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1.
Nursing Economics ; 39(5):215-224, 2021.
Article in English | Scopus | ID: covidwho-2072996

ABSTRACT

During the early stages of the COVID-19 pandemic, providers initially based treatment decisions upon established guidelines for adult respiratory distress syndrome. Even though emergency intubation and mechanical ventilation were recommended for first-line treatment of critically ill patients, clinical leaders in one New Jersey hospital observed mortality rates increased sharply for patients with COVID-19 receiving mechanical ventilation, particularly among the elderly. An interprofessional team created a Deterioration Report, which aggregated key laboratory, radiologic, and other clinical biomarkers. A follow-up provider satisfaction survey indicated treatment decisions were positively influenced by the Deterioration Report, to the extent at-risk patients were identified rapidly and accurately, placed on high-flow oxygenation as first-line treatment, and successfully avoided intubation in most cases. © 2021, Anthony J. Jannetti Inc.. All rights reserved.

2.
Journal of General Internal Medicine ; 37:S318, 2022.
Article in English | EMBASE | ID: covidwho-1995830

ABSTRACT

BACKGROUND: The East Harlem Health Outreach Partnership (EHHOP) is a student-run clinic that serves a particularly vulnerable patient population lacking access to basic health insurance, largely because many do not meet USA residency requirements. COVID-19 has exacerbated the existing health disparities faced by our patients, who are predominantly Black and/or Hispanic/Latino living in East Harlem, one of the hardest hit neighborhoods in NYC. We hypothesized that high engagement in longitudinal care through the student-run clinic is associated with especially high rates of vaccine confidence and vaccine uptake. METHODS: This study included phone interviews with 63 EHHOP patients between 12/13/20 and 3/3/21. We asked 14 questions in order to measure vaccine confidence, COVID-19 sentiment, and patient trust. Patients were ages 21-78 with an even distribution of male and female patients. Most interviews were conducted in Spanish with professional translators, and the survey was created both in English and Spanish. All questions were scored on a 1-5 scale of agreement with a given. Patients were then followed through December of 2021 in order to ascertain vaccine uptake over time. RESULTS: 95.2% of those interviewed are now confirmed to be vaccinated (60/63), 3.2% have refused (2/63), and only 1.6% have unknown status (1/63). Both patients who chose not to be vaccinated had responded they were unlikely to get the COVID-19 vaccine. When comparing those likely to get the vaccine versus those who were not, the most highly significant differences in scores came when asking whether patients are more likely to take the vaccine due to their physician recommending it, and when asked whether they generally trusted those recommending they get the vaccine (p = 4.8E-5 and 4.3E-6 respectively). The next most significant differences were in perceptions of whether the vaccine would be effective and whether they felt the vaccine was created too quickly (p = 3.3E-2 and 5.3E-3 respectively). We also have precise day of first dose information for 51/60 vaccinated respondents. While there may be confounders, we found that choosing to be vaccinated earlier correlated most significantly with whether individuals were likely to take the vaccine, whether the trusted those recommending the vaccine, and whether they felt the vaccine was created too quickly (p = 3.6E-2, 1.5E-2, and 1.4E-2 respectively). CONCLUSIONS: These data indicate that the strongest predictors of vaccine uptake rate and timing are not just vaccine confidence in general, but specifically trust in those recommending the vaccine. This indicates that even in the context of marginalized populations often underserved by the healthcare system, longitudinal trust-building relationships may be a significant part of successful vaccine uptake. Those with the highest burden of disease should be given preferential treatment with high-quality, longitudinal care, and such care is shown to make a great difference in the context of vaccine uptake.

