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1.
Cancers (Basel) ; 14(17)2022 Sep 05.
Article in English | MEDLINE | ID: covidwho-2009955

ABSTRACT

BACKGROUND: Patients with sarcoma often require individualized treatment strategies and are likely to receive aggressive immunosuppressive therapies, which may place them at higher risk for severe COVID-19. We aimed to describe demographics, risk factors, and outcomes for patients with sarcoma and COVID-19. METHODS: We performed a retrospective cohort study of patients with sarcoma and COVID-19 reported to the COVID-19 and Cancer Consortium (CCC19) registry (NCT04354701) from 17 March 2020 to 30 September 2021. Demographics, sarcoma histologic type, treatments, and COVID-19 outcomes were analyzed. RESULTS: of 281 patients, 49% (n = 139) were hospitalized, 33% (n = 93) received supplemental oxygen, 11% (n = 31) were admitted to the ICU, and 6% (n = 16) received mechanical ventilation. A total of 23 (8%) died within 30 days of COVID-19 diagnosis and 44 (16%) died overall at the time of analysis. When evaluated by sarcoma subtype, patients with bone sarcoma and COVID-19 had a higher mortality rate than patients from a matched SEER cohort (13.5% vs 4.4%). Older age, poor performance status, recent systemic anti-cancer therapy, and lung metastases all contributed to higher COVID-19 severity. CONCLUSIONS: Patients with sarcoma have high rates of severe COVID-19 and those with bone sarcoma may have the greatest risk of death.

2.
J Health Commun ; 27(6): 416-426, 2022 Jun 03.
Article in English | MEDLINE | ID: covidwho-2008415

ABSTRACT

Widespread COVID-19 vaccination is critical to slow the spread of the illness. This study investigates how political ideology is associated with COVID-19 vaccine intention via perceived effectiveness of the vaccine, perceived side effects, and perceived severity of the illness, three key aspects of the Health Belief Model (HBM). This study also examines how partisan information flow moderates the effects of ideology on these three HBM components. Using survey data collected from two battleground states in the 2020 election (N = 1849), regression, mediation and moderation analyses revealed that conservatives were less likely to intend to get vaccinated against COVID-19, and this association was significantly mediated by perceived effectiveness and perceived side effects of vaccination, as well as perceived severity of COVID-19. In addition, partisanship of news sources and discussion partners were significant moderators of ideology's association with perceived vaccine effectiveness, with conservatives viewing COVID-19 vaccination as less effective if they were frequently exposed to liberal news, and if they had frequent conversations with fellow conservatives. This suggests boomerang effects for cross-cutting mass media exposure, and reinforcement effect for interpersonal communication. Implications for efforts to promote COVID-19 vaccine uptake are discussed, including tailored and targeted campaign strategies.


Subject(s)
COVID-19 Vaccines , COVID-19 , Humans , COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Vaccination , Communication , Intention
3.
Viruses ; 14(6)2022 06 13.
Article in English | MEDLINE | ID: covidwho-1911628

