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1.
BJGP Open ; 6(1), 2022.
Article in English | EMBASE | ID: covidwho-1818242

ABSTRACT

As a consequence of the COVID-19 pandemic, health systems have seen sudden and significant increases in the use of telehealth services.1 The Australian population has shared in this experience, with studies showing a rapid uptake of telehealth services.2 A high level of satisfaction with telehealth consultations in Australia has been reported, but some responders report reduced satisfaction compared to traditional face-to face consultations.3

2.
BMJ Open Gastroenterol ; 9(1), 2022.
Article in English | PubMed | ID: covidwho-1807372

ABSTRACT

BACKGROUND: Northern England has been experiencing a persistent rise in the number of primary liver cancers, largely driven by an increasing incidence of hepatocellular carcinoma (HCC) secondary to alcohol-related liver disease and non-alcoholic fatty liver disease. Here we review the effect of the COVID-19 pandemic on primary liver cancer services and patients in our region. OBJECTIVE: To assess the impact of the COVID-19 pandemic on patients with newly diagnosed liver cancer in our region. DESIGN: We prospectively audited our service for the first year of the pandemic (March 2020-February 2021), comparing mode of presentation, disease stage, treatments and outcomes to a retrospective observational consecutive cohort immediately prepandemic (March 2019-February 2020). RESULTS: We observed a marked decrease in HCC referrals compared with previous years, falling from 190 confirmed new cases to 120 (37%). Symptomatic became the the most common mode of presentation, with fewer tumours detected by surveillance or incidentally (% surveillance/incidental/symptomatic;34/42/24 prepandemic vs 27/33/40 in the pandemic, p=0.013). HCC tumour size was larger in the pandemic year (60±4.6 mm vs 48±2.6 mm, p=0.017), with a higher incidence of spontaneous tumour haemorrhage. The number of new cases of intrahepatic cholangiocarcinoma (ICC) fell only slightly, with symptomatic presentation typical. Patients received treatment appropriate for their cancer stage, with waiting times shorter for patients with HCC and unchanged for patients with ICC. Survival was associated with stage both before and during the pandemic. 9% acquired COVID-19 infection. CONCLUSION: The pandemic-associated reduction in referred patients in our region was attributed to the disruption of routine healthcare. For those referred, treatments and survival were appropriate for their stage at presentation. Non-referred or missing patients are expected to present with more advanced disease, with poorer outcomes. While protective measures are necessary during the pandemic, we recommend routine healthcare services continue, with patients encouraged to engage.

3.
Open Forum Infectious Diseases ; 8(SUPPL 1):S341, 2021.
Article in English | EMBASE | ID: covidwho-1746517

ABSTRACT

Background. SARS-CoV-2 infection is typically a mild illness in children. Multisystem inflammatory syndrome in children (MIS-C) is a rare, post-infectious, hyperinflammatory condition associated with SARS-CoV-2 infection. The presentation of MIS-C is nonspecific and diagnostic criteria is broad. The Centers for Disease Control (CDC) defines MIS-C as a hospitalized patient < 21 years presenting with fever, laboratory evidence of inflammation, no alternative plausible diagnosis, and with positive exposure history or testing for current or recent SARS-CoV-2 infection. Since there is no single diagnostic test for MIS-C, there are other disease processes that can mimic its presentation and delay prompt diagnosis and management. Methods. Between March 2020 and February 2021, we reviewed 282 charts of patients admitted for evaluation of MIS-C at our institution. Results. 101 were found to have MIS-C, 45 found to have Kawasaki Disease (KD), and 129 were ruled out. Of the ruled-out group, the most common final diagnoses were viral infection, urinary tract infection, and acute SARS-CoV-2 infection. Other diagnoses included rickettsial infections, pneumonia, rheumatologic conditions, and bloodstream infection. Rhinovirus/enterovirus, adenovirus, Epstein-Barr virus (EBV), and Herpes Simplex Virus (HSV) were the most common viruses other than SARS-CoV-2 identified. Conclusion. These findings highlight the importance of maintaining a broad differential when evaluating a patient for MIS-C, especially as community seroprevalence rises, making antibody presence less predictive of MIS-C.

