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Objective: To describe the characteristics of patients with acute respiratory distress syndrome due to bilateral COVID-19 pneumonia on invasive mechanical ventilation (IMV) and analyze the effect of prolonged prone decubitus > 24 h (PPD) compared to prone decubitus < 24 h (PD). Design: Retrospective observational descriptive study. Uni and bivariate analysis. Setting: Department of Intensive Care Medicine. General University Hospital of Elche. Participants: Patients with SARS-CoV-2 pneumonia (2020-2021) in VMI for moderate-severe acute respiratory distress syndrome, ventilated in PD. Interventions: IMV. PD maneuvers. Main variables of interest: Sociodemographic; analgo-sedation; neuromuscular blockade; PD (duration), ICU stay and mortality, days of IMV; non-infectious complications; health care-associated infections. Results: Fifty-one patients required PD and of these 31 (69.78%) required PPD. No differences were found in patient characteristics (sex, age, comorbidities, initial severity, antiviral and anti-inflammatory treatment received). Patients on PPD had lower tolerance to supine ventilation (61.29 vs. 89.47%, p = 0.031), longer hospital stay (41 vs. 30 days, p = 0.023), more days of IMV (32 vs. 20 days, p = 0.032), longer duration of neuromuscular blockade (10.5 vs. 3 days, p = 0.0002), as well as a higher percentage of episodes of orotracheal tube obstruction (48.39 vs. 15%, p = 0.014). Conclusions: PPD was associated with higher resource use and complications in patients with moderate-severe acute respiratory distress syndrome by COVID-19.
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Objective: To investigate epidemiological features of skin damage among front-line healthcare workers fighting against COVID-19 pandemic. Method(s): A self-designed questionnaire was released on an online survey website "wenjuan.com", and sent to the front-line medical staff caring for patients with confirmed COVID-19 in 6 infectious disease wards of the General Hospital of Central Theater Command of PLA via WeChat from March 10th to 20th, 2020. Then, the questionnaires were collected, a database was established, and statistical analysis was performed on the incidence, types and epidemiological characteristics of skin damage among the medical staff. Result(s): A total of about 550 medical staff were surveyed, 404 questionnaires were collected, of which 391 were valid, and 303 cases had skin damage. The survey showed that females, hand cleaning frequency > 10 times per day, wearing three-level protective equipment for more than 6 hours per week were risk factors for skin damage, and frequent use of a hand cream could reduce skin problems. Among the respondents, the incidence of skin damage was significantly higher in the females (79.81%, 249/312) than in the males (38.35%, 54/79;chi2 = 4.741, P = 0.029), and higher in the groups with hand cleaning frequency of 10-20 times per day (79.73%, 118/148) and > 20 times per day (85.71%, 84/98) than in the group with hand cleaning frequency of 1-10 times per day (69.66%, 101/145;chi2 = 9.330, P = 0.009). The incidence of skin damage was significantly lower in the group wearing protective equipment for 1-5 hours per week (64.04%, 73/114) than in the groups wearing protective equipment for 6-10 hours per week (81.48%, 66/81), 11-15 hours per week (95.24%, 20/21), 16-20 hours per week (81.82%, 36/44), 21-25 hours per week (86.49%, 32/37), and > 25 hours per week (80.85%, 76/94;chi2 = 19.164, P = 0.002). Among the 391 respondents, the skin damage related to disinfection and protective equipment mainly manifested as dry skin (72.89%), desquamation (56.78%), skin pressure injury (54.48%), skin maceration (45.01%), and sensitive skin (33.50%);acne (27.11%) was the related skin disease with the highest incidence, followed by facial dermatitis (23.27%), eczematous dermatitis (21.48%), folliculitis (18.92%), dermatomycosis (11.00%), urticaria (9.21%), etc. Conclusion(s): There was a high incidence of skin damage related to protective equipment among the front-line healthcare workers fighting against COVID-19, and strengthening skin protection could markedly reduce the incidence of skin damage.Copyright © 2020 by the Chinese Medical Association.