ABSTRACT

BACKGROUND: This study assessed the predictive performance of inflammatory, hepatic, coagulation, and cardiac biomarkers in patients with prediabetes and diabetes mellitus hospitalized for COVID-19 in Austria. METHODS: This was an analysis of a multicenter cohort study of 747 patients with diabetes mellitus or prediabetes hospitalized for COVID-19 in 11 hospitals in Austria. The primary outcome of this study was in-hospital mortality. The predictor variables included demographic characteristics, clinical parameters, comorbidities, use of medication, disease severity, and laboratory measurements of biomarkers. The association between biomarkers and in-hospital mortality was assessed using simple and multiple logistic regression analyses. The predictive performance of biomarkers was assessed using discrimination and calibration. RESULTS: In our analysis, 70.8% had type 2 diabetes mellitus, 5.8% had type 1 diabetes mellitus, 14.9% had prediabetes, and 8.6% had other types of diabetes mellitus. The mean age was 70.3 ± 13.3 years, and 69.3% of patients were men. A total of 19.0% of patients died in the hospital. In multiple logistic regression analysis, LDH, CRP, IL-6, PCT, AST-ALT ratio, NT-proBNP, and Troponin T were significantly associated with in-hospital mortality. The discrimination of NT-proBNP was 74%, and that of Troponin T was 81%. The calibration of NT-proBNP was adequate (p = 0.302), while it was inadequate for Troponin T (p = 0.010). CONCLUSION: Troponin T showed excellent predictive performance, while NT-proBNP showed good predictive performance for assessing in-hospital mortality in patients with diabetes mellitus hospitalized with COVID-19. Therefore, these cardiac biomarkers may be used for prognostication of COVID-19 patients.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Prediabetic State , Aged , Aged, 80 and over , Austria/epidemiology , Biomarkers , Cohort Studies , Female , Hospital Mortality , Humans , Male , Middle Aged , Registries , Risk Factors , Troponin T
4.
Stem Cell Rev Rep ; 18(5): 1809-1821, 2022 06.
Article in English | MEDLINE | ID: covidwho-1704701

ABSTRACT

BACKGROUND: SARS-CoV-2 infection causes acute respiratory distress, which may progress to multiorgan failure and death. Severe COVID-19 disease is accompanied by reduced erythrocyte turnover, low hemoglobin levels along with increased total bilirubin and ferritin serum concentrations. Moreover, expansion of erythroid progenitors in peripheral blood together with hypoxia, anemia, and coagulopathies highly correlates with severity and mortality. We demonstrate that SARS-CoV-2 directly infects erythroid precursor cells, impairs hemoglobin homeostasis and aggravates COVID-19 disease. METHODS: Erythroid precursor cells derived from peripheral CD34+ blood stem cells of healthy donors were infected in vitro with SARS-CoV-2 alpha variant and differentiated into red blood cells (RBCs). Hemoglobin and iron metabolism in hospitalized COVID-19 patients and controls were analyzed in plasma-depleted whole blood samples. Raman trapping spectroscopy rapidly identified diseased cells. RESULTS: RBC precursors express ACE2 receptor and CD147 at day 5 of differentiation, which makes them susceptible to SARS-CoV-2 infection. qPCR analysis of differentiated RBCs revealed increased HAMP mRNA expression levels, encoding for hepcidin, which inhibits iron uptake. COVID-19 patients showed impaired hemoglobin biosynthesis, enhanced formation of zinc-protoporphyrine IX, heme-CO2, and CO-hemoglobin as well as degradation of Fe-heme. Moreover, significant iron dysmetablolism with high serum ferritin and low serum iron and transferrin levels occurred, explaining disturbances of oxygen-binding capacity in severely ill COVID-19 patients. CONCLUSIONS: Our data identify RBC precursors as a direct target of SARS-CoV-2 and suggest that SARS-CoV-2 induced dysregulation in hemoglobin- and iron-metabolism contributes to the severe systemic course of COVID-19. This opens the door for new diagnostic and therapeutic strategies.


Subject(s)
COVID-19 , SARS-CoV-2 , Erythrocytes/metabolism , Ferritins , Heme/metabolism , Hemoglobins/metabolism , Humans , Iron/metabolism
5.
Front Med (Lausanne) ; 9: 823577, 2022.
Article in English | MEDLINE | ID: covidwho-1690428

