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1.
Journal of General Internal Medicine ; 37:S147-S148, 2022.
Article in English | EMBASE | ID: covidwho-1995806

ABSTRACT

BACKGROUND: Hypertension (HTN) affects 29% of US adults, however in-office blood pressure (BP) readings are often inaccurate leading to clinical inertia. Repeating BP within 6 weeks leads to quicker control but patients and primary care practices have limited resources for frequent visits. Home blood pressure monitoring (HBPM) is accurate and convenient. In reviewing HTN burden at a suburban Maryland primary care practice, we found 19% of patients had an encounter BP >140/90, and a sample chart review estimated half were advised to self-monitor but lacked standardized follow up. We aimed to implement a quality improvement program to increase HBPM among our patients. METHODS: We engaged stakeholders (practice leadership, frontline staff) and content experts (HTN, patient engagement) to develop educational materials on HBPM and reporting results via the patient portal. We planned in office implementation, identifying patients with elevated BP during encounters and utilizing nurses to provide counseling. However, with COVID-19, we pivoted to asynchronous outreach and home delivery of BP cuffs. We developed messaging, delivered via the patient portal, for patients with uncontrolled HTN, controlled HTN, and elevated BP readings without HTN. Eligible patients, covered by a single insurance that provides reimbursement for BP cuffs, had HTN on their problem list and/or a BP >140/90 during an encounter between Jan-Oct 2020. For interested patients, we placed BP cuff orders and sent the educational materials. RESULTS: We identified 243 eligible patients who received outreach about HBPM;4 did not have patient portal access and received letters with no responses. Of the remaining 239 patients, 77% (N=183) read the electronic message and 43% (N=103) responded. Among responders, 81% (N=83) requested a cuff and 14% (N=14) reported having an up-to-date device. Among patients with a cuff, 18% (N=17) reported a BP reading to their primary care physician, with systolic and diastolic readings on average 11 and 6 mmHg lower, respectively, than the most recent in-office measurement. Initial review found some patients did not receive a cuff after the order resulting from delayed order processing and patients not scheduling delivery. CONCLUSIONS: Patients with elevated BP readings or HTN responded to messaging through the patient portal and were interested in receiving BP cuffs for HBPM. However, many patients did not report BP values after a device was ordered. Next steps include addressing barriers to delivery of the cuffs and incorporating follow up visits, including with our clinical pharmacist, to encourage reporting of HBPM. We will use lessons learned from this pilot to plan outreach and encourage self-monitoring during the COVID-19 era.

2.
JOURNAL OF GENERAL INTERNAL MEDICINE ; 37(SUPPL 2):147-148, 2022.
Article in English | Web of Science | ID: covidwho-1935309
3.
ISSUES & STUDIES ; 58(02), 2022.
Article in English | Web of Science | ID: covidwho-1938080

ABSTRACT

Effective pandemic response has become an increasingly important focus for research in the face of the COVID-19 pandemic. While there are a number of variables that may be considered as influencing effective response, this paper focuses on the potential impact of an "authoritarian advantage" in achieving an effective response in the period prior to pharmaceutical interventions being available with China as a case study. In essence, this paper explores whether China enjoys an authoritarian advantage, and if so, how it functions. This study compares China's SARS-CoV-1 (2003) response with its SARS-CoV-2 (2019) response by exploring the impact of the authoritarian advantage on the state's ability to effectively engage three key explanatory variables - centralized decision-making powers, public support and media engagement.

