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1.
Critical Care Medicine ; 51(1 Supplement):547, 2023.
Article in English | EMBASE | ID: covidwho-2190664

ABSTRACT

INTRODUCTION: An impacted population of the COVID-19 pandemic is those with limited English proficiency (LEP). Due to visitor restrictions, caregivers were unable to facilitate communication with hospital staff, and those with LEP were more susceptible to poor communication with their healthcare providers. METHOD(S): Data was ed from the BIDMC site of the SCCM VIRUS Discovery Database, a de-identified, HIPAA-compliant database containing clinical information for COVID-19 patients admitted to BIDMC. Patients were placed into two groups, either requiring translator services for any language or not. Statistical analyses were performed in R Version 3.0 to calculate test statistics such as ANOVA and Chi-Square p-values. The primary outcome assessed length of stay (LOS). Secondary outcomes included complications, discharge status of alive or deceased, discharge location of either home or another care facility, and number of symptomatic days before hospital admission. The association between non-White, non-Hispanic demographics and need for translation services was also examined. RESULT(S): 1522 patients were included with 91 excluded due to unknown use of translator services. The relationship between the requirement of an interpreter and LOS, complications, and symptomatic days was not statistically significant. However, statistically significant findings include patients who required translational services were more likely discharged alive (OR 1.53, 95% CI 1.07-2.24), and discharged to their homes (OR 1.42, 95% CI 1.07-1.91). Use of translator services was strongly associated with minority status (OR 5.20, 95% CI 3.81-7.21). A limitation of this dataset is that deceased status is only recorded if the patient dies during the index visit, potentially missing those who expire from COVID-related complications post-discharge. CONCLUSION(S): The requirement of a translator was not correlated with longer hospital stays, more complications, or days symptomatic prior to admission in comparison to the patients' English-speaking counterparts. However, the use of a translator was positively correlated with survival, discharge home, and minority status. The increased odds of discharge home could be due to the cultural values of minorities providing care in a familial setting.

2.
Critical Care Medicine ; 51(1 Supplement):545, 2023.
Article in English | EMBASE | ID: covidwho-2190662

ABSTRACT

INTRODUCTION: Racism has been identified as a driver of health disparities. The COVID pandemic has widened the gap between Whites and racial minorities, resulting in an even greater burden of disease and poorer health outcomes. The Boston area has a greater wealth disparity between these groups compared to the national average. We hypothesize that African American and Hispanic groups in the Boston Area have carried a greater burden of severe disease compared to Whites. METHOD(S): This cross-sectional study included 1,272 single-event adults admitted to Beth Israel Deaconess Medical Center (Boston, MA) due to COVID from March 2020 to April 2022. Patients were grouped by demographics captured in the medical records. Three groups were determined to have the appropriate sample sizes for analysis: Hispanics of any race, African American Non-Hispanics, and White Non-Hispanics. The primary outcome assessed was ICU admission rates;secondary analyses included length of hospitalized and ICU stay and comorbidity rates. Statistical analyses were performed in R Version 3.0. RESULT(S): Out of our sample, 31% were African American (AA), 20% Hispanic, and 49% White. Compared to Whites, ICU admission rates for AA patients were higher than for Hispanics, with an odds ratio (OR) of 1.45 (95% CI, [1.11,1.91]) and 1.21 [1.27, 1.64], respectively. When adjusting for sex, age, and comorbidities, the same pattern was observed: ICU admission rates for AAs were positively associated for both males (1.64, [1.11,2.43] and females (1.19, [1.04,1.36]), but only for Hispanic females (1.44, [1.05,1.97]). AAs and Hispanics had a significantly higher OR of having 3+ comorbidities (1.3, [1.13,1.72] and 1.47 [1.12, 1.96]). CONCLUSION(S): Ethnic minority groups have suffered a disproportionately greater burden of disease related to COVID. Our study shows that ICU admission was positively associated with AA and Hispanic race, opposite to what had been previously shown in some publications. Our findings could help reorient public health measures to improve health outcomes in these populations.

4.
Swiss Medical Weekly ; 152(264):11S, 2022.
Article in English | EMBASE | ID: covidwho-2125588

ABSTRACT

Background: The outbreak of the COVID-19 pandemic had, besides the huge impact on private lives for the individual, also a big impact on health care systems worldwide. [1,2] An association between healthcare workers' stress as a main component of wellbeing and patient safety has been shown in different studies. [3] Aim/objective: The presented study is part of a project on "Sustainable PRofessional life under a pandEMic" (SUPREM) which includes standardized, validated instruments and has the aim to investigate stress factor perception and safety climate among coworkers in ICUs while caring for COVID-19 positive patients. This study was conducted at five Swedish hospitals and one German hospital during the pandemic. This refers to the German data. Method(s): All participants (physicians, nurses, physiotherapists;n = 120) gave their written informed consent. A nine-item questionnaire was used to collect the self-reported perception of stress factors in which each proposal was rated on a five-point Likert-type scale from 'I strongly disagree' (1) to 'I strongly agree' (5). Data is presented in percent of participants answering, "strongly agree". Additionally, free text questions were used to provide the participants with the opportunity to add stress factors. Result(s): The fear of infecting someone else was rated as a main stress factor in the German survey (45,0%). The fact that relatives were not allowed to visit the patients was also rated high (35,0%) together with the concern of making mistakes (29,2%). Discussion/conclusions: The fear of infecting someone else as the main stress factor in this study might mirror the mix of a pandemic where so much knowledge was lacking in the beginning together with a potential lack of protection gear. Other top stress factors show a commitment to involve relatives and keep up patient safety. This study might contribute to improve conditions regarding times of exceeded workload, like in a pandemic and to maintain staff wellbeing by highlighting factors that contribute to perceived stress.