7.
Molecular Therapy ; 28(4):416-417, 2020.
Article in English | EMBASE | ID: covidwho-1379239

ABSTRACT

Background: Novel coronaviruses (CoV) caused 3 global outbreaks over the past 2 decades: SARS-CoV (2002), MERS-CoV (2012), and 2019-nCoV in Wuhan, China. Each caused pneumonia with mortality of 10%, 35% and 2%, respectively (2019-nCoV estimated). GLS-5300 DNA vaccine targeting MERS-CoV Spike (S) was first to enter clinical trial, was safe and immunogenic (Lancet ID;2019). In Phase I, a 3 dose series at Day0, 4 and 12 weeks of GLS-5300 at either 0.67, 2 or 6mg was given IM followed by electroporation (EP, IM+EP) with CELLECTRA-5P device. GLS-5300 induced antibodies (Abs) in 94%, Tcell response in 76%, and neutralizing Abs in 50% of participants. No dose response was observed. GLS-5300 response was similar to those recovered from natural MERS-CoV infection. The absence of dose response and prior experience showing benefits of ID+EP vs IM+EP (JID;2019) led us to design this trial of lower ID dosing with an arm for a 2-dose regimen. We report results from MERS-002, the ongoing Phase I/IIa study of GLS-5300. Methods: MERS-002 is an open label, dose ranging, phase I/IIa study of GLS-5300. Participants were enrolled at 2 Korean sites into 3 groups receiving GLS-5300 ID+EP with the CELLECTRA-3P device: Group 1 received three 0.3mg doses at Day0 and weeks 4 and 12;Group 2 received three 0.6mg doses at Day0 and weeks 4 and 12;Group 3 received two 0.6mg doses at Day0 and week 8. Safety and tolerability of GLS-5300 was evaluated at each visit. Samples were collected at baseline, before each dose, and at both 2 and 4 weeks post dose 2 and post dose 3. Study data through 4 weeks after the primary series for a subset of immunoassays were included here. Findings: GLS-5300 given ID+EP was well-tolerated with no vaccine-associated SAEs. Preliminary results were available for: full length S (flS) ELISA, EMC2012-Vero neutralization (MERS-neut) and MERS-CoV S IFNg ELISPOT. GLS-5300 at 0.6mg induced MERS-CoV-specific Abs by flS ELISA and MERS-neut in 74% and 48%, respectively, after 1 dose. After the 2 or 3 dose vaccine series at 0.6mg per dose, flS ELISA response was seen in 100% and 92% of participants, respectively. MERS-neut response was 92% in both 2 and 3 dose 0.6mg groups. Antibody responses and rates were higher during and after primary series in 0.6mg group regardless of regimen than 0.3mg per dose. GLS-5300 induced Tcell responses via MERS-CoV IFNg ELISPOT in 60% and 84% receiving 0.6mg after the 2 or 3 dose series, respectively. Compared to 0.67mg of GLS-5300 given IM+EP in the first trial, 0.6mg of GLS-5300 given ID+EP in MERS-002, binding Abs appeared sooner and neutralizing Abs were observed in a higher fraction of participants (92% vs 50%) while Tcell reactivity was similar between vaccination schema. Conclusions: GLS-5300 was well tolerated with no vaccine-associated SAEs. Like prior studies, DNA vaccines given by ID+EP had fewer injection-related AEs relative to IM+EP. In MERS-002, 0.6mg of GLS-5300 in a 2-dose regimen spanning 8 weeks had similar reactivity and rate to the longer 3-dose regimen. GLS-5300 was safe and immunogenic when given IM+EP and, similarly, when given ID+EP in both 2- and 3-dose regimens in this ongoing MERS-002 Phase I/IIa trial. A Phase II clinical evaluation of the use of GLS-5300 to prevent MERS-CoV infection in endemic regions is planned.

8.
Canadian Journal of Dietetic Practice & Research ; 82(3):146-146, 2021.
Article in English | CINAHL | ID: covidwho-1366075

ABSTRACT

Introduction: The COVID-19 pandemic has presented many food security challenges. Eat Well Saskatchewan (EWS), a free dietitian contact service in Saskatchewan, implemented a 16-week social media campaign (#eatwellcovid19) using a storytelling approach. This campaign allowed Saskatchewan residents to share their experiences on how they coped with food insecurity challenges during COVID-19 with others. Objectives: To describe implementation and evaluation of #eatwellcovid19 using social media analytics and qualitative interviews of campaign followers. Methods: EWS encouraged Saskatchewan residents to submit personal stories that demonstrated their own coping strategies in dealing with food security challenges during COVID-19. Each week, 1--3 stories were featured on EWS social media platforms (Facebook, Twitter, Instagram), along with social media posts featuring related evidence-based nutrition information. Social media metrics and semi-structured qualitative interviews of campaign followers were used to evaluate campaign impact. The interviews were analyzed using content analysis and NVivo. Results: EWS received 75 stories from Saskatchewan residents and 42 were featured on social media. Stories were on various topics (e.g., traditional food skills, gardening). On Facebook, the campaign reached 100,571 people, left 128,818 impressions and 9,575 engaged with posts. On Instagram, the campaign reached 11,310 people, and made 14,145 impressions. On Twitter, the campaign made 15,199 impressions and received 424 engagements. All EWS social media platforms saw an increase in followers during the campaign;Instagram's growth was the largest (+30%). Not including campaign posters promoted with paid advertising, featured story submission posts made the largest impact on all platforms (except Twitter), followed by supplemental content related to featured stories. Interview participants (n = 20) appreciated the positive, local and reliable content and stated the storytelling format helped them to feel connected to their community during social isolation. Conclusions: Storytelling appeared to be a successful approach for this campaign. Residents appreciated hearing local stories to help deal with food security concerns experienced during the pandemic. Significance: Social media health promotion campaigns are gaining popularity and have potential to reach large audiences and counteract nutrition misinformation. Storytelling is an approach dietitians could use when designing similar campaigns. Funded by: Saskatchewan Health Research Foundation and University of Saskatchewan.