4.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927777

ABSTRACT

INTRODUCTION: Dietary and herbal supplements can contain clinically significant amounts of exogenous thyroid stimulants and hormones, including T3 and T4, thus placing consumers at increased risk of thyrotoxicosis and other metabolic-related adverse effects. We present a case of thyrotoxicosis in a young man with no history of thyroid disease, who was found to be consuming an extensive variety of supplements. DESCRIPTION: A 31 year old man with hypertension presented with 1 week of intermittent palpitations. He was in his usual state of health until 1 week prior to admission, when he noticed intermittent, self-resolving episodes of tachycardia as high as the 160s on his smart watch, associated with palpitations, dyspnea, low grade fevers, and intermittent dry cough. He came to the ED for persistence of symptoms. In the ED: T 98.8 F, HR 129, BP 152/77, RR 18, SpO2 98% on RA. CBC, BMP, UA, UTox, blood alcohol content, troponin and COVID tests were unremarkable. TSH was < .007 [0.358-3.740 ulU/mL], with a free thyroxine of 0.54 [0.70-1.48 ng/dL];other thyroid studies later returned with TSI < 0.10 [0.00-0.55 IU/L], free T3 32.50 [1.80-4.60 pg/mL], and an unremarkable thyroid ultrasound. CXR showed no acute infiltrates. EKG revealed sinus tachycardia, no Wolff-Parkinson-White syndrome, and no Brugada waveforms. He was given 2L NS, ceftriaxone 1g IV, aspirin 81mg PO, and tylenol 650mg PO, and admitted to the telemetry unit. Exam revealed an anxious appearing man with tachycardia. On ROS, patient admitted to drinking 6-8 cups of coffee daily, and to taking at least a dozen different supplements. He was started on propranolol 30 mg every 6 hours with improvement in his heart rate, and was counseled to stop the supplements and wean his caffeine intake. He was discharged the following day with plan for endocrinology and primary care follow-up. DISCUSSION: Thyrotoxicosis in this young patient with no history of thyroid disease posed a diagnostic quandary. This prompted further investigation into a more detailed social history, which revealed the extensive variety of supplements he was taking, consistent with thyrotoxicosis factitia. In patients presenting with newonset tachycardia, our case highlights the importance of collecting a thorough social history and maintaining early suspicion for thyroid disease and thyrotoxicosis.

5.
Sleep ; 45(SUPPL 1):A287, 2022.
Article in English | EMBASE | ID: covidwho-1927430

ABSTRACT

Introduction: Prolonged exposure to stressful environments is associated with adverse psychological outcomes, including sleep disturbance and burnout. Burnout rates have increased substantially during the unprecedented challenges faced by healthcare workers (HCWs) during the COVID-19 pandemic. Since burnout has been associated with significant health risk and adverse organizational outcomes, it is important to identify factors that inform preventive or therapeutic approaches to mitigate adverse outcomes in HCWs. Methods: Participants were HCWs (physicians, nurses, advanced practice providers, technicians etc.) from 4 emergency departments in New York City who completed a cross-sectional electronic survey (completed at study enrollment between November 2020-October 2021). The Pittsburgh Sleep Quality Index (PSQI) assessed global sleep quality. The Maslach Burnout Inventory (MBI) assessed 3 burnout dimensions: emotional exhaustion (EE;feelings of being emotionally overextended and exhausted by one's work);Feelings of depersonalization (DP;unfeeling and impersonal response towards patients);and reduced personal accomplishment (PA;feelings of competence and successful achievement in one's work). Descriptive statistics were calculated and separate binary logistic regressions were used to predict poor global sleep quality (PSQI >5) from individual MBI subscales (dimensions of burnout), while controlling for age, race, ethnicity, and gender. Results: Ninety-one participants, studied to date, were included in the analysis (51% non-Hispanic/Latino White, 63% female, mean age: 40 [SD: 9.6] y). Poor global sleep quality was reported by 68%. High EE (score >9), DP (score >6) and reduced PA (score <9) were reported by 44%, 27%, and 18% of participants, respectively. Poor global sleep quality was significantly associated with presence of elevated EE (OR: 3.04, 95% CI: 1.07-8.63, p=0.037), but not with elevated DP (OR: 1.35, 95% CI: 0.44-4.10, p=0.603) or reduced PA (OR: 3.29, 95% CI: 0.65-16.44, p=0.146). Conclusion: During the COVID-19 pandemic, poor sleep quality was reported by the majority of participants and associated with increased burnout in HCWs. Poor global sleep appears to have the most influence on the burnout dimension EE, thus suggesting new evidence about associations between sleep and emotional regulation in HCW during the pandemic. Future trials should test whether existing (or novel) interventions can improve sleep and thereby support HCWs in high stress periods.