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Background: Spondyloptosis is caused by high force trauma. The vast majority of cases occur in the sagittal plane and at transition points where ridged sections meet more flexible regions. Lateral thoracic spondyloptosis is extremely rare and there is no current consensus on the optimal treatment plan. Case Description: Here we present a case of a previously physically healthy 24-year-old polytrauma patient after he was struck as a pedestrian by a motor vehicle. Of note the patient was found to have lateral spondyloptosis between T9-10 with complete spinal cord transection. The patient also sustained multi-ligamentous left knee injury, pelvic fractures, open comminuted left tibia and fibular fracture, lacerated liver, bilateral renal lacerations, ischemic bowel, and an aortic arch pseudoaneurysm. Conclusion(s): Lateral thoracic spondyloptosis is a devastating injury with an extreme rate of persistent neurologic deficits. There is no unanimously accepted treatment because of the rarity if the injury and the poor outcomes that patients face. Additionally, patients who experience high level trauma often develop severe psychiatric illness, and the importance of identifying risk factors and implementing care early may improve patient outcomes.Copyright © AME Medical Journal.
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Objective: To describe the characteristics of patients with acute respiratory distress syndrome due to bilateral COVID-19 pneumonia on invasive mechanical ventilation (IMV) and analyze the effect of prolonged prone decubitus > 24 h (PPD) compared to prone decubitus < 24 h (PD). Design: Retrospective observational descriptive study. Uni and bivariate analysis. Setting: Department of Intensive Care Medicine. General University Hospital of Elche. Participants: Patients with SARS-CoV-2 pneumonia (2020-2021) in VMI for moderate-severe acute respiratory distress syndrome, ventilated in PD. Interventions: IMV. PD maneuvers. Main variables of interest: Sociodemographic; analgo-sedation; neuromuscular blockade; PD (duration), ICU stay and mortality, days of IMV; non-infectious complications; health care-associated infections. Results: Fifty-one patients required PD and of these 31 (69.78%) required PPD. No differences were found in patient characteristics (sex, age, comorbidities, initial severity, antiviral and anti-inflammatory treatment received). Patients on PPD had lower tolerance to supine ventilation (61.29 vs. 89.47%, p = 0.031), longer hospital stay (41 vs. 30 days, p = 0.023), more days of IMV (32 vs. 20 days, p = 0.032), longer duration of neuromuscular blockade (10.5 vs. 3 days, p = 0.0002), as well as a higher percentage of episodes of orotracheal tube obstruction (48.39 vs. 15%, p = 0.014). Conclusions: PPD was associated with higher resource use and complications in patients with moderate-severe acute respiratory distress syndrome by COVID-19.
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The aim of this study is to examine the results of physiotherapy in a patient with critical illness polyneuropathy (CIP) due to coronavirus disease 2019 (CO-VID-19). The 48-year-old male patient with CIP due to COVID-19 was enrolled in a physiotherapy program for 3 months with 5 sessions/week. Pain intensity, motor skills, daily living activities, fatigue level, cognitive status, and decubitus ulcer were evaluated with a visual analogue scale, the Medical Research Coun-cil-Sum Score, the Functional Independence Scale, the Fatigue Severity Scale, the Standardized Mini-Mental Test, and pressure wound staging, respectively. Positive improvements were achieved in functional level, fatigue, pain, and pressure sores with the physiotherapy program for this patient with CIP due to COVID-19. This report provides an idea about the effects of physiotherapy programs for COVID-19-related CIP to academics and clinicians working in this field.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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Healthcare workers (HCWs) assessed by dermatologists during the first wave of the COVID-19 pandemic had high rates of irritant hand dermatitis, facial dermatitis and acne triggered by wearing personal protective equipment (PPE) (Ferguson FJ, Street G, Cunningham L et al. Occupational dermatology in the time of the COVID-19 pandemic: a report of experience from London and Manchester, UK. Br J Dermatol 2021;184: 180-2). We report data from a tertiary National Health Service trust during the second COVID-19 wave in winter 2020-21. At its peak, the Trust had 835 COVID-positive inpatients and 263 intensive care unit (ICU) beds - one of the largest ICUs in Europe. Building on the published experience of dermatology units, we ran 30 dermatology pop-up clinics over 3 weeks in allocated rest areas across the Trust: 08.00-09.00 h and 13.00-14.00 h on weekdays, from 18 January 2021. HCWs requiring formal dermatology referral were provided with letters to their line managers. In 3 weeks, 401 HCWs were assessed: 327 females and 74 males (mean age 35 2 years). The most frequently seen occupation was nurses (n = 130;32 4%) followed by doctors (n = 74;18 4%). On average, staff spent 9 5 h in PPE per shift. Consistent with the existing literature, the most common diagnosis was irritant hand dermatitis (n = 186;46 4%). There was an increased incidence of acne (n = 171;42 6%) vs. the first wave, where the reported incidence was 17% in a multicentre study (O'Neill H, Narang I, Buckley DA et al. Occupational dermatoses during the COVID-19 pandemic: a multicentre audit in the UK and Ireland. Br J Dermatol 2021;184: 575-7). Less common in the second wave was facial eczema (n = 50, 12 5%) and pressure injury (n = 30;7 5%). Thirty-one (16 7%) of the HCWs with hand dermatitis required the prescription of potent topical corticosteroids, suggesting at least moderate symptoms. The majority received emollient samples. It was rare for HCWs to require formal referral (n = 11;2 7%). In our cohort, at least four (1 0%) HCWs required time off work owing to their skin problems. Our data support previous reports of increased occupational dermatoses in HCWs during the COVID-19 pandemic. We highlight the sheer scale of the issue, with 401 HCWs presenting for dermatological assessment in only 3 weeks in one trust. Compared with our experience during the first wave, acne exacerbated or precipitated by masks is increasingly common, which may be due to emollient use to prevent facial eczema or injury when wearing masks.
