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BACKGROUND: Monoclonal antibody (MAB) treatments for COVID-19 received Emergency Use Authorization in the United States. METHODS: We used surveillance data from Rhode Island to conduct a retrospective, statewide cohort study to estimate the effectiveness of MABs for preventing hospitalization and death during periods when Alpha and Delta variants were predominant. RESULTS: From 1/17/2021-10/26/2021, 285 long-term congregate care (LTCC) residents and 3,113 non-congregate patients met our eligibility criteria and received MAB; they were matched to 285 and 6,226 controls, respectively. Among LTCC residents, 8.8% (25/285) of patients who received MAB were hospitalized or died compared to 25.3% (72/285) of those who did not receive MAB (adjusted difference=16.7%, 95% confidence interval CI=11.0-22.3%). Among non-congregate patients, 4.5% (140/3,113) of patients who received MAB were hospitalized or died compared to 11.8% (737/6,226) of those who did not receive MAB (adjusted difference=7.2%, 95% CI=6.0-8.4%). CONCLUSIONS: Administration of MABs led to an absolute reduction in hospitalization or death during periods when Alpha and Delta variants were predominant.
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COVID-19 , Humans , Cohort Studies , Retrospective Studies , SARS-CoV-2 , Hospitalization , Antibodies, Monoclonal/therapeutic useABSTRACT
Introduction Delirium is an acute alteration in attention, awareness, arousal, and cognition, precipitated by a sudden illness and highly prevalent in older, frail and acutely hospitalized patients. It is associated with poor outcomes, and few effective treatment alternatives. Non-pharmacological interventions and music show promising effects, warranting further research. This pilot randomized repeated measures trial aims to test feasibility of the trial methodology, acceptability, fidelity and safety of the music interventions, suitability of the effect-outcomes. and preliminary effectiveness. Method Acute geriatric patients with delirium or subsyndromal delirium will be randomized to Preferred Recorded Music (n = 30) or Preferred Live Music (n = 30), delivered for 30 minutes, over three consecutive days. Planned feasibility outcomes will comprise recruitment rate, retention and attrition rates, percentage of adherence, deviations rates, and success of treatment fidelity. Clinical outcomes will include: (a) trajectory of delirium symptoms: level of arousal as assessed by Observational Scale of Level of Arousal (OSLA) and modified Richmond Agitation Sedation Scale (mRASS);attention, assessed using backwards tests and digit span tests;orientation and short-term memory, assessed using recall tasks and orientation questions from Memorial Delirium Assessment Scale, (b) duration of delirium, (c) length of hospital stay, and (d) use of PRN medication (benzodiazepines and antipsychotics). Discussion The trial will provide results needed to design a subsequent sufficiently powered RCT, informing on the expected recruitment, feasibility and acceptability of the interventions and assessments and preliminary effectiveness (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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The coronavirus disease (COVID-19) pandemic forced care providers, including training clinics, to quickly shift mental health services to a remote modality to continue serving vulnerable populations. However, research on the effectiveness of psychotherapy delivered by novice clinicians using videoconferencing technology is limited. Therefore, the goal of this study was to examine the effectiveness of psychotherapy via videoconferencing technology, delivered by doctoral student trainees in a community training clinic. Participants (n = 34) were ethnically diverse, adult, outpatient psychotherapy clients from a large, urban setting, and the university community. Student clinicians (n = 11) were novice psychotherapy providers in their second or third year of training. Results indicated that client scores on inventories of overall distress Outcomes Questionnaire (OQ), center for epidemiological studies-depression (CES-D), and generalized anxiety disorder-7 (GAD-7) decreased significantly from baseline to the most recent readministration, and Working Alliance Inventory-Short Revised (WAI-SR) increased significantly. Collectively, by Session 16, symptom scores were in the typical range (below the clinical cutoff) for the OQ and GAD-7, and were one point above the CES-D clinical cutoff;by the 24th session, the average score on all measures was below the clinical cutoff, and WAI-SR scores approached the highest possible total score. Additionally, attendance during this time was quite high (87.6%) and was higher than rates during in-person service provision (80.7%). The results from this study suggest that novice clinicians can successfully use videoconferencing to deliver effective, evidence-based treatment in a community clinic, across a range of presenting concerns, and that such services can yield significant improvement of symptom distress and functioning, with patterns comparable to in-person services. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement Training clinics are utilized by many underserved populations, students, and residents of the surrounding area. If student trainees are able to provide effective mental health care via telehealth, that would remove barriers for many clients that might not otherwise seek treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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The article describes how physician autonomy is at issue if patients demand ineffective treatments as indicated in a Wisconsin Supreme Court case which centers on whether physicians can be legally required to provide ivermectin for COVID-19 if a patient or family requests it, citing the ethical obligations to consider.
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Previous research has shown that a semester-long multicultural psychology course can effectively increase students' cultural competence-related attitudes when students complete the class in-person and online. Cultural competence refers to the knowledge, awareness, and skills required to appreciate, recognize, and effectively work with members of other cultural groups. This dissertation examined several components of a multicultural psychology course: ethical grading, skill development, and intergroup contact. The first paper discussed techniques used to minimize grading bias and examined whether cultural competence shifts impacted grading. Students' cultural competence scores did not relate to or predict their grades in the course, which supported the notion instructors can grade fairly and objectively regardless of students' attitudes and values. The second paper highlighted the importance of social justice competence in addition to cultural competence, as well as the importance of targeting skill development in addition to knowledge and awareness. This study investigated the impact of adding a skills-focused Difficult Dialogues group assignment to the course on students' shifts in cultural competence-related attitudes and social justice orientation and also discussed of implementation considerations for instructors. Results suggested that the Difficult Dialogues project had a particular impact on improving students' social justice behavioral intentions. The third paper focused on the impact of intergroup contact with diverse others. The multicultural psychology course typically requires direct contact by attending at least three cultural events every semester. However, due to the COVID-19 pandemic, this requirement was shifted to indirect contact activities. This study examined differential shifts on students' cultural competence-related attitudes in sections where students were required to engage in direct intergroup contact versus students who were allowed to engage in indirect intergroup contact due to taking the course during the COVID-19 pandemic. Results suggest that indirect contact contributed to positive shifts in cultural competence equally as well as direct intergroup contact. These studies advance the evidence-based teaching of multicultural psychology by empirically examining specific course components. The manuscripts provide useful information for educators, administrators, advocates, and policymakers about the impact of multicultural education, the efficacy of cultural competence training, and feasibility of ethical implementation in the classroom. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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During COVID-19, the author, like most psychoanalysts and psychotherapists, was forced to move her practice from in-person to a digital platform (Zoom) Although her Initial expectation was that much of the therapeutic value of the group experience would be diminished, she was surprised that the contrary proved to be evident: Her pre-existing groups flourished, and there appeared to be no loss in efficacy based on member self-report data. The author makes the case that group analysis is essential to a comprehensive analytic experience and not an addendum to individual analysis. The author explores her theoretical positions and provides personal commentary from some of her patients on the transition to and experience of in-person versus telehealth options. [ FROM AUTHOR]
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The article offers tips for nurses on providing care for patients with continence issues. Topics discussed include the consequences of pressures on continence services, the lack of confidence among nurses in continence, tools used for initial assessment of bladder symptoms in adults, and the lack of services for younger patients with bladder and bowel issues in the Untied Kingdom.
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Presents a case report of a woman with depressive episodes, which began in early 2019 and was worsened by the change of her long-standing antidepressant regimen of fluoxetine to mirtazapine. Subsequently, she received 12 right unilateral ultrabrief pulse electroconvulsive therapy (ECT) treatments without any benefit. She experienced no benefit from 4 additional trials of antidepressants and during our evaluations over several weeks, her mood remained severely depressed. After 6 treatments, she experienced >50% reduction in her depression. However, her esketamine treatments were paused for 8 weeks due to COVID-19. Her depression worsened and a 4-week-long course of twice-weekly treatments was initiated, which resulted in a >50% reduction in her depression. After switching to weekly maintenance treatments, her symptoms of low mood, anhedonia, and suicidal ideation returned to her pre-treatment baseline. As she had responded well to twice-weekly treatments, the frequency of treatments was increased. In summary, this patient responded to twice-weekly esketamine treatments, experienced symptomatic worsening after switching to weekly treatments, but was able to attain remission with prolonged twice-weekly treatments. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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Background: Patients with hematological disorders especially those who underwent bone marrow transplantation are known for having some degree of immune system derangement and cytokine signaling instability as well as patients who were diagnosed with active malignancy and needed chemotherapy. Objective: The study aimed to compare the outcome between patients infected with COVID 19 who use immune suppression (either acute or chronic immune suppression) to fight COVID infection and how our different bodies and immune systems can handle it versus the normal population. Patients and Methods: This study was a cross-sectional study in December 2020 conducted on 96 subjects who caught COVID-19 infection, the subjects were categorized into three groups: Group 1: consists of 32 patients who underwent BMT (patients on chronic immunosuppressive drugs), Group 2: consists of 32 patients with hematological diseases (patients on chemotherapy or acute immunosuppressive drugs), and Group 3: control group (non-immunosuppressed patients) consists of 32 patients with patients had symptomatic COVID-19 infections requiring hospital admission. Results: We found improved overall survival in group 1 with 4 out of the total 32 patients succumbed to their deaths, 2 of the 4 patients were in the peri-engraftment period with the statistically significant improved OS when compared to patients in group 2 with a P-value of 0.038. Conclusion: Acute immune suppression is done by chemotherapy worsen the outcome of COVID-19 infection, while chronic immunosuppression had the best outcome in COVID-19 patients even better than the normal population due to loss of immune cell signaling and absent cytokines storm that might occur. [ FROM AUTHOR] Copyright of Egyptian Journal of Hospital Medicine is the property of Egyptian Journal of Hospital Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Aims: To investigate the clinical outcome of patients with confirmed COVID-19 who had diabetes mellitus as a comorbidity at King Abdulaziz University Hospital, Jeddah. Methods: Retrospective study conducted at an academic tertiary hospital, included 147 adults with a confirmed diagnosis of diabetes mellitus, and a confirmed diagnosis of COVID-19. The data included: age, gender, body mass index (BMI), HbA1c level, medications, co-morbidities, length of hospital stay, the clinical outcome of the patients, and complications related to COVID-19 during the hospital stay. Data were analyzed using Stata version 16. Results: 54% had HbA1c levels >9%. With regard to other health problems, 73% reported having health problems. 