11.
International Food and Agribusiness Management Review ; 24(5):887-900, 2021.
Article in English | Web of Science | ID: covidwho-1326100

ABSTRACT

This case concerns an analyst's task to value Cal-Maine Foods, Inc., the largest and only publicly traded U.S. egg production firm. The case takes place in 2020, at the time of the Covid-19 pandemic. Historically volatile egg prices were even more volatile in April 2020, with a large spike in prices that led the state of Texas to sue the firm for price gouging. Added to this, Cal-Maine had an unexpectedly bad earnings report a few months earlier, and prior to that, the firm cut its dividend. How should the analyst incorporate these shocks - or should they be included at all? How can the analyst assess the risk of a company that has volatile revenues and costs and a widely varying beta? Which factors is the analysis most sensitive to? Was the market overvaluing Cal-Maine? Or, was there potential for investors to profit from investing in the firm?

12.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277439

ABSTRACT

Rationale: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, has led to a global health crisis unlike any our contemporaries have witnessed before. SUNY Downstate Health Sciences University was designated as one of three COVID-19-only hospitals on March 28, 2020. This retrospective, single-center observational study grants a unique perspective surrounding the experience of the critical care service at a public institution serving a predominantly Afro-Caribbean, inner city population. Methods: Between March 11 and April 30, 2020, the critical care service was consulted for a total of 271 COVID-19 patients. We queried the electronic medical record for patient visits with critical care consult notes and collected data on demographics, comorbidities, ICU acceptance, treatment strategies, and clinical outcomes. Non-COVIDrelated consults were excluded. Chi-squared tests compared categorical variables, and independent samples ttest assessed differences in continuous variables based on mortality and ICU admission status. Logistic regression models determined if various factors independently predicted the odds of mortality. We conducted retrospective analyses to identify factors associated with survival and ICU acceptance. Results: Of the 271 patients with critical care consults, 33% (n=89) survived and 67% (n=182) expired. At the bivariate level, age, BUN, and neutrophil percentage were significantly associated with mortality, with age showing the strongest correlation (age: survivors, 61.62±1.50 vs. non-survivors, 68.98±0.85, p<0.001). There was a significant association between neutrophil percentage and mortality in the univariate logistic regression model (Q4 vs. Q1, OR 2.73, 95% CI (1.28-5.82), p trend = 0.044). In the multivariate analyses, procalcitonin exhibited a positive correlation with the odds of mortality, adjusting for age, sex, and race/ethnicity (procalcitonin: Q4 vs. Q1, OR 5.65, 95% CI (2.14-14.9), p trend <0.001). Adjusting for the same covariates, platelets exhibited a negative correlation with the odds of mortality (Q4 vs. Q1, OR 0.47, 95% CI (0.22-0.998), p trend = 0.010). Interestingly, of these factors, only elevated procalcitonin levels were associated with an increased likelihood of ICU acceptance. Conclusions: This retrospective, observational study during the first peak of the COVID-19 pandemic identified key factors linked to disease severity and outcomes. Of note, procalcitonin was the factor most strongly associated with both mortality and likelihood of ICU acceptance at the bivariate level. Respiratory failure is the primary cause of death in COVID-19, and our data suggests that procalcitonin is a useful marker that accurately reflects the severity of lung involvement during SARS-CoV-2 infection.

