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1.
Circulation: Cardiovascular Quality and Outcomes ; 15, 2022.
Article in English | EMBASE | ID: covidwho-1938116

ABSTRACT

Background: Asymptomatic patients with atrial fibrillation (AF) pose challenges to diagnosis. Early diagnosis can reduce morbidity and mortality. Systematic screening in primary care may result in early intervention. Objectives: We sought to examine the implementation outcomes of a systematic, team-based quality improvement education (QIE) intervention for AF screening in primary care during the COVID-19 pandemic. Methods: QIE intervention was implemented in academic-based (n=4) and community-based (n=2) practices to address COVID-19 challenges. Surveys administered by site identified existing approaches and provider teams developed screening protocol based on targeted education, deploying a mobile ECG device (Kardiamobile™). Patient charts were reviewed (Dec 2020-May 2021) to determine eligibility, i.e., patients aged 65-74 (with prior stroke/TIA or two other risk factors) or aged ≥75 (with one other risk factor) without prior AF. Patient EHR data were examined for demographic/clinical data and screening outcome. Provider interviews (n=12) and validation from representative patients (n=2) accounted for sustainability of outcomes. Results: A total of 1,221 patients were evaluated for AF risk, with 408 eligible for screening. Of these, 277 (68%) were female and CHA2DS2-VASc varied-score=3 (45%);score=4 (24%);score=5+ (31%). Patients (n=7;2%) who screened positive for AF were referred or started on anticoagulation, like other primary care studies. Figure 1 shows how systematic screening was re-imagined and implemented Satisfaction and engagement increased among providers and patients-attributed, in part, to benefits of team-based planning and targeted education. Conclusion: An AF screening program was adapted to improve patient care despite COVID-19 related challenges. A QIE toolkit was launched to assist primary care practices with implementing streamlined, sustainable, and patient-engaging strategies to reduce stroke.

2.
Sleep ; 45(SUPPL 1):A55, 2022.
Article in English | EMBASE | ID: covidwho-1927388

ABSTRACT

Introduction: The COVID-19 pandemic has disrupted the lives of many people. The risk and interpersonal cost of infection as well as the public health measures implemented to mitigate the spread likely have psychological costs. Yet, due to the ever-changing nature of the pandemic, psychological impact has been difficult to capture through research efforts. Here, we leveraged an on-going, geographically representative study to examine the relationship among sleep, stress, and memory function before and during the COVID-19 pandemic. Methods: Participants (N=1958, aged=18+) were enrolled in a 21-day ecological momentary assessment study. All participants provided demographic information, including zipcodes, which were used to identify rural vs urban locale. Participants were instructed to complete up to three daily check-ins during set time windows-morning, afternoon, night--via a phone application. At each morning check-in, participants were asked about sleep duration and quality, and at every check-in, participants reported perceived stress ratings. Participants also completed a paired-associates memory task on Day 2 of the study. For the task, participants were instructed to encode a list of 20 unrelated word and picture pairs. Immediately after encoding, participants were tested on five picture-word pairs. Tests 2 and 3 occurred on a unique set of five words from the initial list three and six days after initial encoding, respectively. Pre- and during COVID assessments were defined as March 2019 to March 2020 and April 2020 to October 2021, respectively. Results: Mixed effects binomial regressions revealed that pre- COVID, longer sleep durations were associated with better memory performance (β=.09, p<.05), and counterintuitively, higher subjective sleep quality was associated with worse memory performance (β=- .35, p<.001). During COVID, longer nighttime awakenings were associated with poorer memory performance (β=-.01, p<.05) and living in a rural vs urban environment was associated with poorer memory performance (β=.48, p<.01). Older age was associated with worse memory performance pre- and during COVID (β=-.01, p<.01). Stress was not related to memory pre- or during COVID in these models. Conclusion: Findings support that sleep difficulty before and during the pandemic likely impacts memory function. Additionally, those living in rural U.S. environments may be particularly vulnerable to cognitive changes in the pandemic context.

3.
Obstetrics and Gynecology ; 139(SUPPL 1):36S, 2022.
Article in English | EMBASE | ID: covidwho-1925516

ABSTRACT

INTRODUCTION: It is recommended to administer the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy. We evaluated whether the COVID-19 pandemic affected Tdap vaccination during periods when (1) many prenatal visits were via telemedicine and (2) patients might be vaccine wary due to COVID-19 vaccination misinformation. METHODS: This was a retrospective observational study using data queried from the Einstein Healthcare Network electronic medical record. The study included patients who delivered between 2019 and 2021 and their Tdap vaccination status during prenatal care. Chi-square tests compared vaccination rates between patients delivering at different times. RESULTS: Of the pre-pandemic pregnancy control group (n=1,408), 60% received Tdap vaccination. In the second quarter of 2020, when many prenatal visits were done via telemedicine, patients (n=688) were 1.3 times more likely to not receive Tdap vaccination (54%;P=.0033). During the second quarter of 2021, when there was much misinformation regarding COVID-19 vaccination, even with all prenatal visits being in person, patients (n5363) were 1.3 times more likely to not have received the Tdap vaccination (54%;P=.028). True percentages of Tdap vaccination were higher than those reported above due to 16% of patients who received either prenatal care elsewhere or no prenatal care, for whom no vaccination data was available. CONCLUSION: Compared to pre-COVID-19 pandemic, pregnant patients were less likely (OR, 1.3) to have consented to and received the Tdap vaccination during periods when (1) many prenatal visits were via telemedicine and (2) patients might be vaccine wary due to COVID-19 vaccination misinformation.

4.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925285

ABSTRACT

Objective: Determine neuromuscular manifestation incidence in COVID-19 patients from the longitudinal electronic health record database Optum. Background: Both central and peripheral nervous system (PNS) manifestations of COVID-19 have been reported. A Chinese retrospective case series, on 214 hospitalized COVID-19 patients, found that 8.9% presented with peripheral nerve disease and 7% had muscular injuries. Other studies looking at the prevalence of PNS manifestations are limited and have significantly lower numbers. Design/Methods: The COVID-19 data is sourced from more than 700 hospitals and 7000 clinics in the US. Patients with numerous neuromuscular diagnoses were identified based on ICD-10 coding. Examples include carpal tunnel syndrome, radial nerve lesion, sciatic nerve lesion, myasthenia gravis, acute transverse myelitis, Bell's palsy, and trigeminal neuralgia. Results: We reviewed a total of 598,847 patients with positive COVID-19 PCR and/or diagnosis coding. Neuromuscular complications must have been within 45 days of diagnosis to be included. Incidence of similar neuromuscular complaints was evaluated in 3,001,153 controls without COVID-19. Critical illness neuropathy was found in 35,782 COVID-positive patients and 6,281 of those without. Retrospective study limitations include temporal relationship to COVID-19 does not necessarily indicate causality and inability to confirm the coding by record review or EMG/NCS. Conclusions: Incidence of neuromuscular disorders is generally lower or equivalent in COVID19 patients than in the general population, except for critical illness neuropathy and myopathy. This finding may be explained by more COVID-19 patients being in the intensive care unit and bedbound for longer periods. It is worth noting that a small case series of COVID-related critical illness neuropathy and myopathy patients showed no histopathological or clinical differences compared to non-COVID patients. To our knowledge, this report includes an analysis of neuromuscular manifestations in one of the largest cohorts of COVID-19 patients. This can assist with risk-benefit discussions regarding treatment initiation, etiology of diagnoses, and counseling for COVID-19 questions.