3.
Journal of General Internal Medicine ; 37:S164, 2022.
Article in English | EMBASE | ID: covidwho-1995679

ABSTRACT

BACKGROUND: The COVID-19 pandemic led to a large increase in virtual care. Traditionally, E-visits (asynchronous provider evaluation via an online portal) and video visits (synchronous evaluation using real-time audio/video) have been utilized. However, there are racial, financial, and age-related disparities in home broadband access (Pew). During the pandemic, payers reimbursed telephone evaluation and management visits, increasing access to virtual care. However, barriers remained for patients without broadband access or video-enabled devices. We aim to assess racial disparity between black and white patients and whether age or socioeconomic status are associated with use of virtual visits. METHODS: A retrospective review was conducted of first-time visits with primary care providers from 3/1/20 to 6/30/20 at a large health system. Data was collected on type of visit, race, age, and area deprivation index (ADI).ADI ranks neighborhoods by socioeconomic status (SES) using census block groups based on income, house quality, employment, and education. Higher ADI is a marker of lower socioeconomic status (ADI of 10 is lowest SES, ADI of 1 is highest SES). RESULTS: 72153 unique patients were identified of whom 31037 (43%) received virtual care;13871 (19.2%) video, 14697 (20.3%) telephone (audio only), and 2469 (3.4%) E-visits. The mean age was 55.6 years, 32760 (45.4%) individuals identified as black, and 44784 (62.1%) were female. The average ADI was 5.23 (±3.17). Black patients had lower SES compared to white patients (6.96±2.93 vs 3.8±2.6). There was no difference in overall virtual care use rate between black and white patients (45.6% vs 45.2%, p=0.240). However, black patients were less likely to use E-visits (4.7% vs 6.4%, p=0.001), with no difference between telephone (26.5% vs 26.2%, p=0.298) or video visits (25.2% vs 25.3%, p=0.823). In multivariable logistic regression (Table 1), although black race was not significantly associated with virtual care use for primary care, age and SES did predict access to virtual care suggesting ages 18-29 and >65 and higher SES were less likely to utilize virtual care. CONCLUSIONS: During the first wave of the COVID-19 pandemic, black and white patients used virtual care at equal rates. However, there is a complex relationship between race, age and virtual care use. Further research is needed to examine the causal mechanisms.

4.
JOURNAL OF GENERAL INTERNAL MEDICINE ; 37(SUPPL 2):164-164, 2022.
Article in English | Web of Science | ID: covidwho-1935185
5.
Plants People Planet ; : 11, 2021.
Article in English | Web of Science | ID: covidwho-1588895

ABSTRACT

Societal Impact Statement Currently, there is no national overview of environmental science engagement in the United Kingdom. Children are key stakeholders in the future of science more generally and environmental science specifically. Appraising the situation immediately before the United Kingdom first entered lockdown due to the COVID-19 pandemic allows both assessment of the achievements of the UK environmental science engagement field before the impacts of the changes resulting from the pandemic, and an up-to-date baseline by which to assess those impacts and identify existing gaps to be addressed post-pandemic. Results indicate that support is needed to increase reach and recognition of the importance of engagement, particularly in rural areas and outside Southeast England. Scoping research was carried out as the first step towards addressing knowledge gaps around engagement of school-aged children with environmental science in the United Kingdom. Key objectives were identifying which institutions carry out this engagement, its scope and where further engagement is needed, and assessing visibility of projects. Examples of good practice were also highlighted to inform the wider community. This was carried out via systematic online searches and an online survey of UK-based environmental science engagement professionals, February to March 2020. Most projects were operating locally with a smaller proportion also operating nationally or internationally. Remote engagement comprised a low proportion of delivery, with most projects engaging children in school during school time, using practical sessions. Universities, charities, trusts and societies comprised the majority of hosting institutions. Visiting a low number of schools, a low number of times per year was common, although some projects reached thousands of children in many schools. There was a focus on reaching children aged 7-14 years, relatively evenly split between primary and secondary phases. All major environmental science themes were well represented. Most evaluation and reporting was simple and descriptive, and while key areas for expansion included widening reach in terms of numbers and geography, funding was highlighted as a barrier to achieving this. Results give a snapshot of the state of play before the United Kingdom entered lockdown during the COVID-19 pandemic, also providing a baseline by which to assess impacts post-pandemic.