14.
Global Advances in Health and Medicine ; 10:31-32, 2021.
Article in English | EMBASE | ID: covidwho-1234539

ABSTRACT

Objective: To support implementation at other integrative health institutions, this poster describes the processes and tools necessary to rapidly establish virtual and distance healthcare options for a variety of integrative treatment modalities to serve as a template for other healthcare facilities. Methods: The Wellness and Integrative Health Center (WIHC) at Huntsman Cancer Institute (HCI) provides primarily in-person and hands-on patient visits for supportive oncology services. With the COVID-19 pandemic dramatically changing the landscape of in-person healthcare, The WIHC worked to quickly roll-out virtual and telemedicine appointments for most of its offerings over the course of only two weeks in March and April 2020. This poster visually showcases key decision-making processes and workflows to prepare and implement necessary technologies, documents, staff trainings, and other key components for a successful and swift transition to telehealth and virtual wellness services. The poster will also display ideas and strategies for utilizing and retaining staff and funding for hands-on modalities that cannot translate to a virtual alternative. Results: The WIHC successfully transitioned physician physical assessments, supervised exercise prescriptions, nutrition, music therapy, art therapy, and group fitness classes to virtual and online alternatives with a high rate of patient retention and satisfaction. Full-time acupuncturists and massage therapists were reassigned to work-fromhome tasks or other administrative and COVID-safety related tasks within the HCI building. Conclusion: The COVID-19 pandemic prompted many healthcare facilities to quickly adapt healthcare treatments and day-to-day operations into online and telehealth offerings. The in-person and hands-on modalities found at Huntsman Cancer Institute's WIHC forced our team to utilize creative and unprecedented measures to ensure continuity of care for our patients. The WIHC team and its leadership hope that by sharing its rapid and adaptable response to clinical and supportive services it can help other wellness programs and healthcare facilities adapt to future emergency and disaster situations. Education Research.

15.
Drama Therapy Review ; 6(2):149-165, 2020.
Article in English | Scopus | ID: covidwho-1220201

ABSTRACT

When ‘shelter in place’ orders in Massachusetts went into effect during the COVID-19 pandemic, a dramatic increase occurred in the utilization of telemental health services, forcing clinicians to have to adapt their work online. This participatory action research (PAR) using inductive thematic analysis (ITA) explored challenges and recommendations in conducting group drama therapy via telehealth. Results included three broad themes: (1) technology literacy, (2) unique social justice dynamics and (3) translating drama therapy processes successfully online. Additionally, an overarching theme emerged that indicated drama therapy may be well suited to online group telemental health. © 2020 Intellect Ltd Article. English language.

17.
Critical Care Medicine ; 49(1 SUPPL 1):75, 2021.
Article in English | EMBASE | ID: covidwho-1193866

ABSTRACT

INTRODUCTION: As we combat the novel coronavirus SARS-CoV-2, elucidating its immunological pathogenesis is vital for both understanding and treating the disease. A few case studies have suggested that the complement system may play an important role in the course of infection, but its specific role is unclear. Our group has shown that higher circulating levels of the complement C3, particularly C3 α-chain, can be a significant predictor of survival in septic shock patients. We therefore sought to investigate if a similar relationship could be seen in SARS-CoV-2. METHODS: Thirty-six COVID-19 patients were consented for this study. Serial blood samples were collected at different time points from 22 patients not in the ICU and 14 in the ICU at the time of collection. The plasma samples were analyzed using Western Blot for circulating C3 α-chain levels. Clinical data on hematologic, respiratory, renal and coagulation status were collected. The data were analyzed for differences in ICU and Non-ICU patients and for correlations of C3 α-chain levels and clinical parameters. RESULTS: In ICU patients, in mean levels of C3 α-chain had a statistically significant increase from Days 0-5 since admission to Days 16-20 (p = 0.042). C3 α-chain levels were positively correlated with time since admission (R = 0.5401, p = 0.0115). In ICU patients, C3 α-chain levels were negatively correlated with Creatinine levels (R = -0.4515, p<0.05), Neutrophil Percentage (R = -0.5525, p<0.001) and Absolute Count (R = -0.6297, p<0.001) and positively correlated with Lymphocyte Percentage (R= 0.6748, p<0.001). In Non-ICU patients, C3 α-chain levels were negatively correlated with Neutrophil Percentage (R = -0.4929, p<0.05), BUN levels (R = -0.5055, p<0.001), and positively correlated with Lymphocyte Percentage (R = 0.45, p<0.05) and Absolute Count (R = 0.6134, p<0.001) and platelet levels (R = 0.4636, p<0.05). CONCLUSIONS: In summary, levels of circulating C3 α- chain increased with time in ICU patients. C3 α-chain levels negatively correlated with renal injury markers and systemic neutrophil levels. Moreover, C3 α-chain levels positively correlated with circulating lymphocyte levels. These results indicate that native C3 is important in fighting against COVID-19 infection and may be a critical prognostic marker of disease progression.