5.
Nephrology Dialysis Transplantation ; 37(SUPPL 3):i439, 2022.
Article in English | EMBASE | ID: covidwho-1915729

ABSTRACT

BACKGROUND AND AIMS: Patient activation refers to the knowledge, skills and confidence needed to manage one's health [1]. Higher patient activation is associated with better health outcomes in long-term conditions [2] such as kidney disease (KD). The COVID-19 pandemic has presented a myriad of additional challenges for people living with KD. Individuals may display different coping strategies in response to stressful and difficult circumstances such as health management during the pandemic [3]. Our group conducted a multicentre survey to evaluate the impact of the pandemic on kidney patient experiences, lifestyle and health care. As part of this larger study, we hypothesized that higher patient activation may be associated with more effective coping strategies. The purpose of this analysis was to explore coping styles utilised during the pandemic across different levels of patient activation in people with nondialysis CKD (ND-CKD) and kidney transplant recipients (KTR). METHOD: 214 ND-CKD and KTR participants [50.9% male, mean age 60.71 (SD 14.15) years, 56.1% KTRs] completed the Patient Activation Measure (PAM-13). Participants were categorised into 'low' and 'high' activation based on their PAM-13 score (levels 1-2 as low;3-4 as high). Coping strategies were assessed using the Brief-COPE questionnaire and categorised into adaptive coping (active coping, information support, positive reframing, planning, emotional support, humour, acceptance and religion) and maladaptive coping (venting, self-blame, self-distraction, denial, substance use and behavioral disengagement) strategies. Chi-square tests were conducted to compare coping strategies used by low-and high-activated patients. RESULTS: Most participants were classified as having 'high' activation levels (n = 164, 77%). Table 1 shows the three most frequently used adaptive and maladaptive coping strategies across activation levels. A significantly greater proportion of those with high activation used acceptance (P = 0.006), active coping (P = 0.045) and positive reframing (P = 0.031) as coping strategies. No significance was observed between maladaptive coping strategies and activation level. CONCLUSION: The most commonly reported coping strategy was 'acceptance' for individuals with high and low activation. The findings suggest that a higher proportion of people with high patient activation used adaptive coping strategies. Worryingly, regardless of activation level, about a third of participants used substance use (i.e. alcohol and drugs) as a form of coping. Identifying people with lower activation in KD can indicate the need for additional support to help them cope in challenging circumstances. Interventions to improve activation may assist in developing effective coping strategies.

6.
Journal of Urology ; 207(SUPPL 5):e655, 2022.
Article in English | EMBASE | ID: covidwho-1886522

ABSTRACT

INTRODUCTION AND OBJECTIVE: Inpatient consultations are sometimes initiated in order to establish care without any acute need for specialist services. This creates additional expense for the health system while potentially delaying patient care and/or discharge. Urinary retention is often straightforward, requiring only bladder rest and medical optimization prior to trial of void in the outpatient setting for resolution. We sought to evaluate whether or not a simple decision tree could assist medical hospitalists in appropriately selecting patients requiring inpatient urologic management from those who can be safely directed to outpatient care. METHODS: Consults for urinary retention were identified based on billing data from July 2019 through June 2021. Male and female retention guideline policies were implemented to assist primary teams in determining if a patient's retention could be managed via simple algorithm, or were deemed complex and requiring of inpatient urologic evaluation. Consults were considered complex if associated with gross hematuria with clots, recent pelvic trauma, neurologic deficits/injury, new or worsening hydronephrosis, or acute kidney injury. Patients were grouped into a pre-intervention 8-month period of July 2019 through February 2020, which was compared to a post intervention 10-month period of September 2020 through June 2021. March to August 2020 were excluded due to COVID-19 hospital volume changes. Chi square analysis was performed. RESULTS: A total of 163 retention consults were placed over the 18 study months. In the pre-intervention period, urology consultation was only truly required in 27/80 (33.8%). After implementation of the pathway, this significantly increased to 47/83 (56.6%, p=0.003). Furthermore while the percentage of monthly consults requiring inpatient consultation increased in the post-intervention period, the overall total number of consults decreased from 10.0/month to 8.3/ month. CONCLUSIONS: Implementation of this urinary retention pathway increased the number of relevant inpatient consults while decreasing the number of simple retention consults. The net effect was a decrease in overall consults. This simple pathway may have identified more complex patients while reducing overutilization of specialist care.