6.
Sleep ; 45(SUPPL 1):A64-A65, 2022.
Article in English | EMBASE | ID: covidwho-1927390

ABSTRACT

Introduction: Emergency Department (ED) healthcare workers (HCWs) may be at elevated risk for the development of cardiovascular disease (CVD), due in part to sleep and/or circadian disturbances. This study aimed to evaluate the relationship of sleep factors with blood pressure, a primary marker of CVD risk, in ED HCWs. Methods: Participants were HCWs (physicians, nurses, advanced practice providers, technicians, etc.) from 4 EDs in New York City who completed study procedures between November 2020-October 2021. Participants completed a 2-week data burst, which included sleep/activity (Fitbit Inspire) and home blood pressure monitoring (Omron 5 Series BP7250;preceding and following their main daily sleep episode). Linear regression models, adjusted for age, gender, and race/ethnicity, were conducted predicting blood pressure from sleep factors. Results: The sample included n=74 ED HCWs (mean [SD] age=38.4 [8.7] years). Most were female (62.2%) and non-Hispanic/ Latino White (55.6%). Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 116.1 (12.5) mmHg and 75.1 (7.6) mmHg, respectively. Actigraphy-derived sleep factor means for the data burst period were: a) Total sleep time (TST): 6.8 (1.0) hours;b) Sleep efficiency (SE): 94.5 (2.2)%;c) Percentage of main sleep episodes throughout the burst with TST <6 hours: 25.9 (20.8)%;d) Sleep start time: 24:06 (01:24);and e) Within-subject inter-daily bedtime variability (i.e., SD of sleep start times): 2.4 (1.8) hours. Higher TST was associated with lower SBP (B [SE] =-0.50 [0.30] mmHg/10 min, p=.04) and DBP (B [SE] =-0.50 [0.20] mmHg/10 min, p=.01). Greater SE was associated with lower SBP (B [SE] =-1.23 [0.55], mmHg/%, p=.03) and DBP (B [SE] =-1.05 [0.39], mmHg/%, p=.01). A higher proportion of nights with TST <6 hours was associated with higher DBP (B [SE] =1.4 [0.40], mmHg/10%, p<0.01) but not SBP. Sleep start time and bedtime variability were not associated with BP. Conclusion: These findings provide support for the relationship between sleep and blood pressure. Of note, data were collected during the COVID-19 pandemic, which may impact observed relationships. Because this is a cross-sectional analysis, the causal direction of the association may be (at least partially) reversed. Further research should examine psychological and work-related factors in ED HCWs that may modify these relationships, e.g., stress/anxiety, burnout, and job strain, and include assessments of the circadian system.

8.
Radical Teacher ; 122:1-12, 2022.
Article in English | Scopus | ID: covidwho-1879593
9.
Pediatric Blood & Cancer ; 69:1, 2022.
Article in English | Web of Science | ID: covidwho-1849389
10.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-333514

ABSTRACT

BACKGROUND: The novel human coronavirus disease 2019 (COVID-19) pandemic has claimed more than 240,000 lives worldwide, causing tremendous public health, social, and economic damages. While the risk factors of COVID-19 are still under investigation, environmental factors, such as urban air pollution, may play an important role in increasing population susceptibility to COVID-19 pathogenesis. METHODS: We conducted a cross-sectional nationwide study using zero-inflated negative binomial models to estimate the association between long-term (2010-2016) county-level exposures to NO2, PM2.5 and O3 and county-level COVID-19 case-fatality and mortality rates in the US. We used both single and multipollutant models and controlled for spatial trends and a comprehensive set of potential confounders, including state-level test positive rate, county-level healthcare capacity, phase-of-epidemic, population mobility, sociodemographic, socioeconomic status, behavior risk factors, and meteorological factors. RESULTS: 1,027,799 COVID-19 cases and 58,489 deaths were reported in 3,122 US counties from January 22, 2020 to April 29, 2020, with an overall observed case-fatality rate of 5.8%. Spatial variations were observed for both COVID-19 death outcomes and long-term ambient air pollutant levels. County-level average NO2 concentrations were positively associated with both COVID-19 case-fatality rate and mortality rate in single-, bi-, and tri-pollutant models (p-values<0.05). Per inter-quartile range (IQR) increase in NO2 (4.6 ppb), COVID-19 case-fatality rate and mortality rate were associated with an increase of 7.1% (95% CI 1.2% to 13.4%) and 11.2% (95% CI 3.4% to 19.5%), respectively. We did not observe significant associations between long-term exposures to PM2.5 or O3 and COVID-19 death outcomes (p-values>0.05), although per IQR increase in PM2.5 (3.4 ug/m3) was marginally associated with 10.8% (95% CI: -1.1% to 24.1%) increase in COVID-19 mortality rate. DISCUSSIONS AND CONCLUSIONS: Long-term exposure to NO2, which largely arises from urban combustion sources such as traffic, may enhance susceptibility to severe COVID-19 outcomes, independent of long-term PM2.5 and O3 exposure. The results support targeted public health actions to protect residents from COVID-19 in heavily polluted regions with historically high NO2 levels. Moreover, continuation of current efforts to lower traffic emissions and ambient air pollution levels may be an important component of reducing population-level risk of COVID-19 deaths.

11.
Journal of the American College of Cardiology ; 79(9):663, 2022.
Article in English | EMBASE | ID: covidwho-1768624

ABSTRACT

Background: Left Atrial Appendage Occlusion (LAAO) with the Watchman device is considered an elective procedure, and thus often deferred during outbreak peaks associated with the COVID-19 pandemic. Patients with bleeding issues on anticoagulation may require additional hospitalization for bleeding episodes or suffering increased risk of stroke by postponing occlusion while anticoagulation is discontinued. We chose to develop a protocol for screening, same day discharge, and follow up of selected LAAO patients and continuing to provide quality clinical outcomes while accounting for decreased bed and staff capacity due to the pandemic. Methods: Utilizing Knowledge to Action (KTA) nursing framework, a protocol was developed and reviewed with key stakeholders. Criteria for Same Day Discharge (SDD) includes: support at home, stable vitals and access site hemostasis prior to DC, agreeable to SDD, tolerant of oral intake, ability to urinate and safely ambulate prior to DC. Exclusion for SDD includes: Liver disease, Plt count <70,000, ESRD or CKD IV or any site or procedure complications. With Perclose usage patients must have 3 hours of bedrest, with manual pressure closure must have bedrest for 6 hours and purse string suture removed. This is followed by a next day phone call to ensure the patient is taking appropriate medicines and have no medical issues. Results: 38 out of 113 patients were screened as SDD candidates from January 2021-October 2021. Average patient age was 76, 31% female, with average CHA2DS2-VASc of 5. One patient required overnight hospitalization due to underlying asthma and need for nebulizer. One patient presented to an outpatient ED on a weekend with chest pain and underwent heart catheterization due to elevated troponin and did not require intervention. There were no access site complications. No patients contracted SARS-Cov-2 within 6 weeks post procedurally, compared with 2 of the overnight stays during the same period (75 patients). Conclusion: SDD in a carefully selected patient population is a feasible and safe strategy for LAAO patients. These patients had a clinically significant, though underpowered decrease in incidence of COVID-19 diagnosis within 6 weeks post implant.

12.
Working Paper Series - National Bureau of Economic Research (Massachusetts)|2021. (w28835):unpaginated. many ref. ; 2021.
Article in English | CAB Abstracts | ID: covidwho-1760215

ABSTRACT

As countries transition from facing COVID-19 vaccine supply shortfalls to requiring novel strategies to facilitate vaccination, modern retail chains-often designed and located to target particular demographic groups-are a potential vaccine delivery vehicle. Using geospatial data, we quantify the proximity to vaccines created by a U.S. federal program that distributes vaccines to commercial retail pharmacies. We then quantify the impact of a proposal to provide vaccines at Dollar General, a low-priced general merchandise retailer. We show that adding Dollar General to the federal program would substantially decrease the distance to vaccine sites for low-income and minority U.S. households.

14.
Circulation ; 144(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1639300

ABSTRACT

Background: Telemedicine use vastly expanded during the Covid-19 pandemic, with uncertain impact on cardiovascular care. quality. Objectives: To examine the association between telemedicine use and blood pressure (BP) control. Methods: This is a retrospective cohort study of 32,727 adult patients with hypertension (HTN) seen in primary care and cardiology clinics at an urban, academic medical center from February to December, 2020. The primary outcome was poor BP control, defined as having no BP recorded OR if the last recorded BP was ≥140/90 mmHg. Multivariable logistic regression was used to assess the association between telemedicine use during the study period (none, 1 telemedicine visit, 2+ telemedicine visits) and poor BP control, adjusting for demographic and clinical characteristics. Results: During the study period, no BP was recorded for 486/20,745 (2.3%) patients with in-person visits only, for 1,863/6,878 (27.1%) patients with 1 telemedicine visit, and for 1,277/5,104 (25.0%) patients with 2+ telemedicine visits. After adjustment, telemedicine use was associated with poor BP control (odds ratio [OR], 2.06, 95% confidence interval [CI] 1.94 to 2.18, p<0.001 for 1 telemedicine visit, and OR 2.49, 95% CI 2.31 to 2.68, p<0.001 for 2+ telemedicine visits;reference, in-person visit only). This effect disappears when analysis was restricted to patients with at least one recorded BP (OR 0.89, 95% CI 0.83 to 0.95, p=0.001 for 1 telemedicine visit, and OR 0.91, 95% CI 0.83 to 0.99, p=0.03 for 2+ telemedicine visits). Conclusions: BP is less likely to be recorded during telemedicine visits, but telemedicine use does not negatively impact BP control when BP is recorded.

15.
BMC Palliat Care ; 21(1): 10, 2022 Jan 13.
Article in English | MEDLINE | ID: covidwho-1630251

ABSTRACT

BACKGROUND: In the SARS-CoV-2 pandemic, general and specialist Palliative Care (PC) plays an essential role in health care, contributing to symptom control, psycho-social support, and providing support in complex decision making. Numbers of COVID-19 related deaths have recently increased demanding more palliative care input. Also, the pandemic impacts on palliative care for non-COVID-19 patients. Strategies on the care for seriously ill and dying people in pandemic times are lacking. Therefore, the program 'Palliative care in Pandemics' (PallPan) aims to develop and consent a national pandemic plan for the care of seriously ill and dying adults and their informal carers in pandemics including (a) guidance for generalist and specialist palliative care of patients with and without SARS-CoV-2 infections on the micro, meso and macro level, (b) collection and development of information material for an online platform, and (c) identification of variables and research questions on palliative care in pandemics for the national pandemic cohort network (NAPKON). METHODS: Mixed-methods project including ten work packages conducting (online) surveys and qualitative interviews to explore and describe i) experiences and burden of patients (with/without SARS-CoV-2 infection) and their relatives, ii) experiences, challenges and potential solutions of health care professionals, stakeholders and decision makers during the SARS-CoV-2 pandemic. The work package results inform the development of a consensus-based guidance. In addition, best practice examples and relevant literature will be collected and variables for data collection identified. DISCUSSION: For a future "pandemic preparedness" national and international recommendations and concepts for the care of severely ill and dying people are necessary considering both generalist and specialist palliative care in the home care and inpatient setting.