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Objective: To measure the prevalence of skin lesions in health personnel related to the use of personal protective equipment (PPE) during the SARS-CoV-2 pandemic. Method(s): A cross-sectional, descriptive and quantitative study was carried out;A questionnaire was applied to medical and nursing staff who treated patients with COVID-19, the most frequent adverse reactions caused by: masks, gloves, glasses, protective clothing and alcohol gel were quantified. Result(s): 90 people participated, of which 81 (90%) presented skin lesions associated with PPE. The accessory that caused the most injuries was the mask (87.7%), followed by glasses (85.5%) and alcohol gel (82.2%). The most frequent reaction to masks was nasal bridge ulcer (68.9%);in glasses it was pressure injury to the forehead (76.7%);and due to the use of alcohol gel it was dryness (75.5%). Conclusion(s): Prolonged use (>5 hours) of PPE can cause adverse skin effects in healthcare personnel. The mask was the accessory that generated the most skin lesions, with pressure ulcers on the nasal bridge being the most frequent.Copyright © 2022, Fundacion Index. All rights reserved.
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Le travail des aides-soignants est insuffisamment valorisé, même si leurs compétences sont mieux reconnues. La relation avec les patients ou résidents comme avec les membres de l'équipe est la source principale de satisfaction au travail. Pourtant, cela ne semble pas suffire pour fidéliser les soignants. © 2022 Elsevier Masson SAS
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Background: Critically ill COVID-19 patients have an elevated risk of experiencing hypercoagulable conditions. Currently, many COVID-19 patients have been administered anticoagulation or antiplatelet therapies to lower the risk of systematic thrombosis. Iliopsoas hematoma is a potentially fatal and rare complication of bleeding disorders or anticoagulation therapy which sometimes grows to become clinically significant. The main purpose of this case review is to emphasize the importance of diagnosing iliopsoas hematomas and the possibility of antiplatelet contribution to its development. Case Presentation: We are reporting a rare presentation of non-traumatic iliopsoas hematoma in a non-anticoagulated patient. The patient is a 59-year-old male, with known type-2 diabetes, on oral hypoglycemic medications, 3-weeks post-COVID-19. He had started aspirin 81 mg orally, once daily, to prevent thrombotic events associated with COVID 19 infection, with no anticoagulant use and no other medications. He came in through the ED, presenting with two weeks history of progressive right lower limb weakness in which an iliopsoas hematoma diagnosis was confirmed based on radiological investigation. Conclusion: The possibility of iliopsoas hematoma should be considered in non-anticoagulated patients with no inherited or acquired coagulation disorders presenting with limb weakness. The link between antiplatelet use in a COVID-19 patient and the development of soft tissue bleeding (e.g., iliopsoas hematoma) must be studied further. © 2022 [The Author/The Authors]
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Case Report: A 46-year-old lady with medical history of hypertension, diabetes mellitus, and peripheral neuropathy was admitted to the hospital with the diagnosis of sepsis without septic shock secondary to a right foot pressure ulcer. Her presentation was non-specific as she was complaining of fatigue, myalgia, fever, and chills. Routine COVID-19 test was done on admission and it came back positive despite her denying having any respiratory symptoms. She was being treated with fluids and antibiotics until her third night of admission. According to the patient, she got up to use the restroom when she suddenly noticed weakness in her lower extremities. She thought it may be due to a muscle spasm;hence, she did not notify the medical team. Later, her nurse was routinely checking the patient's blood pressure when she noted a blood pressure of 220/105 mmHg. She then received a total of 3 doses of intravenous labetalol over three hours;however, her blood pressure continued to be elevated. Patient did endorse right flank pain but it was responding to