7.
Journal of Urology ; 207(SUPPL 5):e491, 2022.
Article in English | EMBASE | ID: covidwho-1886510

ABSTRACT

INTRODUCTION AND OBJECTIVE: Patients with non-muscleinvasive bladder cancer (NMIBC) that recurs after treatment with intravesical Bacillus Calmette-Guerin (BCG) must weigh the risk of progression of bladder cancer and loss of a window of potential cure with medical therapy against the risk of morbidity and loss of quality of life (QOL) with radical cystectomy. The CISTO Study (NCT03933826) is a pragmatic, prospective observational cohort study comparing medical therapy (i.e., intravesical therapy or systemic immunotherapy) with radical cystectomy for recurrent highrisk NMIBC. Here we report on the design and progress of the CISTO Study. METHODS: 900 patients with recurrent high-risk NMIBC that has failed first-line BCG and who have chosen to undergo standard of care treatment will be enrolled. Patient stakeholders helped determine the primary outcome: 12-month patient-reported QOL using the EORTC QLQ-C30. Secondary outcomes include urinary and sexual function, decisional regret, financial distress, healthcare utilization, return to work/normal activities, progression, and recurrence-free, metastasis-free, and overall survival. Participants will be followed for up to 3 years. RESULTS: Enrollment is active at 32 sites across the US, including 23 university-based centers and 9 community sites. As of November 1, 2021, 173 participants have been enrolled, 104 of whom chose medical therapy and 69 of whom chose radical cystectomy. The completion rate for the primary outcome of QOL at 12 months is 94% (15 out of 16 participants to date). The inclusion of electronic consent and collection of PROs allowed recruitment and follow-up to continue remotely during the COVID-19 pandemic. Significant pandemic-related challenges have included slow study start-up at sites, staffing, periods of suspension, and delays in patients obtaining care. Strategies to address these challenges include improved methods for onboarding and training sites, all-site communication, confirming study eligibility, ing EHR data, and remote monitoring while adhering to the highest study standards. CONCLUSIONS: The CISTO Study will compare patient reported outcomes for those undergoing medical therapy with radical cystectomy for recurrent high-risk NMIBC. The CISTO Study has the potential to fill critical evidence gaps and provide for personalized, patient-centered care.

8.
Journal of Urology ; 207(SUPPL 5):e257, 2022.
Article in English | EMBASE | ID: covidwho-1886490

ABSTRACT

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has impacted various clinical and research processes in urologic care. As part of a pragmatic clinical trial in bladder cancer, we collected information regarding the impact of COVID-19 at participating sites, which provides insight into how the pandemic has imposed constraints on clinical bladder cancer care and research. METHODS: Starting in May 2020, we distributed a monthly survey to sites participating in CISTO (Comparison of Intravesical Therapy and Surgery as Treatment Options for Bladder Cancer, NCT0393382). The survey included questions about interruptions in routine clinical bladder cancer care, specifically assessing elective surgery restrictions, impact on radical cystectomy, TURBT, office cystoscopies, intravesical therapy, and intravesical bacillus Calmette- Guerin (BCG) supply. We report survey responses for sites that responded to > 50% of the monthly surveys from May 2020 to October 2021. RESULTS: From May 2020 through October 2021, 21 sites (66%) had > 50% monthly response rate. The time periods of greatest limitations on bladder cancer procedures (Figure 1) were May-July 2020, Dec-Jan 2020/2021, and Sept-Oct 2021, corresponding to the peak waves of COVID-19 infections. Elective surgery was most affected, with limitations or holds in those time periods at up to 76%, 38%, and 28% of CISTO sites, respectively. Most of the restrictions involved surgeries that required inpatient stays, potential intensive care unit admission, and staffing shortages. 9 sites (28%) experienced transient BCG shortages during the survey period. CONCLUSIONS: Clinical activity was most limited during the initial COVID-19 surge in Spring/Summer 2020. Despite higher COVID- 19 infection rates in subsequent waves, bladder cancer clinical activity has been maintained at CISTO sites throughout the COVID pandemic. Periodic BCG shortages continue to affect bladder cancer care across the US. (Figure Presented).