5.
Open Forum Infectious Diseases ; 8(SUPPL 1):S18-S19, 2021.
Article in English | EMBASE | ID: covidwho-1746813

ABSTRACT

Background. While COVID-19 carries substantial morbidity and mortality, the extent of long-term complications remains unclear. Reports suggest that acute lung damage associated with severe COVID-19 can result in chronic respiratory dysfunction. This study: (1) estimated the incidence of dyspnea and ILD after COVID-19 hospitalization, and (2) assessed risk factors for developing dyspnea and ILD in a real-world cohort of patients hospitalized with COVID-19 using US electronic health records (EHR). Methods. Patients in the Optum de-identified COVID-19 EHR database who were hospitalized for COVID-19 (lab confirmed or diagnosis code) between February 20 and July 2020 and had at least 6 months of follow-up were eligible for analysis. Dyspnea and ILD were identified using diagnosis codes. The effects of baseline characteristics and hospitalization factors on the risk of incident dyspnea or ILD 3 to 6 months' post discharge were evaluated. Results. Among eligible patients (n=26,339), 1705 (6.5%) had dyspnea and 220 (0.8%) had ILD 3 to 6 months after discharge. Among patients without prior dyspnea or ILD (n=22,613), 110 (0.5%) had incident ILD (Table 1) and 1036 (4.6%) had incident dyspnea (Table 2) 3 to 6 months after discharge. In multivariate analyses, median (IQR) length of stay (LOS;5.0 [3.0, 9.0] days in patients who did not develop ILD vs 14.5 [6.0, 26.0] days in patients who developed ILD;RR: 1.12, 95% CI: 1.08, 1.15;P=4.34 x 10-10) and age (RR: 1.02, 95% CI: 1.01, 1.03;P=4.63 x 10-3) were significantly associated with ILD. Median (IQR) LOS (5.0 [3.0, 9.0] days in patients who did not develop dyspnea vs 7 [4.0, 14.0] days in patients who developed dyspnea;RR: 1.04, 95% CI: 1.02, 1.06;P=8.52 x 10-4), number of high-risk comorbidities (RR: 1.18, 95% CI: 1.12, 1.24;P=3.85 x 10-9), and obesity (RR: 1.52, 95% CI: 1.25, 1.86;P=2.59 x 10-4) were significantly associated with dyspnea. Conclusion. In a real-world cohort, 4.6% and 0.5% of patients developed dyspnea and ILD, respectively, after COVID-19 hospitalization. Multivariate analyses suggested that LOS, age, obesity, and comorbidity burden may be risk factors for post-COVID-19 respiratory complications. Limitations included sensitivity of diagnosis codes, availability of labs, and care-seeking bias.

6.
Open Forum Infectious Diseases ; 8(SUPPL 1):S359-S360, 2021.
Article in English | EMBASE | ID: covidwho-1746482

ABSTRACT

Background. COVID-19 remains a threat to public health, with over 30 million cases in the US alone. As understanding of optimal patient care has improved, treatment guidelines have continued to evolve. This study characterized real-world trends in treatment for US patients hospitalized with COVID-19, stratified by whether patients required invasive ventilation. Methods. US patients diagnosed and hospitalized with COVID-19 between March 23 and December 31, 2020, in the Optum de-identified COVID-19 electronic health record (EHR) data set were identified. Both drug and procedure codes were used to ascertain medications, and both procedure and diagnostic codes were used to detect invasive ventilation during hospitalization. Medication trends were estimated by computing proportions of hospitalized patients receiving each drug weekly during the study period. Results. In this cohort of 71,366 hospitalized patients, the largest observed change in care was related to chloroquine/hydroxychloroquine (HCQ) (Figure). HCQ usage peaked at 87% of patients receiving invasive ventilation (54% without ventilation) in the first week of this study (March 23-29), but declined to < 5% of patients, regardless of ventilation status, by the end of May. In contrast, dexamethasone usage was 10% at baseline in patients receiving ventilation (1% without ventilation) and increased to a steady state of >85% of patients receiving ventilation ( >50% without ventilation) by the end of June. Similarly, remdesivir usage increased sharply from a baseline of 2% of patients and continued to rise to a peak of 79% of patients receiving invasive ventilation (44% without ventilation) in November before declining. Conclusion. Meaningful shifts in treatments for US patients hospitalized with COVID-19 were observed from March through December 2020. A dramatic decline was observed for HCQ use, likely owing to safety concerns, while usage of dexamethasone and remdesivir increased as evidence of their efficacy mounted. Across medications, usage was substantially more prevalent among patients requiring invasive ventilation compared with patients with less severe cases.

7.
Urban Book Series ; : 33-49, 2021.
Article in English | Scopus | ID: covidwho-1353647

ABSTRACT

This research investigates the potential for using call detail records (CDRs) data to determine public compliance to two government mandated confinement measures in Sierra Leone: a three day lockdown and fourteen day inter district travel restriction during the first wave of the COVID19 pandemic in April 2020. We use a distance-based mobility indicator, the average distance travelled per district per day to determine compliance to government mandates. The measure is used to proxy the change in mobility compared to a baseline period for both inter- and intra-district trips in Sierra Leone. Our results show significant compliance across all districts in Sierra Leone. We also show that the intensity of compliance is influenced by poverty and population. Our work demonstrates how using CDR-based mobility analysis was carried out in Sierra Leone during the COVID19 crisis to aid policy makers in understanding the effectiveness of their COVID19 mitigation measures. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

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