intravenous fentanyl. The on-call physician then proceeded to perform a full physical examination and noted paleness, weakness, and absent pulses in bilateral lower extremities. A STAT computed tomography (CT) angiogram of the abdominal aorta and iliofemoral arteries was performed and it revealed low-density defects in the right kidney compatible with infarcts, occlusive thrombus in the infrarenal abdominal aorta and extensive bilateral arterial thrombosis. Vascular surgery was immediately consulted and they kept the patient on heparin drip and took her to the operation room within few hours for thrombectomies. Her blood pressure improved following the removal of the thrombus and there were no other documented occurrence of uncontrolled hypertension during her hospitalization. Discussion(s): Acute renal infarction is an arterial vascular event that leads to sudden disruption of blood flow in the renal artery. It can often be diagnosed late due to its rare incidence. In addition, it has a nonspecific clinical presentation that can mimic many common causes. The most common causes of renal infarction include atrial fibrillation, endocarditis, ischemic heart disease, hypercoagulable disorders, and spontaneous renal artery dissection. A case report published by Bourgault M, et al. on renal infarction suggested that around 97% had abdominal/flank pain and 48% of patients had marked uncontrolled hypertension at initial presentation of renal infarction. Our patient did not have any of the afore mentioned risk factors except for a possible hypercoagulable state from her COVID-19 infection and she did present with the two most common presentations. In conclusion, clinicians should have a low threshold for the suspicion of renal ischemia in patients with severe hypertension and flank pain. Copyright © 2023 Southern Society for Clinical Investigation.
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Background. Data on COVID-19 related nursing home infections and mortality accumulated at a rapid pace;yet little is known about the impact of nursing homes' response to COVID-19 on resident clinical, functional, and psychosocial outcomes. Methods. We examined aggregated Minimum Data Set (MDS) assessments to describe resident outcomes using an interrupted times series methodology for three timeframes: pre-COVID (1/2019 to 2/2020), pandemic (3/2020-12/2021), and vaccination (1/2021-6/2021). Data included 307,558 federally mandated resident MDS assessments from 60,846 resident in 489 nursing homes in a Mid-Western state. We calculated MDS based quality measures (QM) using definitions available from Centers for Medicare and Medicaid Services. Each QM-based outcome was fit to a logistic regression model using the method of generalized estimating equations. Results. None of the QMs displayed a statistically significant trend pre-COVID. The prevalence of excessive weight loss and ADL decline increased sharply during the pandemic and reversed that trend with vaccination. Pressure ulcers among high-risk residents followed a similar trend, although pandemic and vaccination-related regression parameters for thatQMwere only marginally significant (p = .08). Pain worsened during the pandemic and vaccination period approaching significance (p=.07). Antipsychotic medication use worsened in the pandemic (p< .001) and did not improve in the vaccination period. Other QMs including any fall, fall with major injury, and incontinence did not exhibit statistically significant change in trend. Prevalence Profiles Circles: Observed proportions, Dashed Line: Model expected value, Solid Lines: 95% confidence limits for expected values Conclusion. We noted significant changes in QMs for antipsychotic use, ADL loss, andweight loss, with the latter two improving in the vaccination period. Isolation, disease outbreaks, and staffing issues in facilities could have affected theseQMs. Data variability may have limited our ability to detect other changes. Antipsychotics may have increased with the need to reduce wandering and other behaviors common in the nursing home population;behaviors high risk for spreading COVID-19. Why antipsychotic use did not improve during the vaccination period is less clear. Data beyond June of 2021 may help clarify the pattern of antipsychotic use. (Figure Presented).