ABSTRACT

OBJECTIVE: The objective of this study was to analyze the feasibility and acceptance of a non-invasive, daily and proactive screening program for SARS-CoV-2 infection employing serial saliva testing, in combination with a digital questionnaire among healthcare providers (HCPs) in a multi-professional setting. DESIGN: This was a prospective cohort study involving HCPs from different units at a single tertiary care center, over a pilot phase of 4 weeks during the first wave of the COVID-19 pandemic from April 18th to June 6th, 2020. SETTING: Pediatric tertiary patient care units, Comprehensive Center for Pediatrics, Medical University of Vienna. SUBJECTS: HCPs from different units, including physicians, nurses, midwives, and administrative staff (with patient contact) were considered eligible for the study. Study participants were working in different settings in our center at varying levels of risk exposure. INTERVENTIONS: Saliva collection from mouth gargle and electronic symptom and exposure monitoring (eSEM) was performed by participants at the onset of each regular clinical shift (day or night shift), using an anonymous ID for matching the results. MEASUREMENTS: RT-PCR of all saliva samples, eSEM, as well as feasibility and acceptance thereof. RESULTS: Two hundred and seventy-five volunteers collected 1,865 saliva samples and responded 1,378 times in the eSEM during a 4-week period. 1,331 (96.7%) responses were that the testing was feasible and acceptable. The most common severe symptom during the 4-week period mentioned by HCPs was headache, reported 54 times (3.9%). Two SARS-CoV-2 positive samples-one of them being associated with symptoms-were identified. The acceptance rate among HCPs was 96.6%. CONCLUSION: Serial saliva screening was a well-accepted and feasible method for monitoring SARS-CoV-2 infectious state in health care professionals. Combination of regular SARS-CoV-2 tests with sequential saliva collection and storage could potentially represent a highly efficient strategy to identify and trace virus positive staff for employee and patient safety.

6.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-323473

ABSTRACT

Background: The coronavirus disease (COVID-19) pandemic limited services during pregnancy, labour, and childbirth that affected families worldwide. However, data on the effects of limiting obstetrical care during the pandemic’s first wave are sparse.Methods: This nationwide cohort study analysed birth registry data from all obstetric departments in Austria. Women who delivered between January and June 2020 were classified as cases, whereas those who delivered between January and June 2015–2019 were classified as controls. We excluded data concerning preterm delivery, birthweight below 500 g, multiple fetuses, fetal malformations and chromosomal anomalies, intrauterine fetal death, maternal cancer, or HIV-infection, and inter-hospital transfers. Perinatal outcomes, postpartum hospitalisation and adverse events were assessed.Findings: Of 33.198 cases and 188.225 controls, data analysis showed significantly increased rates of labour induction, instrumental delivery, obstetric anaesthesia, NICU transfer, and 5-min Apgar score below 7 during the COVID-19 period. There was a significantly shorter length of postpartum hospitalisation during the COVID-19 period compared to the non-COVID-19 period (3·1 ± 1·4 vs. 3·5 ± 1·5 days p< 0·001). Significantly more women opted for outpatient delivery during the COVID-19 period (3·7% vs. 2·4% p < 0·001). Those who delivered during the COVID-19 period were also more likely to experience postpartum adverse events (3·0% vs. 2·6% p < 0·001), which was confirmed in the logistic regression model (odds ratio, 2·137;95% confidence interval, 1·805–2·530 p < 0·001).Interpretation: Perinatal and postpartum care during the first wave of the COVID-19 pandemic differed significantly from that provided before. Increased rates of adverse events underline the need to ensure access to high-quality obstetrical care in order to prevent collateral damage.Funding Statement: None.Declaration of Interests: The authors report no conflict of interest in connection with this article.Ethics Approval Statement: The study was approved by the Ethics Committee of the Medical University of Vienna (reference number 1637/2020). Due to the retrospective study design, patient informed consent was not required. All patient data were handled anonymously.

7.
Viruses ; 13(12)2021 11 30.
Article in English | MEDLINE | ID: covidwho-1591432

ABSTRACT

BACKGROUND: It is a matter of debate whether diabetes alone or its associated comorbidities are responsible for severe COVID-19 outcomes. This study assessed the impact of diabetes on intensive care unit (ICU) admission and in-hospital mortality in hospitalized COVID-19 patients. METHODS: A retrospective analysis was performed on a countrywide cohort of 40,632 COVID-19 patients hospitalized between March 2020 and March 2021. Data were provided by the Austrian data platform. The association of diabetes with outcomes was assessed using unmatched and propensity-score matched (PSM) logistic regression. RESULTS: 12.2% of patients had diabetes, 14.5% were admitted to the ICU, and 16.2% died in the hospital. Unmatched logistic regression analysis showed a significant association of diabetes (odds ratio [OR]: 1.24, 95% confidence interval [CI]: 1.15-1.34, p < 0.001) with in-hospital mortality, whereas PSM analysis showed no significant association of diabetes with in-hospital mortality (OR: 1.08, 95%CI: 0.97-1.19, p = 0.146). Diabetes was associated with higher odds of ICU admissions in both unmatched (OR: 1.36, 95%CI: 1.25-1.47, p < 0.001) and PSM analysis (OR: 1.15, 95%CI: 1.04-1.28, p = 0.009). CONCLUSIONS: People with diabetes were more likely to be admitted to ICU compared to those without diabetes. However, advanced age and comorbidities rather than diabetes itself were associated with increased in-hospital mortality in COVID-19 patients.


Subject(s)
COVID-19/mortality , Comorbidity , Diabetes Mellitus/epidemiology , Hospital Mortality , Public Health , Adult , Aged , Aged, 80 and over , Austria/epidemiology , Cohort Studies , Female , Hospitalization , Humans , Intensive Care Units , Male , Middle Aged , Odds Ratio , Propensity Score , Retrospective Studies , Risk Factors , SARS-CoV-2 , Young Adult
8.
Birth ; 49(2): 243-252, 2022 06.
Article in English | MEDLINE | ID: covidwho-1455513

ABSTRACT

BACKGROUND: This study aimed to analyze perinatal outcomes and adverse events during the COVID-19 pandemic's first wave to help direct decision making in future waves. METHODS: This study was an epidemiological cohort study analyzing comprehensive birth registry data among all 80 obstetric departments in Austria. Out of 469 771 records, 468 348 were considered eligible, whereof those with preterm delivery, birthweight <500 g, multiple fetuses, fetal malformations and chromosomal anomalies, intrauterine fetal death, maternal cancer, HIV infection, and/or inter-hospital transfers were excluded. Women who delivered between January and June 2020 were then classified as cases, whereas those who delivered between January and June 2015-2019 were classified as controls. Perinatal outcomes, postpartum hospitalization, and adverse events served as outcome measures. RESULTS: Of 33 198 cases and 188 225 controls, data analysis showed significantly increased rates of labor induction, instrumental delivery, obstetric anesthesia, NICU transfer, and 5-min Apgar score below 7 during the COVID-19 period. There was a significantly shorter length of postpartum hospitalization during the COVID-19 period compared with the non-COVID-19 period (3.1 ± 1.4 vs 3.5 ± 1.5 days; P < .001). Significantly more women opted for short-stay delivery during the COVID-19 period (3.7% vs 2.4%; P < .001). Those who delivered during the COVID-19 period were also more likely to experience postpartum adverse events (3.0% vs 2.6%; P < .001), which was confirmed in the logistic regression model (odds ratio, 2.137; 95% confidence interval, 1.805-2.530; P < .001). CONCLUSIONS: Perinatal and postpartum care during the first wave of the COVID-19 pandemic differed significantly from that provided before. Increased rates of adverse events underline the need to ensure access to high-quality obstetric care to prevent collateral damage.


Subject(s)
COVID-19 , HIV Infections , COVID-19/epidemiology , Cohort Studies , Female , Humans , Infant, Newborn , Pandemics , Postnatal Care , Pregnancy
9.
PLoS One ; 15(2): e0229658, 2020.
Article in English | MEDLINE | ID: covidwho-1453108

ABSTRACT

Over the past decade, outbreaks of new or reemergent viruses such as severe acute respiratory syndrome (SARS) virus, Middle East respiratory syndrome (MERS) virus, and Zika have claimed thousands of lives and cost governments and healthcare systems billions of dollars. Because the appearance of new or transformed diseases is likely to continue, the detection and characterization of emergent diseases is an important problem. We describe a Bayesian statistical model that can detect and characterize previously unknown and unmodeled diseases from patient-care reports and evaluate its performance on historical data.


Subject(s)
Disease Outbreaks , Models, Biological , Bayes Theorem , Humans
10.
Lancet Reg Health Eur ; 5: 100086, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1386168

ABSTRACT

BACKGROUND: The role of schools in the SARS-CoV-2 pandemic is much debated. We aimed to quantify reliably the prevalence of SARS-CoV-2 infections at schools detected with reverse-transcription quantitative polymerase-chain-reaction (RT-qPCR). METHODS: This nationwide prospective cohort study monitors a representative sample of pupils (grade 1-8) and teachers at Austrian schools throughout the school year 2020/2021. We repeatedly test participants for SARS-CoV-2 infection using a gargling solution and RT-qPCR. We herein report on the first two rounds of examinations. We used mixed-effects logistic regression to estimate odds ratios and robust 95% confidence intervals (95% CI). FINDINGS: We analysed data on 10,734 participants from 245 schools (9465 pupils, 1269 teachers). Prevalence of SARS-CoV-2 infection increased from 0·39% at round 1 (95% CI 028-0·55%, 28 September-22 October 2020) to 1·39% at round 2 (95% CI 1·04-1·85%, 10-16 November). Odds ratios for SARS-CoV-2 infection were 2·26 (95% CI 1·25-4·12, P = 0·007) in regions with >500 vs. ≤500 inhabitants/km2, 1·67 (95% CI 1·42-1·97, P<0·001) per two-fold higher regional 7-day community incidence, and 2·78 (95% CI 1·73-4·48, P<0·001) in pupils at schools with high/very high vs. low/moderate social deprivation. Associations of regional community incidence and social deprivation persisted in a multivariable adjusted model. Prevalence did not differ by average number of pupils per class nor between age groups, sexes, pupils vs. teachers, or primary (grade 1-4) vs. secondary schools (grade 5-8). INTERPRETATION: This monitoring study in Austrian schools revealed SARS-CoV-2 infection in 0·39%-1·39% of participants and identified associations of regional community incidence and social deprivation with higher prevalence. FUNDING: BMBWF Austria.

11.
Euro Surveill ; 26(34)2021 08.
Article in English | MEDLINE | ID: covidwho-1376683

ABSTRACT

This study evaluates the performance of the antigen-based anterior nasal screening programme implemented in all Austrian schools to detect SARS-CoV-2 infections. We combined nationwide antigen-based screening data obtained in March 2021 from 5,370 schools (Grade 1-8) with an RT-qPCR-based prospective cohort study comprising a representative sample of 244 schools. Considering a range of assumptions, only a subset of infected individuals are detected with the programme (low to moderate sensitivity) and non-infected individuals mainly tested negative (very high specificity).


Subject(s)
COVID-19 , SARS-CoV-2 , Austria , Humans , Prospective Studies , Schools , Self-Testing
12.
Arch Dis Child Fetal Neonatal Ed ; 107(2): 156-160, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1367410

ABSTRACT

OBJECTIVE: The aim of this study was to determine the experience with, and the feasibility of, point-of-view video recordings using eye-tracking glasses for training and reviewing neonatal interventions during the COVID-19 pandemic. DESIGN: Observational prospective single-centre study. SETTING: Neonatal intensive care unit at the Leiden University Medical Center. PARTICIPANTS: All local neonatal healthcare providers. INTERVENTION: There were two groups of participants: proceduralists, who wore eye-tracking glasses during procedures, and observers who later watched the procedures as part of a video-based reflection. MAIN OUTCOME MEASURES: The primary outcome was the feasibility of, and the proceduralists and observers' experience with, the point-of-view eye-tracking videos as an additional tool for bedside teaching and video-based reflection. RESULTS: We conducted 12 point-of-view recordings on 10 different patients (median gestational age of 30.9±3.5 weeks and weight of 1764 g) undergoing neonatal intubation (n=5), minimally invasive surfactant therapy (n=5) and umbilical line insertion (n=2). We conducted nine video-based observations with a total of 88 observers. The use of point-of-view recordings was perceived as feasible. Observers further reported the point-of-view recordings to be an educational benefit for them and a potentially instructional tool during COVID-19. CONCLUSION: We proved the practicability of eye-tracking glasses for point-of-view recordings of neonatal procedures and videos for observation, educational sessions and logistics considerations, especially with the COVID-19 pandemic distancing measures reducing bedside teaching opportunities.


