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1.
Journal of General Internal Medicine ; 37:S604, 2022.
Article in English | EMBASE | ID: covidwho-1995731

ABSTRACT

SETTING AND PARTICIPANTS: Montefiore Health System is the largest health care provider in Bronx, New York, a community that is disproportionately impacted by substance use disorders (SUDs). To better prepare resident physicians to care for patients with SUDs, we developed a novel addiction medicine rotation required for internal medicine residents. DESCRIPTION: The 2-week rotation includes inpatient and outpatient clinical experiences. During the inpatient week, residents rotate on the Addiction Consult Service, staffed by an addiction medicine attending, a fellow, and a peer navigator. Residents attend a weekly interdisciplinary meeting with the Psychiatry Consult Service to discuss cases. During the outpatient week, residents rotate through an opioid treatment program, an intensive outpatient substance use treatment program, and an addiction medicine “Bridge” clinic, which links patients with SUDs to primary care post- hospitalization. Residents also complete a self-study curriculum that includes addiction-focused readings and podcasts as well as the 8-hour online buprenorphine waiver training. All residents participate in Addiction Medicine Rounds, a weekly case conference and journal club led by addiction medicine faculty and trainees. EVALUATION: Between July and November 2021, 22 internal medicine residents participated in the rotation and 12 (55%) completed formal evaluations. All residents rated the overall rotation to be valuable for their education, with 33% in strong agreement based on a 4-point scale from strongly disagree to strongly agree. All residents also agreed (with 42% strongly agreed) that the rotation increased their knowledge and skills in diagnosing SUDs, and managing medication treatment for SUDs. One resident summarized: “This rotation is one of the best rotations I have experienced during my time as a resident. After completing this rotation, I felt very confident in my ability to diagnose, navigate, and manage the complexities of addiction related illness.” DISCUSSION / REFLECTION / LESSONS LEARNED: The Addiction Medicine Rotation was well-received in its first months of implementation. The experience on the Addiction Consult Service stood out as high-yield training, building on residents' familiarity with hospital-based care and leveraging multidisciplinary partnerships with psychiatry, pharmacy, and nursing departments. Providing rigorous inpatient training in addiction medicine is a unique feature of this rotation, as addiction consult services are not the mainstay in most hospitals. The “Bridge” clinic has also been valuable in training residents to provide medication treatment for SUDs within primary care. However, the outpatient experience in specialty care settings faced many scheduling challenges related to the COVID-19 pandemic, with reduced availability of preceptors, decreased number of in-person visits, and suspended group treatment. Optimizing outpatient addiction medicine training will be an ongoing goal in future rotation iterations. ONLINE RESOURCE URL: Rotation document: https://tinyurl.com/ MontefioreAddMedRotation.

2.
Journal of Allergy and Clinical Immunology ; 149(2):AB174-AB174, 2022.
Article in English | Web of Science | ID: covidwho-1798104
3.
Anaesthesia ; 2022 Mar 23.
Article in English | MEDLINE | ID: covidwho-1752489

ABSTRACT

Respiratory adverse events in adults with COVID-19 undergoing general anaesthesia can be life-threatening. However, there remains a knowledge gap about respiratory adverse events in children with COVID-19. We created an international observational registry to collect airway management outcomes in children with COVID-19 who were having a general anaesthetic. We hypothesised that children with confirmed or suspected COVID-19 would experience more hypoxaemia and complications than those without. Between 3 April 2020 and 1 November 2020, 78 international centres participated. In phase 1, centres collected outcomes on all children (age ≤ 18 y) having a general anaesthetic for 2 consecutive weeks. In phase 2, centres recorded outcomes for children with test-confirmed or suspected COVID-19 (based on symptoms) having a general anaesthetic. We did not study children whose tracheas were already intubated. The primary outcome was the incidence of hypoxaemia during airway management. Secondary outcomes included: incidence of other complications; and first-pass success rate for tracheal intubation. In total, 7896 children were analysed (7567 COVID-19 negative and 329 confirmed or presumed COVID-19 positive). The incidence of hypoxaemia during airway management was greater in children who were COVID-19 positive (24 out of 329 (7%) vs. 214 out of 7567 (3%); OR 2.70 (95%CI 1.70-4.10)). Children who had symptoms of COVID-19 had a higher incidence of hypoxaemia compared with those who were asymptomatic (9 out of 51 (19%) vs. 14 out of 258 (5%), respectively; OR 3.7 (95%CI 1.5-9.1)). Children with confirmed or presumed COVID-19 have an increased risk of hypoxaemia during airway management in conjunction with general anaesthesia.

