Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 14 de 14
Filter
2.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003238

ABSTRACT

Background: Physicians are working to older ages, lending experience and knowledge that benefits patient care and education. Studies show advanced age as a risk factor for morbidity/mortality from acute respiratory syndrome-coronavirus-2 (COVID-19), placing older physicians at high-risk during this pandemic. As pediatric hospitalists (PH) care for children with respiratory illnesses, these providers may be exposed to patients with COVID-19 infection. The objective of this study is to describe current practice regarding modifications to work hour requirements and patient encounters for late career (≥50 years) PH during the COVID-19 pandemic. Methods: This observational mixed-methods study used an anonymous cross-sectional survey sent to the American Academy of Pediatrics Hospital Medicine Division Chief listserv between May and June 2020. The survey used Yes/No, multiple choice, and open-ended questions to assess modifications made due to COVID-19 for late career PH. The Fisher exact test examined the association of program characteristics with COVID-19 accommodations. Grounded theory was used to analyze responses to open-ended questions, with questions coded, developed into themes, and compared until consensus was achieved (Table). Results: Surveys were completed by directors of 47 programs, including 43 (91%) with PH ages 50-64 years, and 13 (28%) with PH ≥65 years. The corresponding total of 982 PH included 117 (12%) 50-64 years and 15 (1.5%) ≥65 years. Employer types included hospital, medical group, or academic center (Table). Accommodations were made by 52% of programs who employed PH up to 65 years of age and 77% of programs who employed PH >65 years (Figure). No statistical difference was noted in accommodations when compared by location, employer type, program size, or total number of PH employed ≥50 years or ≥65 years (Table). Qualitative analysis of responses related to method of accommodation revealed 2 themes: time (15%) and exposure-based (85%) modifications. Time-based example;“we offered those over 65 to move (clinical shifts) into next year”. Exposure-based example;“kept off of clinical service during COVID if ≥65 years”. Conclusion: While nearly all respondingprograms employed PH ≥50 years, only 28% had PH ≥65 years. COVID-19 accommodations increased from 52% to 77% when PH ≥65 years were present. Modifications were time or exposure-based, with .exposure-based changes having a higher prevalence. In order to retain the valuable input from late career PH, programs will need to consider how to extend safe use of these practitioners over the remaining course of the pandemic. (Table Presented).

3.
Developmental Medicine and Child Neurology ; 64(SUPPL 3):31-32, 2022.
Article in English | EMBASE | ID: covidwho-1916116

ABSTRACT

Introduction: Participation of children with autism spectrum disorder (ASD) is influenced by child, family, and environmental factors. However, little is known about the impact of parents' own participation on their child's participation, especially during COVID-19. We estimated to what extent complexity of child condition, income, mother's actual participation, and environmental barriers/supports, explains participation (frequency, involvement, and desire for change) of school-aged children with ASD in home and community. Patients and Methods: Mothers (n = 130) of children with ASD aged 6-13 years (mean = 9.09, SD = 1.89) completed an online survey including the Participation and Environment Measurement for Children and Youth (measuring child participation, environmental barriers/supports), the Health Promoting Activities Scale (assessing mother's participation), a checklist of child's functional issues, and a socio-demographic questionnaire. Multiple linear regressions were conducted and R2 change was calculated to determine the unique contribution of each factor. Results: On average, parents desired change in 71% of activities in both settings. Involvement and desire for change at home had the highest variance explained (20.9% and 17.4% respectively), and mother participation was more pronounced for explaining involvement levels (β = 0.34, ΔR2 = 10.4%). Income consistently explained child's frequency (ΔR2 = 41.4%) and involvement (ΔR2 = 8.7%) in community;other factors had negligible contributions. COVID-19' s impact was negatively associated with the child's participation frequency in community (r = -0.51, p <0.01), whereas at home, this association was positive (r = 0.188, p <0.05). Conclusion: Mother's own participation positively impacts the involvement of children with ASD at home. This can re-direct clinicians' attention towards improving parental participation. The environment had limited impact on child participation in the community, due in part to the pandemic.