Subject(s)
COVID-19/epidemiology , Eye-Tracking Technology , Intensive Care Units, Neonatal , Internship and Residency/methods , Video Recording , Gestational Age , Humans , Infant, Newborn , Infant, Premature , Intubation/methods , Pandemics , Prospective Studies , Pulmonary Surfactants/administration & dosage , SARS-CoV-2
14.
BMJ Open ; 11(1): e041396, 2021 01 08.
Article in English | MEDLINE | ID: covidwho-1228878

ABSTRACT

INTRODUCTION: Occurrence of inaccurate or delayed diagnoses is a significant concern in patient care, particularly in emergency medicine, where decision making is often constrained by high throughput and inaccurate admission diagnoses. Artificial intelligence-based diagnostic decision support system have been developed to enhance clinical performance by suggesting differential diagnoses to a given case, based on an integrated medical knowledge base and machine learning techniques. The purpose of the study is to evaluate the diagnostic accuracy of Ada, an app-based diagnostic tool and the impact on patient outcome. METHODS AND ANALYSIS: The eRadaR trial is a prospective, double-blinded study with patients presenting to the emergency room (ER) with abdominal pain. At initial contact in the ER, a structured interview will be performed using the Ada-App and both, patients and attending physicians, will be blinded to the proposed diagnosis lists until trial completion. Throughout the study, clinical data relating to diagnostic findings and types of therapy will be obtained and the follow-up until day 90 will comprise occurrence of complications and overall survival of patients. The primary efficacy of the trial is defined by the percentage of correct diagnoses suggested by Ada compared with the final discharge diagnosis. Further, accuracy and timing of diagnosis will be compared with decision making of classical doctor-patient interaction. Secondary objectives are complications, length of hospital stay and overall survival. ETHICS AND DISSEMINATION: Ethical approval was received by the independent ethics committee (IEC) of the Goethe-University Frankfurt on 9 April 2020 including the patient information material and informed consent form. All protocol amendments must be reported to and adapted by the IEC. The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings. TRIAL REGISTRATION NUMBER: DRKS00019098.


Subject(s)
COVID-19 , Mobile Applications , Artificial Intelligence , Delivery of Health Care , Emergency Service, Hospital , Humans , Observational Studies as Topic , Prospective Studies , Randomized Controlled Trials as Topic , SARS-CoV-2
15.
J Neurol Sci ; 425: 117438, 2021 06 15.
Article in English | MEDLINE | ID: covidwho-1174388

ABSTRACT

The main objective of this study was to analyse neurological symptoms during a Covid-19 infection and determine the pattern of symptoms by comparing outpatients with inpatients. A further goal was to identify possible predictors, such as pre-existing conditions and neurological symptoms. We recorded the clinical data of 40 inpatients and 42 outpatients in this retrospective, cross sectional study. Of them, 68 patients (83%), evenly distributed between the two groups, suffered from neurological symptoms. We identified the onset of neurological symptoms and the related time ranges in 41 patients (36 outpatients and 5 inpatients). Of these, 63.4% reported neurological symptoms on the first or second day of illness. 49 patients (72%) showed combinations of at least two to a maximum of seven different neurological symptoms. A more severe course of disease was correlated with age and male sex, but age was not identified as a predictor for the occurrence of neurological symptoms. Women suffered from central and neuromuscular symptoms more often than men (p = 0,004). The most common symptoms were fatigue (54%), headache (31%), loss of taste (31%), and loss of smell (27%). Pre-existing dementia was associated with increased lethality; similarly, pre-existing stroke was associated with a more severe course of Covid-19 infection. Hallucinations and confusion were related to an increased likelihood of death. The present data demonstrate the importance of comprehensive neurological support of inpatients and outpatients affected by Covid-19.