4.
Open Forum Infectious Diseases ; 8(SUPPL 1):S22-S23, 2021.
Article in English | EMBASE | ID: covidwho-1746807

ABSTRACT

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

5.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-293573

ABSTRACT

Despite the great promise of vaccines, the COVID-19 pandemic is ongoing and future serious outbreaks are highly likely, so that multi-pronged containment strategies will be required for many years. Nanobodies are the smallest naturally occurring single domain antigen binding proteins identified to date, possessing numerous properties advantageous to their production and use. We present a large repertoire of high affinity nanobodies against SARS-CoV-2 Spike protein with excellent kinetic and viral neutralization properties, which can be strongly enhanced with oligomerization. This repertoire samples the epitope landscape of the Spike ectodomain inside and outside the receptor binding domain, recognizing a multitude of distinct epitopes and revealing multiple neutralization targets of pseudoviruses and authentic SARS-CoV-2, including in primary human airway epithelial cells. Combinatorial nanobody mixtures show highly synergistic activities, and are resistant to mutational escape and emerging viral variants of concern. These nanobodies establish an exceptional resource for superior COVID-19 prophylactics and therapeutics.

6.
European Journal of Public Health ; 31, 2021.
Article in English | ProQuest Central | ID: covidwho-1514834

ABSTRACT

Background The COVID-19 pandemic demonstrated the need for better pandemic preparedness and response, and more international collaboration. The H2020 EU-funded PANDEM-2 project aims to prepare Europe for future pandemics. As part of the project, an European dashboard consisting of epidemiological data and insights on available pandemic health care capacity is developed. To model and map the availability of pandemic resources, data on the use of these resources and interdependencies between resources are needed to parametrize the resource model of the PANDEM-2 dashboard. Methods We conduct a systematic literature review. The database Embase.com was searched on articles that include a model, scenario, or simulation of pandemic resources and/or describe resource parameters, for example PPE usage, length of stay on the ICU, or vaccine efficacy. Our search included data from all continents and focuses on infectious diseases that have been declared a pandemic by the WHO in the last twenty years, which are the H1N1 influenza (2009-2010) and COVID-19 (ongoing). Preliminary results The search query and additional sources resulted in 1215 articles, of which 187 are included for the full text eligibility assessment. We identified several pandemic resources in the field of vaccination (vaccine efficacy), contact tracing (apps), general practitioners, the hospital (staff, PPE, ventilators), and national and regional public health institutes. Furthermore, interdependencies between resources and possible resource gaps were found, for example in hospital staff and PPE. Conclusions To be better prepared and to be able to respond fast to a pandemic outbreak, it is important to have insight in the availability of pandemic resources on a national and regional level, their use and mutual dependencies. This makes it possible to anticipate on fast changes and possible shortages by reallocating resources within and between regions.