4.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-333710

ABSTRACT

BACKGROUND: The novel coronavirus, SARS-CoV2 that causes COVID-19 has resulted in the death of more than 2.31 million people within the last year and yet no cure exists. Whereas passive immunization with COVID-19 convalescent plasma (CCP) provides a safe and viable option, selection of optimal units for therapy and lack of clear therapeutic benefit from transfusion remain as barriers to the use of CCP. STUDY DESIGN AND METHODS: To identify plasma that is expected to benefit recipients, we measured anti-SARS-CoV2 antibody levels using clinically available serological assays and correlated with the neutralizing activity of CCP from donors. Neutralizing titer of plasma samples was measured by assaying infectivity of SARS-CoV-2 spike protein pseudotyped retrovirus particles in the presence of dilutions of plasma samples. We also used this assay to identify evidence of passive transfusion of neutralizing activity in CCP recipients. RESULTS: Viral neutralization and anti-spike protein antibodies in 109 samples from 87 plasma donors were highly varied but modestly correlated with each other. Recipients who died of COVID-19 were found to have been transfused with units with lower anti-spike antibody levels and neutralizing activity. Passive transfer of neutralization activity was documented in 62% of antibody naive plasma recipients. CONCLUSIONS: Since viral neutralization is the goal of CCP transfusion, our observations not only support the use of anti-spike SARS-CoV2 serology tests to identify beneficial CCP units, but also support the therapeutic value of convalescent plasma with high titers of anti-spike antibodies.

5.
AMIA ... Annual Symposium Proceedings/AMIA Symposium ; 2021:285-294, 2021.
Article in English | MEDLINE | ID: covidwho-1749340

ABSTRACT

Since the COVID-19 pandemic began, the United States's case fatality rate (CFR) has plummeted. Using national and Florida data, we unpack the drop in CFR between April and December 2020, accounting for such confounders as expanded testing, age distribution shift, and detection-to-death lags. Guided by the insight that treatment improvements in this period should correspond to decreases in hospitalization fatality rate (HFR), and using a block-bootstrapping procedure to quantify uncertainty, we find that although treatment improvements do not follow the same trajectory in Florida and nationally (with Florida undergoing a comparatively severe second peak), by December, significant improvements are observed both in Florida and nationally (at least 17% and 55% respectively). These estimates paint a more realistic picture of improvements than the drop in aggregate CFR (70.8%-91.1%). We publish a website where users can apply our analyses to selected demographics, regions, and dates of interest.

6.
MEDLINE;
Preprint in English | MEDLINE | ID: ppcovidwho-326689

ABSTRACT

The novel coronavirus SARS-CoV2, which causes COVID-19, has resulted in the death of nearly 4 million people within the last 18 months. While preventive vaccination and monoclonal antibody therapies have been rapidly developed and deployed, early in the pandemic the use of COVID-19 convalescent plasma (CCP) was a common means of passive immunization, with the theoretical risk of antibody-dependent enhancement (ADE) of viral infection remaining undetermined. Though vaccines elicit a strong and protective immune response, and transfusion of CCP with high titers of neutralization activity are correlated with better clinical outcomes, the question of whether antibodies in CCP can enhance infection of SARS-CoV2 has not been directly addressed. In this study, we analyzed for and observed passive transfer of neutralization activity with CCP transfusion. Furthermore, to specifically understand if antibodies against the spike protein (S) enhance infection, we measured the anti-S IgG, IgA, and IgM responses and adapted retroviral-pseudotypes to measure virus neutralization with target cells expressing the ACE2 virus receptor and the Fc alpha receptor (FcalphaR) or Fc gamma receptor IIA (FcgammaRIIA). Whereas neutralizing activity of CCP correlated best with higher titers of anti-S IgG antibodies, the neutralizing titer was not affected when Fc receptors were present on target cells. These observations support the absence of antibody-dependent enhancement of infection (ADE) by IgG and IgA isotypes found in CCP. The results presented, therefore, support the clinical use of currently available antibody-based treatment including the continued study of CCP transfusion strategies.

7.
Evidence-Based Practice in Child and Adolescent Mental Health ; 2021.
Article in English | EMBASE | ID: covidwho-1327307

ABSTRACT

Distancing requirements due to the pandemic have halted many in-person therapeutic programs, including cognitive behavior therapy (CBT), increasing the likelihood that autistic children with mental health problems will struggle without adequate access to evidence-based care. Policies meant to limit the spread of COVID have inadvertently exacerbated the difficulties experienced by autistic children and further exposed them to vulnerabilities that will impact their mental health. In response, interventions have been adapted for remote delivery. There is limited evidence of the acceptability, feasibility, and clinical utility for treating mental health challenges in autistic children through an online medium, within the context of a pandemic. The current study used an explanatory sequential mixed methods design to assess parents’ experience as they participated in an adapted manualized CBT program (Secret Agent Society: Operation Regulation, SAS:OR;Beaumont, 2013) with their autistic child. Parents reported child-related behavioral changes in pre- and post-program surveys, and both parents and therapists were interviewed about their experience through the program. The quantitative findings suggest that children learned new emotion regulation through online participation, and parents were satisfied with the program. The qualitative data supported the quantitative findings and provided new insight into factors that facilitated child engagement or made participation challenging. Overall, the findings suggest that adapted online CBT programs for autistic children can have clinical utility, and further research is needed to determine their efficacy.

