho-1125228

ABSTRACT

INTRODUCTION: We aim to describe the performance of combined IgM and IgG point-of-care antibody test (POC-Ab) (Wondfo®) compared to real-time reverse transcriptase (rRT-PCR) (Allplex™ 2019-nCoV Assay) in detecting coronavirus disease 2019 (COVID-19). METHODOLOGY: We compared POC-Ab with rRT-PCR results among patients in a tertiary hospital from January to March 2020 in Bandung, Indonesia. We selected presumptive COVID-19 patients with positive rRT-PCR consecutively and 20 patients with negative rRT-PCR results were selected randomly from the same group of patients as controls. We described the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) with corresponding 95% confidence interval using serum and capillary blood samples. We also tested POC-Ab using non-COVID-19 (confirmed dengue and typhoid) patients' sera. RESULTS: Twenty-seven patients with positive rRT-PCR result and 20 negative controls were included (68.1% males, mean age 46 (SD: 15.4)). Using the serum, the sensitivity of the POC-Ab was 63.0% (42.4-80.6), specificity was 95.0% (75.1-99.9), PPV was 94.4% (72.7-99.8), NPV was 65.5% (45.7-82.1). A subset of 20 patients was tested using a capillary blood sample. The accuracy of the capillary blood sample is lower compared to serum (50.0% vs. 78.7%). None of the non-COVID-19 sera tested were reactive. CONCLUSIONS: POC-Ab for COVID-19 has a high specificity with no false-positive result in non-COVID-19 sera. Therefore, it can be used to guide diagnostic among symptomatic patients in resource limited settings. Given its low sensitivity, patients with high suspicion of COVID-19 but non-reactive result should be prioritized for rRT-PCR testing.


Subject(s)
COVID-19 Serological Testing/methods , Adult , Aged , COVID-19/diagnosis , COVID-19/etiology , COVID-19 Nucleic Acid Testing/methods , False Positive Reactions , Female , Humans , Immunoglobulin G/blood , Immunoglobulin M/blood , Indonesia , Male , Middle Aged , Nasopharynx/virology , Point-of-Care Systems , Reverse Transcriptase Polymerase Chain Reaction/methods , Sensitivity and Specificity , Tertiary Care Centers
14.
The International Student Journal of Nurse Anesthesia ; 19(3):17-20, 2020.
Article in English | ProQuest Central | ID: covidwho-1063878

ABSTRACT

The Centers for Disease Control and Prevention (CDC) has stated that the time period between exposure to COVID-19 and the appearance of symptoms, called the incubation period, is estimated to be between two and 14 days.3 The CDC also stated that the median time from exposure to onset of symptoms is four-five days.4 Testing for the virus was a challenging issue in the early stages of the pandemic which contributed to rapid spread of the virus. In March 2020, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus stated, "The chronic global shortage of personal protective equipment is now one of the most urgent threats to our collective ability to save lives. Research has shown that COVID-19 is predominantly transmitted through respiratory droplets meaning transmission can take place within close proximity (<2 meters) of an infected person through a cough or sneeze.6 As time has progressed from the onset of the virus, the CDC has established and published recommendations to healthcare facilities regarding aerosol-generating procedures such as extubation, mechanical ventilation, suctioning, bag-mask ventilation (BMV), and chest compressions which the risk of airborne transmission.7 A respiratory droplet is a droplet particle >5-10 qm in diameter, while anything less than 5 qm in diameter refers to a droplet nuclei.3 The measurement of a droplet particle is a determining factor as to whether a particular mask provides protection against the spread of the virus via the airway (mouth and nose).

17.
World Dev ; 135: 105072, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-641743

ABSTRACT

This note presents three important facts on the COVID-19 pandemic and 22 developing countries, namely those in the Pacific. First, social protection systems are less common in the Pacific than in the rest of the world, meaning the region is not particularly well equipped to deal with the sharp decline in economic activity associated with the disease and standard policy responses (e.g., lockdowns) without plunging a large share of the population into poverty. Second, aggressive travel restrictions and effective domestic policy responses have spared many Pacific countries from the worst impacts of COVID-19. Ten countries have not had a single confirmed case. The experience of the region thus offers helpful lessons for other developing countries in keeping the crisis at bay. Third, the relative success of Australia and New Zealand in managing the virus provides an opportunity to pilot and test in the region what a carefully managed pathway to allow the tourism, migration, and remittances, that many countries depend on, to begin flowing again. Against its relative success, the Pacific has a unique opportunity to show the world how to safely emerge from the current crisis and address underlying vulnerabilities before the next one.

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