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Objectives: Hospital-acquired pressure injuries (HAPrI) are areas of injury to the skin and/or underlying tissues. Risk stratification is essential for guiding prevention in the ICU, but current risk assessment tools require labor-intensive input. This motivates a tactical, parsimonious, and automatic risk profiling algorithm, that can be based on readily available clinical measures (e.g., COVID status, race, Medicare/Medicaid status). Additionally, International Pressure Injury Prevention guidelines call for the development of machine learning-based risk assessment algorithms that are clinician-interpretable and context-informed. Method(s): Adult patients admitted to one of two ICUs between April 2020, and April 2021 were eligible for inclusion. Discrete and ensemble super-learning models, adjusting for class imbalance, were created from a rich library of candidate base learners. For explainability, SHAP (SHapley Additive exPlanations) global and local values were derived to help explain variable average marginal contributions (across all permutations) to the model. An iteration of clinical expert review was performed with the SHAP values, and simulations of patient profiles and results were used to reformat and re-weight predictor variables. All analysis was run in open Python (version 3.7), and code/results will be made available via a GitHub page. Result(s): The final sample consisted of 1,911 patients (removing 9 with missing pressure injury status). Hospital-acquired pressure injuries (defined as stage 2, or worse) occurred in 18.5% of the sample (n=354). We achieved the best overall performance on the testing data with a stacked ensemble using three base models: random forest (rf), gradient boosted machine (gbm), and neural network (NN) (Performance on 20% holdout: Accuracy: 81%;AUC: 0.77;AUCPR: 0.53). Conclusion(s): Prediction engineering should be done in collaboration with clinical experts to optimize tactical implementation to both optimize performance, with minimal interruption to workflow. XAI enhanced adoption of the experts' advice based on the selected model features. Copyright © 2022
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Case Diagnosis: A 50-year-old man developed severe critical illness polyneuropathy, and other severe medical complications, as a rare complication of COVID-19 which required extensive and an unusually long inpatient rehabilitation Case Description or Program Description: This is an unusual case of a 50-year-old man who developed severe critical illness polyneuropathy (CIP) after COVID-19 infection. His acute care stay was notable for respiratory failure, cardiac arrest, pressure sore, and quadriparesis. Diagnostic evaluation was consistent with CIP. He was transferred to a long term acute care hospital (LTACH) for medical care, wound care, pulmonary management and rehabilitation, dependent for all self care and mobility upon admission. His rehabilitation started upon admission to the LTACH. He ultimately fully engaged an interdisciplinary team approach which incorporated specialized technology such as a robotic powered exoskeleton. His length of stay at the LTACH was 10 months, while the average length of stay in LTACH's is approximately 1 month. By the end of his unusually prolonged inpatient stay, he was ambulatory with bilateral ankle foot orthosis and a walker. Setting(s): LTACH Assessment/Results: Upon discharge, he was ambulatory with bilateral ankle foot orthosis, a walker, and was discharged home. Discussion (relevance): The COVID 19 challenges include medical complications, neurologic sequelasuch as CIP, the average length of stays of inpatient care, and insurance approval of inpatient care. A successful strategy for those profoundly impacted requires a comprehensive view of the challenges, engagement of an interdisciplinary team, and powerful patient advocacy. Conclusion(s): This case highlights the importance of recognizing the challenges of COVID 19 infection, reviews interventions in the context of patient's functional goals, reviews the unusually long length of stay that may be required, reviews the advocacy needed to ensure patient access to inpatient rehabilitation, and reviews the literature.
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Case Diagnosis: Guillain-Barre Syndrome secondary to COVID-19 pneumonia complicated by reactivation of Herpes Simplex and Epstein-Barr virus causing ventriculitis/ encephalitis Case Description or Program Description: 64 y/o male admitted to acute care hospital (ACH) with progressive bilateral lower extremity weakness associated with recent "flu-like" symptoms and positive COVID-19 test. ACH course was complicated by flaccid tetraplegia, hypoxemic respiratory failure and altered mental status. Initial CSF studies revealed elevated protein with albuminocytologic dissociation, negative cultures and negative viral panel, consistent with Guillain Barre Syndrome (GBS) in the setting of recent COVID-19 pneumonia. Patient was treated with plasmapheresis and IV corticosteroids with no neurological improvement. Setting(s): Inpatient rehab Assessment/Results: Patient then developed visual loss and was diagnosed with cortical blindness that could not be explained by his underlying GBS. MRI brain revealed findings consistent with ventriculitis/ encephalitis. Repeat CSF studies revealed positivity for Herpes Simplex Virus (HSV-2) as well as Epstein-Barr virus, both of which were previously undetected on admission. Patient was transferred to acute inpatient rehabilitation facility (IRF) with flaccid tetraplegia, cortical blindness, pressure ulcers, malnutrition at a total assist level of function. During IRF stay majority of rehab efforts were focused on training family to care for his various needs;tube feeds, medications, avoiding pressure ulcers. Discussion (relevance): The initial negative CSF studies and sequential development of this patient's symptoms are evidence to support that the COVID-19 virus can likely cause reactivation of other viruses. One study, "Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation", reported that up to 66.7% of COVID-19 patients were found to be positive for EBV reactivation. In our patient, the reactivation of HSV-2 and EBV causing ventriculitis/ encephalitis with cortical blindness had major implications on his rehabilitation outcomes. Conclusion(s): To date, there has been minimal published research on the potential of COVID-19 to cause reactivation of other viruses. This case report emphasizes the remarkable ability of the COVID-19 virus to reactivate other viruses and also provides an example of the clinical implications of this within acute rehabilitation.