8.
Gastrointestinal Endoscopy ; 93(6):AB96-AB97, 2021.
Article in English | Web of Science | ID: covidwho-1260350
9.
Topics in Antiviral Medicine ; 29(1):293-294, 2021.
Article in English | EMBASE | ID: covidwho-1250718

ABSTRACT

Background: Public health emergencies increase stress, anxiety, and fear, and older adults and those with pre-existing conditions may be especially vulnerable. We used a survey-based pilot study to explore the psychosocial impact of COVID-19 on older PLWH and correlate the level of COVID-19 related distress with baseline HIV disease metrics. Methods: Participants were PLWH > age 50 who had previously (2017-2020) enrolled in the HARC HIV biorepository study at Yale. 48 PLWH were contacted and 22 participated in this study, conducted Aug-Sep 2020. An 8-part survey was administered to inquire about COVID-19 exposure, financial distress, medication adherence/medical follow-up, social support, substance use, and mood symptoms (Table 1). Cross-sectional analysis was performed on results at the time of survey administration, and longitudinal analysis was performed to compare anxiety (GAD-7), alcohol/drug use (ASSIST), and depression (CES-D) to baseline values obtained pre-pandemic (median 1.3 years prior). Results: Participant demographics are reported in Table 1. 2 participants reported having been diagnosed with COVID-19, 1 of whom had a known COVID-19 positive contact. 68% of participants were retired and reported no changes to their work due to COVID-19, and most reported moderate (4.1 on scale of 0-7) financial distress. Most reported excellent medication adherence, with 77% reporting no missed doses. 95% stated they felt “very well supported” by their primary HIV care providers, with 18% saying their care was improved during COVID-19. Only 18% felt their care was “somewhat worse.” Most participants also scored highly on the social support scale, with an average score of 11 out of 14. There were no significant differences between pre-pandemic and current scores for anxiety, alcohol/drug use, and depression, and there was no correlation between baseline HIV metrics and current level of distress. However, there was an association between COVID-19-associated worsening in GAD-7 score and a history of substance use disorder (p = 0.02). Conclusion: These results suggest that overall, most participants were doing well with excellent medication adherence and no significant changes in scores for anxiety, depression, and substance use, but that older PLWH with a history of substance use disorder had a greater risk for increased anxiety during COVID- 19. These findings can help identify groups who may be the most at-risk to experience distress from a second wave of COVID-19 and put support measures in place.

10.
Open Forum Infectious Diseases ; 7(SUPPL 1):S295-S296, 2020.
Article in English | EMBASE | ID: covidwho-1185818

ABSTRACT

Background: Smell loss has been recognized as an important, and potentially early, sign of COVID-19. However, to date smell loss has only been assessed in retrospective, COVID+ cohorts, and largely through self-report. The objective of this study was to implement a daily standardized behavioral test of smell sensitivity in healthcare workers (HCW) to capture changes in smell sensitivity over time and to assess whether these changes occur prior to positive COVID test. Methods: The study enrolled 500 high-risk COVID-negative HCW during the COVID-19 epidemic in Connecticut, beginning March 28, 2020 (80% F, mean age 38, 58% nurses). Initially, HCW received a daily symptom questionnaire with parosmia screening questions. On April 23 we introduced the “Jiffy”, a daily at-home psychophysical test of smell sensitivity, where olfactory stimuli are sampled and rated for perceived intensity. SARS-CoV-2 infection was tested every three days by PCR of nasopharyngeal swabs or saliva Results: Of the first 500 enrolled HCW, 376 HCW (75%) completed the Jiffy 4528 times (mean 12 times/HCW). 17/500 HCW (3.4%) had a COVID+ test, of which 9/17 (53%) reported smell loss through the Jiffy or the daily symptom survey. 6/9 (67%) reported smell loss that preceded or was concurrent with a COVID+ test. 8/17 COVID+ HCW completed the Jiffy, with 5/8 (63%) reporting reductions in smell versus 42/368 (11%) COVID- HCW (OR=13, 95% CI: 2.4-85, p=.001). COVID+ HCW rated their greatest reduction in smell sensitivity as slight (40%) and severe (60%), versus slight (88%) and moderate (12%) in COVID- HCW. 16/17 COVID+ HCW completed a daily symptom survey (mean 14 times/HCW), with 8/16 (50%) ever reporting parosmia versus 90/466 (19%) of COVID- HCW (OR=4.2, 95% CI: 1.3-13, p=.007). Overall, parosmia was the first reported symptom in 3/13 (23%) COVID+ HCW who reported symptoms. Conclusion: We conducted a prospective study of smell testing in a population at high risk for COVID-19 using two parallel approaches. Our results demonstrate the feasibility of at-home smell testing for assessing parosmia during COVID-19, in some cases even prior to a positive PCR result. Given the urgent need for widespread, lowcost, non-invasive testing for COVID-19, we are now developing an easy-to-use app to distribute this survey more widely to high-risk populations. (Table Presented).