18.
Postgraduate Medicine ; 132(SUPPL 1):14-15, 2020.
Article in English | EMBASE | ID: covidwho-1108972

ABSTRACT

Purpose The opioid epidemic is a serious national crisis that has detrimental impacts on both public health, and social and economic welfare. Therefore, any efforts to combat the opioid epidemic, including minimizing or weaning opioid prescriptions, and using other modes of analgesia when possible are undeniably necessary in this day and age. With the onset of Covid-19 pandemic, healthcare providers abruptly changed their care delivery. In-person clinic visits were changed to telemedicine, and elective cases were canceled. Due to a growing concern that chronic pain patients may have limited resources from this unprecedented time of social and economic shutdown, organizations such as American Medical Association and Drug Enforcement Administration have supported implementing measures to ensure these patients achieve adequate pain control by improving access to pain medications, but at the cost of reducing barriers and restrictions to controlled substances. Some of these policies include allowing all 'authorized practitioners' to prescribe controlled substances via telemedicine without first conducting an inperson examination, and removing existing barriers for patients, which includes dose, quantity, refill restrictions on controlled substances. In addition, FDA has advised patients stating the use of NSAIDs could worsen coronavirus disease. Given the cancellation of elective interventional pain management procedures, relaxed regulations on controlled substances, and cautioned use of NSAIDs during the Covid-19 pandemic, it is reasonable to suspect a dramatic increase in opioid prescription during this time. However, to my understanding, there are no reports measuring the rate of opioid prescriptions during the pandemic although there has been numerous reports of increased rates of opioid-overdose related cases when compared to previous years. Our study will focus on the change in opioid consumption in chronic pain patients who were unable to undergo their interventional pain procedure during the Covid-19 pandemic. By demonstrating whether or not there has been a significant increase in opioid consumption in this patient population, we can justify the efficacy of these procedures and the necessity of these elective procedures to be allowed to be performed during future pandemics. Methods Our study will take place at King's County Hospital Center. It will be a retrospective study looking into the medical charts of chronic pain patients who had a scheduled interventional pain procedure to be performed in the OR, from March 1, 2020 to May 30, 2020. EPIC and QuadraMed are the EMR systems that will be used to collect data. Subjects will be classified into groups based on their canceled interventional pain procedure. For each patient, the number of opioid(s), frequency, dose, and duration of each opioid prescribed will be obtained from the visits just prior and after the notification of the canceled procedure. The secondary outcome will determine if there are any co-variates (age, gender, race/ethnicity, and number of procedures received in the past) associated with an increase in opioid consumption. Results This study anticipates including a total of about 100 subjects. These subjects will be further divided into their respectiveplanned interventional pain procedures including: epidural steroid injections, facet joint injections, trigger point injections, sympathetic blocks, and radiofrequency nerve ablations. In each group, the change in opioid consumption will be quantified by calculating the change in MME. Data will be further stratified by covariates. Conclusions If the results do show a statistically significant increase in opioid consumption with the cancellation of interventional pain procedures, then this may justify that these procedures should be allowed to be performed during a future pandemic and to think twice before canceling all elective procedures.

19.
Anaesthesia ; 76 Suppl 3: 19-20, 2021 03.
Article in English | MEDLINE | ID: covidwho-1066600
20.
Anaesthesia ; 76(2): 225-237, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-960777

ABSTRACT

We convened a multidisciplinary Working Party on behalf of the Association of Anaesthetists to update the 2011 guidance on the peri-operative management of people with hip fracture. Importantly, these guidelines describe the core aims and principles of peri-operative management, recommending greater standardisation of anaesthetic practice as a component of multidisciplinary care. Although much of the 2011 guidance remains applicable to contemporary practice, new evidence and consensus inform the additional recommendations made in this document. Specific changes to the 2011 guidance relate to analgesia, medicolegal practice, risk assessment, bone cement implantation syndrome and regional review networks. Areas of controversy remain, and we discuss these in further detail, relating to the mode of anaesthesia, surgical delay, blood management and transfusion thresholds, echocardiography, anticoagulant and antiplatelet management and postoperative discharge destination. Finally, these guidelines provide links to supplemental online material that can be used at readers' institutions, key references and UK national guidance about the peri-operative care of people with hip and periprosthetic fractures during the COVID-19 pandemic.


Subject(s)
Case Management/standards , Hip Fractures/therapy , Anesthesia/standards , COVID-19 , Guidelines as Topic , Hip Fractures/surgery , Humans , Pandemics , Quality Improvement
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