7.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277773

ABSTRACT

Rationale: Severe coronavirus disease 2019 (COVID-19) is associated with important variations within the immune system and the coagulation cascade. We have developed a robust method for computing ventilation (CT-V) and perfusion (CT-P) from dynamic non-contrast CT scan, which can detect ventilation-perfusion (VQ) mismatch at a voxel level. We hypothesize that COVID-19 patients with mild disease will still have a higher VQ mismatch compared to patients with no respiratory symptoms. Methods: We included 12 random patients with mild symptoms from a prospective study characterizing quantitative lung function in patients with COVID-19 (NCT04320511) and compared their VQ scores to 12 patients with no respiratory symptoms in the NORM dataset (NCT00848406) matched to age, gender and BMI. The CT-P and CT-V methods apply image processing and physical modeling to an Inhale/Exhale CT image pair to generate a quantitative CT-P and CT-V images. We calculated VQ mismatch as the percent of lung voxels with residual fit errors 4 standard deviations apart from a least median of squares quadratic regression model describing CT-P as a function of CT-V.Results: All included COVID cases were hospitalized to regular floors and were breathing at room air, except for 3 patients on supplemental oxygen < 3L/min. The mean CT-V scores were significantly lower in COVID-19 cases compared to controls (0.46 vs. 1.39, 95% CI difference 0.51, 1.33, p 0.001). Likewise, the mean CT-P scores were significantly lower in COVID-19 cases vs. controls (0.14 vs. 0.18, 95% CI difference 0.02, 0.08, p 0.004). However, the median VQ mismatch scores were significantly higher in COVID-19 cases [0.300 (IQR 0.287,0.320) vs. 0.270 (IQR 0.233,0.293), p 0.04], see figure. Conclusion: Patients with COVID-19 have significant derangements in pulmonary physiology, VQ mismatch despite having minimal to no-oxygen requirements. Progression of VQ mismatch from an early stage could be studied to identify patients at risk for mechanical ventilation and mortality. Figure: (Left) Box plots of the VQ scores for each COVID cases vs. controls. (Right) Representative CT-V and CT-P in a patient with COVID-19 pneumonia with corresponding CT scan. Higher function areas appear red and low function areas appear bluer. Top row depicts "Dead space ventilation" with normal appearing CT scan but diminished areas of perfusion in the right lung and preserved ventilation. Bottom row demonstrates area of pneumonia in the left upper lung zone with "Shunt physiology". CT-P shows increased activity with reddish hue, whereas corresponding ventilation is diminished in the same area.

8.
Jnp-Journal for Nurse Practitioners ; 17(4):492-496, 2021.
Article in English | Web of Science | ID: covidwho-1235958

ABSTRACT

The purpose of this quality improvement initiative was to identify anxious/distressed lung cancer patients and address their mental health needs directly related to the COVID-19. A total of 441 patients were screened utilizing a national distress thermometer. 47% were counseled by the NP, 32% sent for referral to the social worker. Patients reported reasons for distress as fear of delaying testing, contracting the virus and changes in their lifestyle. We found that screening all patients during the pandemic, yielded a higher than normal percentage of patients who were in need of some level of mental health services. (c) 2020 Elsevier Inc. All rights reserved.

9.
Dental Update ; 47(8):662-668, 2020.
Article in English | Scopus | ID: covidwho-891689

ABSTRACT

Silver diamine fluoride (SDF) is applied topically to arrest caries and has an increasing evidence base to support its efficacy, both in the primary dentition and to arrest root caries in older patients. It can be used as a non-aerosol generating procedure and is a simple technique. It has a side-effect of discolouring caries black, a factor which requires discussion with patients and their carers prior to application. Due to its efficacy and simplicity, it is a useful intervention for the management of caries. CPD/Clinical Relevance: Caries is a common condition in the UK, and silver diamine fluoride offers a simple alternative management technique when case selection is appropriate. © 2020 George Warman Publications. All rights reserved.

10.
Psychiatry Res ; 292: 113345, 2020 10.
Article in English | MEDLINE | ID: covidwho-680656

ABSTRACT

We report distress levels and functional outcomes based on self-reported pre-existing mental health conditions among U.S. young adults (N=898) during the COVID-19 pandemic (April 13-May 19, 2020). Depression, anxiety, and PTSD symptoms, as well as COVID-19-related concerns, sleep problems, and quality of life were compared across the following pre-existing mental health groups: 1) no diagnosis, 2) suspected diagnosis, 3) diagnosed and untreated, and 4) diagnosed and treated. Compared to those without a diagnosis, the likelihood of scoring above the clinical threshold for those with a diagnosis - whether treated or not - was more than six-fold for depression, and four-to six-fold for anxiety and PTSD. Individuals with a suspected diagnosis were 3 times more likely to score above the clinical threshold for depression and anxiety and 2 times more as likely to score above this threshold for PTSD compared to those with no diagnosis. We also present higher levels of COVID-19-related worry and grief, poorer sleep, and poorer reported health-related quality of life among those with either a suspected or reported mental health diagnosis. Findings provide evidence of vulnerability among individuals with a mental health diagnosis or suspected mental health concerns during the initial weeks of the COVID-19 pandemic.


Subject(s)
Coronavirus Infections/psychology , Mental Disorders/epidemiology , Pneumonia, Viral/psychology , Psychological Distress , Quality of Life/psychology , Sleep Initiation and Maintenance Disorders/epidemiology , Anxiety/epidemiology , Anxiety/psychology , Anxiety Disorders/epidemiology , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Depression/epidemiology , Depression/psychology , Female , Humans , Male , Mental Health , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Sleep Initiation and Maintenance Disorders/psychology , United States/epidemiology , Young Adult
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