7.
Multiple Sclerosis Journal ; 27(2 SUPPL):621-622, 2021.
Article in English | EMBASE | ID: covidwho-1496023

ABSTRACT

Introduction: Cladribine tablets (CladT) are taken as 2 short annual courses for the treatment of multiple sclerosis (MS), with treatment indications differing by country. Adveva® is a nurse/ pharmacy-led patient support programme (PSP) that provides drug education and support to patients taking CladT, and collects treatment-related clinical information. Objectives: Evaluate treatment adherence during Year 2 of treatment with CladT in Australia, Canada, and the UK, and whether there was an effect of the COVID-19 pandemic on treatment adherence. Methods: PSP data routinely collected from Australia, Canada, and the UK between 05Dec2017 (launch of CladT in first participating country) and 28Feb2021 (cut-off date) were included in this analysis. Demographics and date of treatment initiation of Year 1 and Year 2 were recorded. Patients were monitored using telephone check-in from treatment initiation until cut-off date, loss to follow-up, or treatment discontinuation. Time to Year 2 of treatment initiation was estimated overall and in two periods (before and during COVID-19) defined by the start date of the pandemic in each country (Australia: 13Mar2020;Canada: 16Mar2020;UK: 23Mar2020). Results: Overall, 3,536 patients initiated CladT during the study period (Australia, n=598;Canada, n=1,973;UK, n=965). Approximately 76% were female in each country. Most had received prior disease-modifying therapy (Australia, 75.6%;Canada, 100%;UK, 44.1%). Among patients with at least 18 months of follow-up since Year 1 initiation, the vast majority had initiated Year 2 of treatment (Australia, n=415 [90.6%];Canada, n=1213 [90.8%];UK, n=578 [88.0%]). The mean time to Year 2 initiation in Australia, Canada, and the UK was 13.02 (standard deviation [SD]: ±2.02), 13.15±1.95, and 14.45±2.71 months, respectively. Mean time (months ±SD) to initiation of Year 2 treatment was similar before and during the COVID-19 pandemic in all countries (Australia: 12.49±1.01 and 13.87±2.81;Canada: 12.79±1.33 and 13.43±2.28;UK: 13.28±1.25 and 15.47±3.19). Among those initiating Year 2 of treatment, a delay of at least 6 months to initiation of dosing was seen for 4.1% of patients in Australia, 2.7% in Canada, and 7.6% in the UK. Conclusions: Treatment adherence to CladT was high and consistent between participating countries, and was not influenced by the COVID-19 pandemic. The existence of a robust nurse/pharmacy- led PSP enables valuable data collection and likely facilitates adherence.

8.
Sci Rep ; 11(1): 3461, 2021 02 10.
Article in English | MEDLINE | ID: covidwho-1078603

ABSTRACT

Despite ongoing efforts to characterize the host response toward SARS-CoV-2, a major gap in our knowledge still exists regarding the magnitude and duration of the humoral response. Analysis of the antibody response in mild versus moderate/severe patients, using our new developed quantitative electrochemiluminescent assay for detecting IgM/IgA/IgG antibodies toward SARS-CoV-2 antigens, revealed a rapid onset of IgG/IgA antibodies, specifically in moderate/severe patients. IgM antibodies against the viral receptor binding domain, but not against nucleocapsid protein, were detected at early stages of the disease. Furthermore, we observed a marked reduction in IgM/IgA antibodies over-time. Adapting our assay for ACE2 binding-competition, demonstrated that the presence of potentially neutralizing antibodies is corelated with IgG/IgA. Finally, analysis of the cytokine profile in COVID-19 patients revealed unique correlation of an IL-12p70/IL33 and IgG seroconversion, which correlated with disease severity. In summary, our comprehensive analysis has major implications on the understanding and monitoring of SARS-CoV-2 infections.


Subject(s)
COVID-19/immunology , Immunoglobulin G/immunology , Interleukin-12/blood , Interleukin-33/blood , Seroconversion/physiology , Antibody Formation , COVID-19/blood , COVID-19/diagnosis , Humans , Severity of Illness Index
9.
Mkg-Chirurg ; 2020.
Article in English | Web of Science | ID: covidwho-863907

ABSTRACT

Background Oncology patients require an interdisciplinary approach to diagnosis and treatment. Therefore, communication structures should be established in order to prevent information gaps between medical partners, particularly in case of larger geographical distances. Objective The article describes different kinds of electronic record systems and emphasizes the differences between electronic case records, managed by medical doctors, and electronic health records (EHR), which will be introduced on January 1, 2021. Some useful applications and experiences in the use of intersectoral health records are presented Materials and methods Communication via EHR must follow current guidelines and approved concepts. As application scenarios in oncologic care or advisory services for COVID-19 patients requiring intensive care or nephrology patients, some experiences of the EHR provider RZV are presented. Finally, a forecast for the period beginning January 1, 2021, describes the linkage of electronic case records with the EHR. Results and discussion The electronic case record has proven its usefulness in several intersectoral settings. In addition to direct integration into primary systems, it enables an entirely digital communication processes. Additional services, e.g., provision of image data or online forms, can increase the acceptance of electronic case records. In the future, it will be important to link electronic case records directly with the EHR, to avoid placing an increased burden on physicians during communication with other service providers and patients.

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