Subject(s)
COVID-19 , Pandemics , Adult , Germany , Humans , Palliative Care , SARS-CoV-2
16.
Physics Teacher ; 59(9):703-705, 2021.
Article in English | Scopus | ID: covidwho-1550867

ABSTRACT

The new normal imposed on us by the COVID-19 pandemic restricted the traditional ways we would teach high school students who are eager to participate in introductory astronomy projects on our university campus. This turned out to be a blessing in disguise as we were forced to come up with creative ways to get around this obstacle. The outcome is an outline of a pedagogically sound and even more robust instructional plan for an astronomy course using RSpec in conjunction with freely available databases. In addition to the traditional topics, the new model will allow an instructor to explore emission lines of variable Be stars like Gamma Cas and the classification of supernovae by an interpretation of their spectra. We argue that this new model should be used even if we return to the old normal. © 2021 Author(s).

17.
Palliative Medicine ; 35(1 SUPPL):34-35, 2021.
Article in English | EMBASE | ID: covidwho-1477110

ABSTRACT

Background: During the SARS-CoV-2 pandemic all health care systems faced enormous challenges. Due to increased severity of illness, palliative care patients continued to require comprehensive care. In order to provide general palliative care during a pandemic, experiences of staff should be utilized. Aim: Description and analysis of experiences, challenges and potential solutions of multiprofessional hospital staff in general palliative care with regard to care of severely ill and dying patients (with/without SARSCoV- 2) and their relatives. Method: After ethical approval qualitative semi-structured online focus groups were conducted. Individual interviews were also used when necessary. The results were recorded, transcribed, and analysed with the qualitative content analysis by Kuckartz. Results: Five focus groups having four to eight participants and one additional individual interview were conducted. The participants either work in intensive care, isolation wards or with patients being exceedingly burdened (e.g. dementia). Fifteen main categories with two to eight subcategories were formed. Patients, relatives and staff as well as visitation regulations and farewell were elaborated as most important main categories. Subcategories are for example insecurity, strain and reprocessing or with regards to visitation: restraints, guidelines or exceptions. The biggest challenge addressed by all interviewees were visitations as the restrictions caused a lot of suffering for everyone involved. Discussion: Current general precautions and general palliative care are insufficiently meeting the needs of severely ill and dying patients. Their needs are still existing throughout the pandemic and should be addressed accordingly. Interprofessional and -disciplinary cooperation is a precondition for individualised care of seriously ill patients and their relatives. Measures preventing infections (e.g. concepts) should be transparently communicated in hospitals. Funding: BMBF.

18.
Palliative Medicine ; 35(1 SUPPL):215, 2021.
Article in English | EMBASE | ID: covidwho-1477054

ABSTRACT

Background: The SARS-CoV-2 pandemic challenged interdisciplinary cooperation between hospital staff and specialized palliative care (SPC) by facing sudden restrictions, yet dying patients still required comprehensive palliative care. Aim: Examination of interdisciplinary cooperation from the point of generalist palliative care between hospital staff and SPC during the SARS-CoV-2 pandemic in German hospitals as a part of a multicenter project (PallPan). Method: A 43-Items-questionnaire was developed based on literature and semi-structured qualitative interviews concerning the first pandemic phase and was sent to hospital staff via the online platform UniPark (n=10.357). Excluded were inhospital specialized palliative care. Interviewees were able to answer the questions beginning from 01/12/20 until 20/01/21. The data was analyzed via SPSS and descriptive statistics and cross tables were done. Results: In total 550 hospital staff did answer the questionnaire and after exclusion of SPC-respondents 530 questionnaires were analyzed. While 32.4% (n=159) did not have the possibility to include SPC into the care process, 74.1% (n=215) did often incorporate SPC in their daily work. There was a significant discrepancy for SPC-co-management regarding Covid-19 positive (46.6%, n=152) and Covid-19 negative patients (69.9%, n=228, p= < .001). Most hospital staff considered additional support by SPC as helpful (83.1%, n=368). This contains mainly easily accessible information (69.0%, n=254) and training in palliative care (63.9%, n=235). Discussion: Inhospital SPC was present in the pandemic, yet there is space for improvement. The discrepancy concerning SPC-co-management at the patients' bed is one major issue that needs to be addressed. In order for a comprehensive care SPC should provide training and easily accessible information to generalist palliative care during and outside a pandemic.

19.
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