12.
Hepatology ; 72(1 SUPPL):303A, 2020.
Article in English | EMBASE | ID: covidwho-986080

ABSTRACT

Background: Some have advocated for hepatitis C virus (HCV) treatment simplification through reduced treatment monitoring, utilization of telehealth, and task-shifting The Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program at Mount Sinai Hospital in New York City provides HCV treatment services for people who use drugs through a harm reduction primary care model COVID-19 created unique barriers such as the sudden closure of REACH's outpatient practice mid-March 2020 and the reassignment of medical providers to inpatient COVID-19- related tasks In response to these barriers, REACH began utilizing telehealth for HCV treatment encounters and shifted toward a nurse-driven treatment-monitoring model We aimed to assess how this natural experiment in sudden treatment simplification affected REACH's ability to engage with and treat people who use drugs and are living with HCV during the COVID-19 pandemic Methods: Data was collected between March 20 and July 6, 2020 In place of in-person visits, telehealth visits were conducted over the phone or through video visits We were able to provide free cell phones with unlimited data plans to all patients who were not able to access telehealth visits due to lack of a phone or data plan A program RN monitored all active HCV-infected patients, reaching out to them by phone to discuss medication adherence and monitor side effects Notes from these encounters were then routed to the medical provider for review and to determine if follow-up from a physician was needed Results: During this 15-week period, REACH engaged twelve new HCV-infected patients and maintained engagement via telemedicine with thirteen additional patients already in the treatment work-up process Sixteen patients started treatment during this period, three of whom had entirely telehealth psychosocial (administration of PREP-C by social worker;prepc org) and medical work-up processes Of the ten patients on treatment at the beginning of this period, there was a treatment completion rate of 80% compared to REACH's pre-COVID treatment rate of 92% Of the eight patients who completed treatment, seven have completed end of treatment HCV RNA labs, all of which were undetectable In total, the program RN followed up with thirtyfour separate HCV-infected patients in fifty-five encounters. Conclusion: COVID-19 dramatically affected REACH's model of HCV care, forcing us toward sudden treatment simplification. Our rapid transition allowed us to provide uninterrupted care during the public health crisis We are now revising our existing HCV care model to systematically incorporate telemedicine, nurse-driven treatment-monitoring, and streamlined patient visit and lab schedules, thereby establishing a hybrid model of telehealth/in-person HCV care to best serve the needs of our patients in the context of ongoing limited in-person visits due to COVID-19.

13.
18th International Conference on Artificial Intelligence in Medicine, AIME 2020 ; 12299 LNAI:336-347, 2020.
Article in English | Scopus | ID: covidwho-878846

ABSTRACT

Respiratory complications due to coronavirus have claimed hundreds of thousands of lives in 2020. Extracorporeal membrane oxygenation (ECMO) is a life-sustaining oxygenation and ventilation therapy that may be used when mechanical ventilation is insufficient. While early planning and surgical cannulation for ECMO can increase survival, clinicians report the lack of a risk score hinders these efforts. We develop the PEER score to highlight critically ill patients with viral or unspecified pneumonia at high risk of mortality in a subpopulation eligible for ECMO. The score is validated across two critical care datasets, and predicts mortality at least as well as other existing risk scores. © 2020, Springer Nature Switzerland AG.

14.
Curr Opin Cardiol ; 36(1): 51-55, 2021 01.
Article in English | MEDLINE | ID: covidwho-846630

ABSTRACT

PURPOSE OF REVIEW: Present a review of relevant literature and suggest a framework for discussion of the considerations affecting the evolution and adoption of Telerobotic Support and Telerobotic Collaboration in the practice of cardiac procedural medicine. RECENT FINDINGS: Recent medical practice has undergone remarkable transformation in the adoption of telemedicine. This evolution has been accelerated by the COVID-19 (SARS-CoV-2) pandemic and has largely been focused on outpatient medicine. Clinical studies and opinion articles have highlighted benefits including reduced costs, increased patient engagement, and saved time, while also raising concerns regarding privacy, care quality and data security. Early and current efforts implementing remote procedural medicine have not only demonstrated technical success but also highlighted the many issues that must be resolved before acceptance as a major aspect of everyday patient care. SUMMARY: It is inevitable that remote technologies will play an increasing role in procedural medicine as they have in outpatient clinical medicine. Thoughtful participation by physicians in the evolution of these technologies and their modes of use will be necessary to maximize the benefits to our patients and healthcare systems.


Subject(s)
COVID-19 , Telemedicine , Delivery of Health Care , Humans , Pandemics , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL