Prevalence Of Heart Failure In COVID Patients And Its Association With Mortality

Background: Moderate to severe COVID infection has been linked to poor cardiovascular outcomes, mainly pericarditis, heart failure and acute coronary syndrome. However, the pathophysiology remains not fully understood. We studied the prevalence of heart failure in patients hospitalized with COVID infections in our local hospital in West Virginia. Method(s): Utilizing ICD-10 codes, we collected data from Cabell Huntington Hospital, West Virginia. Patients who had COVID infection were selected. We analyzed the data of patients who had pre-existing heart failure, atrial fibrillation, coronary artery disease, diabetes and hypertension. We calculated odds ratio for patients with pre-existing conditions in regards to mortality. All p-values were based on 2-tailed tests and were considered statistically significant when p < 0.05. Result(s): 2,532 patients were admitted due to COVID, out of which 260 (10.27%) had pre-existing diagnosis heart failure. Heart failure patients had a higher odds of in hospital mortality [2.87, 2.35-3.50 CI 95%]. Similarly, patients with other pre-existing conditions were associated with higher inpatient mortality, which included hypertension [1.25, 1.02-1.54 CI 95%], diabetes [1.36, 1.11-1.66 CI 95%], atrial fibrillation [2.74, 2.52-3.42 CI 95%] and coronary artery disease [1.19, 0.56-2.49 CI 95%]. Length of stay was longer among those individuals with HF (13.93 days vs 8.54 days). Conclusion(s): Data analysis demonstrates that the patients with COVID infection and concomitant heart failure have worse mortality outcomes.Copyright © 2022

Exploring Introductory Communication Course Administrators' Relationship Management during COVID-19

The COVID-19 pandemic rapidly changed the context of higher education during the Spring 2020 semester. As the virus began to spread across the United States, colleges and universities canceled inperson classes and activities, closed campus, and moved all operations online. Within the communication discipline, introductory communication course (ICC) administrators and instructors were not only dealing with these challenges, but they were also navigating the transition of large multi-section, often standardized, courses online at large institutions. This research project used semistructured, in-depth interviews with 18 ICC administrators from institutions located in 14 states across the Midwest, mid-Atlantic, Southeastern, and West Coast regions of the U.S. to explore how they engaged in relationship management with their instructors and how their approach to relationship management informed their transition to remote learning due to COVID-19. The analysis results in four emerging themes: (1) rhetorical approaches to relationship management, (2) relational approaches to relationship management, (3) relationship management [right arrow] positive outcomes, and (4) relationship management as central to navigating COVID-19. Based on these findings we suggest a rhetorical/relational goals approach to course administration and offer practical implications ICC administrators can implement to engage in successful relationship management during times of crisis.

Successful Implementation of a Rural Appalachian Kidney Transplant Program, One Year Outcomes

Purpose: Kidney transplantation has become the optimal treatment for end stage renal disease (ESRD), allowing dialysis free survival. Despite widespread availability of transplant programs;rural patients have limited access to transplantation due to several barriers including increased travel time and financial burden. We report outcomes after establishment of a kidney transplant program serving rural West Virginia. Method(s): A retrospective review of the first 15 kidney transplants performed at a newly established Appalachian transplant program was conducted. Primary outcomes measured were graft survival and function. Other outcomes included graft rejection, patient survival and complications. Data related to patient demographics, etiology of ESRD, type of renal replacement therapy, time on transplant waitlist and average travel to transplant center were also collected. Result(s): The first 15 kidneys transplanted had an overall death censored graft survival rate of 100%. Median patient age was 53 (Range 31- 73 years) and a median follow-up of 6 months (Range 1-13 months). The average time on dialysis for this cohort was 4 years (n=13, Range 1-6 years) and average time on waitlist was 4.06 months (Range 0.4-13.2 months). The most common type of dialysis was hemodialysis (77%) followed by peritoneal dialysis (15%). Two patients were predialysis. Diabetes with hypertension (20%), IgA nephropathy (13%) and diabetes without hypertension (13%) were the most common causes of ESRD. Median graft creatinine was 1.51 mg/dL (Range 1.26 - 1.83 mg/dL) with a glomerular filtration rate (GFR) at 51.38 (Range 41.86-70) at one year. One patient developed acute antibody mediated rejection and one developed borderline T cell mediated rejection (13.3%), which were successfully treated with steroids, plasmapheresis and immune globulin therapy. Two patients died (13.3 %);one from acute respiratory failure following coronavirus (COVID-19) infection and one from cardiac arrest secondary to myocarditis (possible COVID-19). Patients experienced COVID-19 infection at a rate of 13.3 %. The average distance patients had to travel was 94 miles (Range 12 - 164 miles) with a travel time of 1 hour and 52 minutes on average (Range 20 minutes - 2.5 hours) to reach the transplant center. Conclusion(s): We report comparable outcomes from our new rural transplant program despite several barriers to delivery of quality care to our population.

Cannulate, Extubate, Ambulate: Effect of a Mobility-Focused Program on Outcomes of COVID+ ECMO Patients at West Virginia University Medicine

Objective: The motto Cannulate, Extubate, Ambulate reflects the care ECMO patients receive at West Virginia University Medicine. Early mobility, crucial in our outcomes, especially with the COVID-19 population, is started with a Physical Therapist. This is followed by all team members participating in ECMO mobilization. This project examined the impact of mobilization for our COVID+ population placed on VV ECMO. Method(s): A WVU retrospective review was completed of COVID-19+ patients on ECMO between 3/2020 and 12/2021, determining survival to decannulation and discharge location. Mobility was examined for ECMOday of first active participation, first active transfer out of bed, and first ambulation. Further, PT sessions during cannulation, total PT, staff assist mobility while cannulated, and total number of sessions during admission. All patients who survived to discharge were included in survival rate, but those transferred to outside facilities for ECMO management were excluded from mobility and discharge location analyses. Result(s): Out of 91 patients, 70% successfully decannulated, and 98.4% survived to discharge. Mobilization began day 1 of ECMO, averaging 7.6 sessions/patient during their hospitalization. 88% performed their first active transfers with PT assist. Mobility sessions were also performed by Nursing/ECMO Specialists (3.6 times vs. 2.8 times). Total active mobilizations ranged 2-69 sessions, averaging 13.9 mobilizations during hospitalization. 60% of COVID-19 ECMO survivors were discharged home. Conclusion(s): Physical therapists lead mobility efforts, however, active involvement of nursing and ECMO Specialists is vital to provide continuity and repetition of mobility. Our results suggest teamwork improves patient survival and other important outcomes.

The Gap Between Breast and Bottle, What Are the Disparities in a Large Community Hospital in Southern West Virginia?

Background: Exclusive breastfeeding is recognized as the ideal feeding method for infants. Newborns receiving formula inhospital are at higher risk for early breastfeeding cessation. Among infants born in 2017, CDC Breastfeeding Report Card, 2020, reported the rate of breastfed infants receiving formula before two days of age as 15% in West Virginia (WV). We aimed to determine factors associated with in-hospital formula supplementation of breastfed newborns at a large community hospital in Southern WV. We hypothesized that disparities exist in supporting women to exclusively breastfeed. Methods: We retrospectively reviewed 500 randomly selected charts of infants born 09/01/2019-09/1/2020. Full-term infants with a recorded maternal decision to exclusively breastfeed were included. Exclusion criteria were prematurity, NICU admission, maternal diabetes, and infant hypoglycemia. Factors associated with formula supplementation were compared between mothers exclusively breastfeeding and those who were not at the time of discharge. Results: Of the reviewed charts, 70% of birth mothers desired to exclusively breastfeed. 211 infants met all inclusion criteria. 70% were delivered via vaginal delivery;52% were induced. Of the included newborns, 41% were supplemented with formula. 32% of mothers met with lactation consultants prior to formula supplementation. Top reasons for formula supplementation were mother request (45%) and newborn difficulty latching (22%). Median time of first supplementation was 20.0 hours (range:0.5-54). 12% of the supplementation occurred within 6 hours and 96.5% within 2 days of age. Rates of formula supplementation did not increase during the nurses' night shift or at nurses' shift change. Exclusive breastfeeding at discharge was associated with higher education level (p=0.002), tobacco abstinence (p=0.03), prior births (p=0.04), and increased maternal age (p=0.02);with every 1 year increase in maternal age, there was 7% decrease in supplementation. No statistically significant associations were present between exclusive breastfeeding at discharge meeting with a hospital lactation consultant, maternal race, marital status, induction need, or neonatal characteristics (p>0.05). When controlling for confounders of maternal age, marital status, tobacco use, and lactation consultation, Cesarean delivery (odd ratio: 2.0,1.03-4.2, 95% confidence interval), primiparity (2.6, 1.4-4.8), and not completing high school (12.5, 1.6-96.5) predicted formula supplementation. Exclusive breastfeeding discharge rates remained relatively steady over the 12 month study period, including during the COVID-19 pandemic. Conclusion: At our center, formula supplementation rate of 41% in the first two days of age appears higher than the state's rate using the CDC report card. Mother request and newborn difficulty latching are the top reasons for formula supplementation. Median age of supplementation was 20 hours. Lactation consultations were not universal and disparities existed for breastfeeding mothers supplementing with formula. Addressing maternal disparities is essential to enhance newborn health equity. Our study's findings will be used to develop prenatal and postnatal interventions to maximize hospital breastfeeding support and minimize formula supplementation.

TELEHEALTH USER EXPERIENCE AND ENVIRONMENTAL IMPACT FOR TELEPHONE AND VIDEO VISITS FOR GASTROESOPHAGEAL REFLUX DISEASE

Introduction: Sars-CoV-2 virus pandemic of 2019 necessitated a transition to telehealth for many healthcare encounters. The telehealth user experience and any potential environmental impact of this transition to e-Visits for gastrointestinal diseases is hitherto unstudied. Methods: We conducted a retrospective cohort study of patients who underwent telehealth encounters (telephone visits and video visits) with the outpatient gastroenterology clinics at West Virginia University, Morgantown. Patients were reached by telephone and were asked to provide information to fill in pre-designed survey questionnaires that incorporated a validated telehealth usability questionnaire. The Telehealth usability questionnaire (TUQ) incorporated Likert scales (1-7) to rate usability questions. Variables were also collected with chart review by two study authors. Distance of patients’ residence from our clinic was calculated using demographic data on EPIC. Environmental protection agency (EPA) calculators were utilized to calculate greenhouse emissions that were prevented due to televisits in lieu of in person visits. Results: A total of 81 video visits and 89 telephone visits were performed for GERD in the study period of March 2020-March 2021. 111 patients were able to be enrolled in the study and filled in the questionnaires, revealing a response rate of 65.29%. Mean age was higher in the telephone visit cohort (43.45 +/- 14.32 vs 52.34 +/- 17.46, p: 0.04) and most participants were female (76.58%). Overall user satisfaction was high (mean scores for all usability variates >5). Comparative analysis of the telephone and video visits revealed significantly higher mean ratings for usefulness and user comfort questions in the patients who had video encounters compared to those with telephone encounters, as shown in Table 2. A total of 7.02 metric tons of greenhouse gas emissions were prevented due to non-usage of the 391.5 gallons of gasoline needed to transport these patients to and from the facility from their residence. Conclusion Telehealth visits for GERD were rated highly in terms of usefulness, satisfaction, and user comfort/usability by patients. Video visits received higher mean ratings for usefulness and user comfort. Tele-visits for GERD are therefore well received by patients and in addition can contribute to notable reductions in unnecessary greenhouse emissions. (Table Presented)

Lung Function and Radiographic Disease Worse Among Former Miners in Central Appalachia Than Other Regions of the United States

RATIONALE The COVID-19 pandemic has disrupted national spirometric surveillance of active and former U.S. coal miners since March 2020. Consequently data collected by the Health Resources and Services Administration (HRSA)-funded Black Lung Clinics Program (BLCP) represents the only major source of recent health data on U.S. former coal miners. Using the first available year of national BLCP data we examined associations between mining region and radiographic disease and lung function impairment. METHODS We analyzed pre-bronchodilator spirometry and International Labour Office chest radiograph classifications from miners seen across 15 BLCP grantees from July 1 2020 to June 30 2021. We calculated percent predicted (PP) and lower limits of normal (LLN) for forced expiratory volume in one second (FEV1) forced vital capacity (FVC) and FEV1/FVC ratio. We determined prevalence of patterns of spirometric abnormality (restrictive obstructive/mixed) and moderate to severe impairment (FEV1<70PP). We classified miners who worked the majority of their coal mining career in Kentucky Virginia or West Virginia as Central Appalachian miners. We examined associations between region worked and lung function impairment using logistic regression. RESULTS The 2,891 miners were predominantly non- Hispanic white (98.1%) and male (99.4%) with mean age 66 years (SD9.3). Mean coal mining tenure was 26 years (SD10.7) and 66% (n=1,900) were Central Appalachian miners. Thirty-seven percent had never smoked. Among those with chest radiographs (n=2,464 85%) Central Appalachian miners had a significant three-fold increase in progressive massive fibrosis (PMF) prevalence compared to miners who worked elsewhere in the U.S. (9% vs 3% p<.0001). Smoking history and spirometry were available in 66% (n=1,918). Of these 40% of never-smokers had abnormal spirometry (obstruction/mixed 10%;restriction 30%);among ever-smokers, 54% had abnormal spirometry (obstruction/mixed 27%;restriction 27%). Abnormal FEV1 was present in 30% of never smokers and 42% of ever-smokers. Mean FEV1PP was significantly lower among Central Appalachian miners compared to miners from other regions. Controlling for age, tenure, and pack-years, Central Appalachian miners had significantly elevated odds of having FEV1 impairment compared to non-Central Appalachian miners (OR 1.31, 95%CI 1.06,1.62). A subanalysis controlling for category of radiographic disease showed that odds of impairment remained elevated among Central Appalachian miners (OR 1.24, 95%CI 0.97,1.60). CONCLUSIONS Controlling for smoking, age, and tenure, former miners who worked most of their career in Central Appalachia have significantly increased odds of disabling impairment. These findings highlight the important role of HRSA-funded black lung clinics in understanding work-related lung disease among U.S. coal miners.

The Compounding Effect of Rurality on Health Disparities Among Black Patients with COVID-19.

Background: West Virginia had garnered national attention for its vaccination rollout against coronavirus 2019 (COVID-19). Outcomes of this mostly rural population, however, have been underreported. As the pandemic continues, identifying high risk populations remains important to further epidemiologic information and target vaccines. Purpose: The objective of this study is to examine the effects of COVID-19 and the influence of race and rurality on hospitalization and outcomes in Appalachians. Methods: In this retrospective study, data from patients who tested positive and were admitted for COVID-19 and seen within the state's largest health system (West Virginia University Health System) between March 18 and September 16, 2020 were analyzed. Cases were stratified into rural or urban based on rural urban continuum codes (RUCCs) and by race into 'white,' 'black,' or 'other.' Associations between rurality, rurality and race, and outcomes were assessed. Results: A total of 2011 adult West Virginians tested positive, of which 8.2% were hospitalized. Of the hospitalized patients, 33.5% were rural and 11.6% were black. Rural black patients were three times more likely (OR: 3.33; 95%CI:1.46-7.60) to be admitted. Rural blacks were also more likely to have a history of obstructive pulmonary disease (OR: 2.73; 1.24-6.01), hypertension (OR: 2.78; 1.38-5.57), and multiple chronic conditions (3.04; 1.48-6.22). Implications: Rural blacks were more likely to have risk factors for severe COVID-19 influencing their increased risk of hospitalization. These findings support that race as a risk factor for severe COVID-19 is compounded by rurality and identifies an important target group for vaccination.

Needs Assessment of Southeastern United States Vector Control Agencies: Capacity Improvement Is Greatly Needed to Prevent the Next Vector-Borne Disease Outbreak

A national 2017 vector control capacity survey was conducted to assess the United States’ (U.S.’s) ability to prevent emerging vector-borne disease. Since that survey, the southeastern U.S. has experienced continued autochthonous exotic vector-borne disease transmission and establishment of invasive vector species. To understand the current gaps in control programs and establish a baseline to evaluate future vector control efforts for this vulnerable region, a focused needs assessment survey was conducted in early 2020. The southeastern U.S. region was targeted, as this region has a high probability of novel vector-borne disease introduction. Paper copies delivered in handwritten envelopes and electronic copies of the survey were delivered to 386 unique contacts, and 150 returned surveys were received, corresponding to a 39% response rate. Overall, the survey found vector control programs serving areas with over 100,000 residents and those affiliated with public health departments had more core capabilities compared to smaller programs and those not affiliated with public health departments. Furthermore, the majority of vector control programs in this region do not routinely monitor for pesticide resistance. Taken as a whole, these results suggest that the majority of the southeastern U.S. is vulnerable to vector-borne disease outbreaks. Results from this survey raise attention to the critical need of providing increased resources to bring all vector control programs to a competent level, ensuring that public health is protected from the threat of vector-borne disease.

INTRODUCTION FROM THE EDITORIAL TEAM

SEDAAG meetings offer a suite of professional development benefits and have excelled in distinguishing exceptional contributions in scholarship, instruction, and service. In the context of risk mitigation strategies associated with potentially increasing flood and landslide events in western North Carolina, Bonevac et al. interviewed key informants (i.e., often residents with subject expertise) in Buncombe and Watauga counties to develop a better understanding of these processes. [...]intersectional factors such as race and gender may also affect the residential selection process in addition to physical symbols (e.g., flags and yard signs), which were used to evaluate neighborhoods.