31% and 18% required ICU admission and intubation respectively. Median length of hospital stay was 12 days. Regarding clinical outcomes, the majority recovered without complications (78%), while 9% recovered with complications and 13% died. Conclusions: The difference in outcomes based on HbA1c levels was not statistically significant, therefore there was no difference in other clinical parameters based on the different levels of HbA1c. Further, large studies should be conducted to determine the relationships between diabetes, antidiabetic medications, and COVID-related morbidity and mortality. [ FROM AUTHOR] Copyright of Egyptian Journal of Hospital Medicine is the property of Egyptian Journal of Hospital Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Lung transplantation is a life saving treatment option for patients with COVID-19 ARDS. We aim to assess the short-term outcomes of patients who underwent lung transplantation for COVID ARDS. This is a single-center retrospective cohort study of patients who underwent lung transplantation for COVID 19 ARDS between 7/1/2020 and 06/30/2021. Study was IRB-approved. Baseline demographic data, pre transplant variables, peri operative data and post transplant variables were extracted. Post-transplant graft function variables were followed until 09/30/2021. Twenty patients underwent lung transplantation alone, and one patient underwent lung kidney transplantation. Nineteen patients (90%) were ECMO bridge to transplant and twenty patients (95%) were on mechanical ventilator until the transplant. These patients were followed for a median of 234 days [IQR (188-339)]. Three patients (14%) completed a one-year follow-up. Eighteen patients (86%) completed six months follow-up. None of the patients required dialysis. At the end of the follow up period, all patients have good graft function and none of the patients are on supplemental oxygen. With careful selection, lung transplants can be performed with reasonable post-transplant outcomes in COVID 19 ARDS patients. However, these patients tend to have a prolonged post transplant hospital stay, a median of 48 days with IQR (28.5 - 73.5). 50% of patients had at least one return to operating room post transplant for hemothorax. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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B Conclusions: b Patients on RAAS inhibitors prior to hospitalization for SARS-CoV-2 infection had higher mortality and complications than those not on these medications. B Introduction: b The aim of our study was to determine the effect of prior use of renin-angiotensin-aldosterone system (RAAS) inhibitors on mortality and outcomes in hospitalized patients with laboratory-confirmed SARS-CoV-2 infection. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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The Structured Team-based Optimal Patient-centered care for COVID-19 VIRUS (STOP-VIRUS) Collaborative was created to identify and implement current best COVID-19 practices using standard quality improvement methodology in a learning community of participating U.S. sites. B Introduction: b Interim SCCM VIRUS Registry analysis demonstrated variation in patient outcomes independent of acuity or comorbidity, suggesting opportunities for critical care process improvement. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Included patients had a BMI>30, required intensive care unit (ICU) level care, and positive pressure ventilation (high-flow nasal canula, continuous or bilevel positive airway pressure, mechanical ventilation). B Introduction/Hypothesis: b Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of patients worldwide since its emergence in 2019. B Conclusion: b Despite an elevated BMI, the associated mortality rate of patients who received tocilizumab in this study was similar to the mortality rate of the tocilizumab group in the RECOVERY trial. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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B Introduction: b COVID-19 is a respiratory infection recognized for its pulmonary complications, but literature later suggested neurologic complications such as the capability to trigger a neuroinflammatory cascade and affect the blood brain barrier. Head CT, chest x-ray, lumbar puncture, and COVID-19 polymerase chain reaction (PCR) were unremarkable. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Unadjusted mortality was higher in Whites than Hispanics (17.1% versus 10.7%;p< 0.001), however, after adjusting for confounding variables, in-hospital mortality was no different for Whites in comparison to Hispanics (HR 0.96, 95% CI 0.76-1.21, p=0.73). We compared in hospital mortality, use of intensive care unit services (rates of mechanical ventilation, vasopressor use and renal replacement therapy) between non-Hispanic whites with non-White/Black Hispanic. B Conclusions: b Hispanics as compared to Whites with COVID-19 require higher rates of ICU admission but have a similar mortality. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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The low dose category was defined as equal to or less than dexamethasone 6 mg/day intravenous or methylprednisolone 120 mg/day intravenous per day dosing in one or divided doses. B Conclusion: b There is no benefit from using high dose corticosteroids in any disease category of patients than the current recommended dose of 6 mg/day dexamethasone for 10 days duration. We categorized patients as per WHO (World Health Organization) severity classification and then divided patients into low and high-dose steroid categories. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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B Conclusions: b Elderly patients with COVID 19 infection who require ICU admission have high rates of comorbidities. At the time of ICU admission, most patients required high flow nasal cannula or noninvasive ventilation (n=45, 66.2%), followed by mechanical ventilation (MV) (n=17, 25%). COVID 19 infections can cause significant morbidity and mortality, especially among elderly patients and those with comorbidities. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)