9.
Journal of Sport & Exercise Psychology ; 44:S106-S106, 2022.
Article in English | English Web of Science | ID: covidwho-1880736
10.
Rheumatology (United Kingdom) ; 61(SUPPL 1):i63, 2022.
Article in English | EMBASE | ID: covidwho-1868393

ABSTRACT

Background/Aims The impact of dealing with COVID-19 for rheumatology higher specialist trainees has been profound. Sacrifices were made to their training to support the UK's pandemic response. Virtual Reality (VR) has long been used as a solution for specific surgical skills;providing a hands-on experience to enable specific delivery of outcomes. We utilised existing technology alongside a specialist VR and haptics team to review ways at delivering a valid and reliable training tool to administer joint injections, beginning with the review of this procedure specific to the knee. We aimed to describe this process. Methods A qualitative study using focus groups was undertaken, one medical student, four higher specialty trainees and two consultants were convened in a focus group to review existing mannequin-based training with the purpose of identifying a skill to develop in virtual reality. A story board was developed through collaboration with a graphic designer. The scenario was imbedded into a virtual reality environment in collaboration with a virtual reality partner. Results The focus group identified intra-articular knee injection as the most appropriate rheumatology skill to develop. Storyboarding built a series of scenarios around clinical situations which would require injection or aspiration. Working with the engineering team we successfully mapped knee joint anatomy and rendered an authentic clinical environment for the storyboards to run inside. Conclusion Virtual reality training scenarios are complex to develop but have enormous potential to create immersive training and assessment experiences which are not boundaried by the challenges of social distancing and COVID-19 risks.

11.
11th IEEE Integrated STEM Education Conference, ISEC 2021 ; : 83-90, 2021.
Article in English | Scopus | ID: covidwho-1861126

ABSTRACT

Since COVID-19 began spreading in the US and quickly established as a global pandemic in March of 2020, the NSF-funded STEM SEALS team at North Florida College faced the touch decision to either cancel their inaugural hands-on STEM enrichment camp planned for Summer 2020 or rushing at full speed to take it virtual. The biggest concern in making the decision to go virtual was a passionate belief in the importance of not losing the hands-on focus that had been planned. After all, the STEM SEALs effort at NFC was designed to expand access to high quality STEM experiences for historically underserved students in a high poverty, rural area. Changing from the in-person delivery to distance learning with minimal preparation presented a daunting challenge and also a unique opportunity;the opportunity to study the process and provide guidance to other STEM providers who are considering a move to a virtual platform. This exploratory study aimed to (1) identify the barriers to moving STEM enrichment programming in a rural environment from in-person to virtual activities during the COVID-19 pandemic, (2) describe key decisions that were made in transitioning to the virtual format along with the rationale behind those decisions, and (3) disseminate best practices that emerged from the inaugural effort. © 2021 IEEE.

12.
Technology and Innovation ; 22(2):219-224, 2022.
Article in English | Web of Science | ID: covidwho-1856507

ABSTRACT

The pandemic caused by the spread of the virus SARS-CoV-2 threatened to severely disrupt the activities of student-athletes. In order to provide a safe environment for athletic competition, the National Collegiate Athletic Association (NCAA) mandated testing of student-athletes. The goal was to rapidly identify student-athletes and the athletic staff member who either tested positive for SARS-CoV-2 or were in contact with individuals who tested positive. Rapid identification of infected individuals and their contacts allowed the University to implement quarantine standards and quarantine facilities quickly as needed. The University of Texas at Arlington (UTA) developed an in-house testing program and was quickly able to meet the NCAA requirements, allowing UTA to continue its athletic participation with minimal forfeiture of scheduled games. The purpose of this paper is to report the implementation UTRs COVID prevention program for the university's athletic program. This program may provide valuable information to other universities' planning for the management of COVID prevention in their athletic programs. Challenges and solutions are identified.

14.
Australasian Journal of Dermatology ; 63:63-63, 2022.
Article in English | Web of Science | ID: covidwho-1849122
15.
Australasian Journal of Dermatology ; 63:87-88, 2022.
Article in English | Web of Science | ID: covidwho-1848680
17.
Journal of the American College of Cardiology ; 79(9):2118-2118, 2022.
Article in English | Web of Science | ID: covidwho-1848364
18.
European Sport Management Quarterly ; 22(1):72-91, 2022.
Article in English | CAB Abstracts | ID: covidwho-1839938

ABSTRACT

Research question: The business of sport has been radically challenged by the COVID-19 pandemic, impelling a rapid reassessment of practices to survive the disruption. One stakeholder comprehensively impacted has been the media, whose investments in augmenting sport's commercial appeal have been immense. The media will need to rethink their strategies to adequately leverage their connections to sport products. Similarly, sport properties and content providers will need to reconsider their mediated offerings and how fan relationships can be sustained. In response, this article outlines a pathway to superior fan activation and engagement, noting the accelerated transformation of sport arising in consequence of the pandemic.

19.
FASEB Journal ; 35(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1821838

ABSTRACT

Due to the COVID-19 pandemic, there is increased interest to effectively deliver educational curricula remotely to diverse student populations. Case-based cadaveric MRI visualization and extended reality (XR) technology enhances learning experiences in medicine. The purpose of this study was to demonstrate that a virtual, multi-departmental workflow utilizing MRI, XR technology, and a “patient” group, represented by the John A. Burns School of Medicine (JABSOM) Willed Body Program, supplements case-based learning and promotes student exploration and engagement equally in cross-cultural cohorts represented by American and Turkish medical students. Virtual case-based learning activities were developed and presented to American medical students at JABSOM and Turkish medical students, selected based on education and English proficiency, via Zoom. Subject, medical history, and physical exam data were presented to students who were then divided into breakout rooms where hypotheses regarding cadaveric, neurological findings were generated. Students then reviewed radiology and pathology reports and accessed relevant 3D segmented, photogrammetric and illustrative models. An optional survey was completed to evaluate student opinion based on a 5-point Likert scale. Comparisons between groups were performed using a non-parametric Mann Whitney U test. Data was reported as mean, median (min-max), and percentile. Significant differences (two-tailed P) less than 0.05 were significant. Results revealed significant differences between American (n=40) and Turkish (n=16) student opinion. The Turkish scale was significantly higher when asked if MRI scans of cadavers were useful as online learning tools (p =0.002), if MRI scans of cadavers provided an understanding of relevant anatomy (p<0.001), if 3D models provided a better understanding of anatomical relationships (p<0.001), whether students would like more interactive sessions using MRI scans (p<0.001), and if students would use similar resources in the future (p<0.001). The American scale was higher when asked if students were able to communicate effectively with their breakout groups (p=0.037). The learning activity was positively received by both cohorts as shown by no average score less than a 4 out of 5 for each question. The American scales may have been lower due to having previous experience with similar activities, whereas the learning activity was novel and exciting to Turkish students. Differences in communicating effectively in breakout rooms can be explained by the fact that American students were broken into longitudinal dissection groups, whereas Turkish students were randomly assigned. Based on these results, case-based learning, utilizing MRI and XR technology, enhances the learning experience of medical students and can be expanded to cross-cultural student populations.

20.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-333661

ABSTRACT

To understand the diversity of immune responses to SARS-CoV-2 and distinguish features that predispose individuals to severe COVID-19, we developed a mechanistic, within-host mathematical model and virtual patient cohort. Our results indicate that virtual patients with low production rates of infected cell derived IFN subsequently experienced highly inflammatory disease phenotypes, compared to those with early and robust IFN responses. In these in silico patients, the maximum concentration of IL-6 was also a major predictor of CD8 + T cell depletion. Our analyses predicted that individuals with severe COVID-19 also have accelerated monocyte-to-macrophage differentiation that was mediated by increased IL-6 and reduced type I IFN signalling. Together, these findings identify biomarkers driving the development of severe COVID-19 and support early interventions aimed at reducing inflammation. AUTHOR SUMMARY: Understanding of how the immune system responds to SARS-CoV-2 infections is critical for improving diagnostic and treatment approaches. Identifying which immune mechanisms lead to divergent outcomes can be clinically difficult, and experimental models and longitudinal data are only beginning to emerge. In response, we developed a mechanistic, mathematical and computational model of the immunopathology of COVID-19 calibrated to and validated against a broad set of experimental and clinical immunological data. To study the drivers of severe COVID-19, we used our model to expand a cohort of virtual patients, each with realistic disease dynamics. Our results identify key processes that regulate the immune response to SARS-CoV-2 infection in virtual patients and suggest viable therapeutic targets, underlining the importance of a rational approach to studying novel pathogens using intra-host models.

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