Subject(s)
COVID-19 , Cross-Sectional Studies , Female , Humans , Male , Nervous System , Retrospective Studies , SARS-CoV-2
16.
Cancer Invest ; 39(4): 315-320, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1132232

ABSTRACT

Outcomes for patients (pts) with sarcoma and COVID-19 are unknown. This is a single institution retrospective study of adults with sarcoma and COVID-19. Ten pts [median age 60 (range 24-69)] were identified. Five were hospitalized; two died from COVID-19 complications; another died from sarcoma. Time between last systemic treatment dose and COVID-19 diagnosis was 6-41 days in pts who died. 5 underwent prior radiation (RT); time between RT and COVID-19 diagnosis was 20-62 days for pts who died. All three pts with WBC differential data (two died) were lymphopenic. Efforts to capture outcomes for a larger cohort are urgently needed.


Subject(s)
COVID-19/prevention & control , SARS-CoV-2/isolation & purification , Sarcoma/therapy , Soft Tissue Neoplasms/therapy , Adult , Aged , COVID-19/complications , COVID-19/virology , COVID-19 Testing/methods , Chemoradiotherapy/methods , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care/methods , Outcome Assessment, Health Care/statistics & numerical data , Retrospective Studies , Risk Factors , SARS-CoV-2/physiology , Sarcoma/complications , Sarcoma/surgery , Soft Tissue Neoplasms/complications , Soft Tissue Neoplasms/surgery , Survival Analysis , Young Adult
18.
Pediatr Emerg Care ; 37(1): 48-53, 2021 Jan 01.
Article in English | MEDLINE | ID: covidwho-1006320

ABSTRACT

OBJECTIVE: We aim to describe the current coronavirus disease 2019 (COVID-19) preparedness efforts among a diverse set of pediatric emergency departments (PEDs) within the United States. METHODS: We conducted a prospective multicenter survey of PED medical director(s) from selected children's hospitals recruited through a long established national research network. The questionnaire was developed by physicians with expertise in pediatric emergency medicine, disaster readiness, human factors, and survey development. Thirty-five children's hospitals were identified for recruitment through an established national research network. RESULTS: We report on survey responses from 25 (71%) of 35 PEDs, of which 64% were located within academic children's hospitals. All PEDs witnessed decreases in non-COVID-19 patients, 60% had COVID-19-dedicated units, and 32% changed their unit pediatric patient age to include adult patients. All PEDs implemented changes to their staffing model, with the most common change impacting their physician staffing (80%) and triaging model (76%). All PEDs conducted training for appropriate donning and doffing of personal protective equipment (PPE), and 62% reported shortages in PPE. The majority implemented changes in the airway management protocols (84%) and cardiac arrest management in COVID patients (76%). The most common training modalities were video/teleconference (84%) and simulation-based training (72%). The most common learning objectives were team dynamics (60%), and PPE and individual procedural skills (56%). CONCLUSIONS: This national survey provides insight into PED preparedness efforts, training innovations, and practice changes implemented during the start of COVID-19 pandemic. Pediatric emergency departments implemented broad strategies including modifications to staffing, workflow, and clinical practice while using video/teleconference and simulation as preferred training modalities. Further research is needed to advance the level of preparedness and support deep learning about which preparedness actions were effective for future pandemics.


Subject(s)
COVID-19/epidemiology , Disaster Planning , Emergency Service, Hospital/organization & administration , Health Care Surveys , Pandemics , Personnel, Hospital/education , SARS-CoV-2 , Child , Cross-Sectional Studies , Disaster Planning/statistics & numerical data , Education, Distance , Emergency Service, Hospital/statistics & numerical data , Hospitals, Pediatric/statistics & numerical data , Humans , Personal Protective Equipment , Prospective Studies , Simulation Training , Telecommunications , Triage , United States
19.
Pediatr Crit Care Med ; 22(6): e333-e338, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-990952

ABSTRACT

OBJECTIVES: Early preparation for the training and education of healthcare providers, as well as the continuation or modification of routine medical education programs, is of great importance in times of the coronavirus disease 2019 pandemic or other public health emergencies. The goal of this study was to characterize these self-reported efforts by the pediatric simulation community. DESIGN: This was a global, multicenter survey developed via a Delphi process. SETTING: International survey study. SUBJECTS: The survey was sent to 555 individual members of the three largest international pediatric simulation societies (The International Pediatric Simulation Society, International Network for Simulation-based Pediatric Innovation, Research & Education, and Netzwerk Kindersimulation e.V.) between April 27, 2020, and May 18, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Description of coronavirus disease 2019 pandemic simulation-based preparation activities of pediatric acute and critical care healthcare providers. The Delphi process included 20 content experts and required three rounds to reach consensus. The survey was completed by 234 participants (42.2%) from 19 countries. Preparation differed significantly between the geographic regions, with 79.3% of Anglo-American/Anglo-Saxon, 82.6% of Indian, and 47.1% of European participants initiating specifically coronavirus disease 2019-related simulation activities. Frequent modifications to existing simulation programs included the use of telesimulation and virtual reality training. Forty-nine percent of institutions discontinued noncoronavirus disease 2019-related simulation training. CONCLUSIONS: The swift incorporation of disease-specific sessions and the transition of standard education to virtual or hybrid simulation training modes occurred frequently. The approach used, however, depended heavily on local requirements, limitations, and circumstances. In particular, the use of telesimulation allowed education to continue while maintaining social distancing requirements.


Subject(s)
COVID-19 , Disasters , Child , Health Personnel , Humans , Pandemics , SARS-CoV-2 , United States
20.
Diabetes Obes Metab ; 23(2): 589-598, 2021 02.
Article in English | MEDLINE | ID: covidwho-969453

ABSTRACT

AIM: To assess predictors of in-hospital mortality in people with prediabetes and diabetes hospitalized for COVID-19 infection and to develop a risk score for identifying those at the greatest risk of a fatal outcome. MATERIALS AND METHODS: A combined prospective and retrospective, multicentre, cohort study was conducted at 10 sites in Austria in 247 people with diabetes or newly diagnosed prediabetes who were hospitalized with COVID-19. The primary outcome was in-hospital mortality and the predictor variables upon admission included clinical data, co-morbidities of diabetes or laboratory data. Logistic regression analyses were performed to identify significant predictors and to develop a risk score for in-hospital mortality. RESULTS: The mean age of people hospitalized (n = 238) for COVID-19 was 71.1 ± 12.9 years, 63.6% were males, 75.6% had type 2 diabetes, 4.6% had type 1 diabetes and 19.8% had prediabetes. The mean duration of hospital stay was 18 ± 16 days, 23.9% required ventilation therapy and 24.4% died in the hospital. The mortality rate in people with diabetes was numerically higher (26.7%) compared with those with prediabetes (14.9%) but without statistical significance (P = .128). A score including age, arterial occlusive disease, C-reactive protein, estimated glomerular filtration rate and aspartate aminotransferase levels at admission predicted in-hospital mortality with a C-statistic of 0.889 (95% CI: 0.837-0.941) and calibration of 1.000 (P = .909). CONCLUSIONS: The in-hospital mortality for COVID-19 was high in people with diabetes but not significantly different to the risk in people with prediabetes. A risk score using five routinely available patient variables showed excellent predictive performance for assessing in-hospital mortality.


Subject(s)
COVID-19/mortality , Diabetes Mellitus, Type 2/mortality , Health Status Indicators , Patient Admission/statistics & numerical data , Prediabetic State/mortality , Aged , Austria , COVID-19/virology , Diabetes Mellitus, Type 2/virology , Female , Hospital Mortality , Hospitals , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Prediabetic State/virology , Prospective Studies , Retrospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2
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