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Prolonged high-flow nasal oxygenation (HFNO), or non-invasive ventilation (NIV), or endotracheal intubation with prone ventilation in COVID-19 patients may result in pressure sores or ulcers at points on sustained pressure at patient-equipment interphase. Expert nursing care and following the relevant guidelines can prevent the development of such injuries. Copyright © 2022 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
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SESSION TITLE: COVID-19 Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Macroglossia is a rare but life-threatening symptom that disrupts a person's ability to talk, swallow, and can also compromise their airway. Although not very well studied, there are several case reports describing a possible association between COVID-19 infection and macroglossia in people with African ancestry. We present an African American man who developed significant macroglossia several days after testing positive for COVID-19. CASE PRESENTATION: A 59 y/o African American male with a history of chronic bronchitis and tobacco use presented with 4 days of dyspnea. Sars-Cov-2 PCR was positive. Chest x-ray revealed bilateral, diffuse lung infiltrates. He had an elevated CRP of 295 and a d-dimer of 265. He became lethargic and hypercapnic requiring intubation which was nontraumatic. He was sedated, paralyzed, and proned. He received steroid therapy, broad spectrum antibiotics and a dose of Sarilumab. About a week later, he developed macroglossia that worsened over the course of days. Side effect profiles of each of his medications did not reveal any increased likelihood of macroglossia. C1Q complement cascade was mildly elevated and C1 esterase inhibitor level was normal. Diagnosis and treatment was necessary at this point as concerns for tongue central necrosis were raised and baseline tongue size would be required for proper evaluation and surgical intervention if necessary. He was given 4 units of FFP for possible angioedema with no improvement. CT Neck W/ contrast revealed edema and protrusion of the tongue without a discrete mass. Workup for acromegaly, sarcoidosis, amyloidosis, and hypothyroidism were negative. A pressure ulcer developed on his tongue due to the endotracheal tube and so he underwent tracheostomy. His tongue was draped in Chlorhexidine soaked gauze as well as Vashe wound solution. As he recovered from COVID-19 pneumonia, his respiratory status improved as well as his macroglossia. His tracheostomy was decannulated and his tongue returned to its baseline size. DISCUSSION: Macroglossia can lead to complications including airway compromise, dysphagia, or speech difficulties. It has been heavily proposed in the literature that COVID-19 infection can lead to postinfectious inflammatory peripheral nerve injury secondary to immune driven mechanisms. It was also previously proposed in literature based on immune-histochemical analysis of a tongue tissue sample taken from a COVID-19 patient that tongue muscle atrophy occurs as well as macrophage infiltration similar to that of nerve injury repair which can eventually lead to macroglossia. CONCLUSIONS: As the effects of COVID-19 are becoming better studied overtime, macroglossia, especially in those with African ancestry, is increasingly coming under the radar. This case report seeks to educate clinicians on this possible sequela and encourage supportive treatment in hopes that the tongue will recover. Reference #1: McCrossan S, Martin S, Hill C. Tongue Reduction for Macroglossia. J Craniofac Surg. 2021;32(5):1856-1859. doi:10.1097/SCS.0000000000007276 Reference #2: Colombo D, Del Nonno F, Nardacci R, Falasca L. May macroglossia in COVID-19 be related not only to angioedema?. J Infect Public Health. 2022;15(1):112-115. doi:10.1016/j.jiph.2021.10.026 Reference #3: Fernandez CE, Franz CK, Ko JH, et al. Imaging Review of Peripheral Nerve Injuries in Patients with COVID-19. Radiology. 2020;298 (3). https://doi.org/10.1148/radiol.2020203116 DISCLOSURES: No relevant relationships by Megan Devine No relevant relationships by Devin Haney No relevant relationships by Es-Haq Hassanin No relevant relationships by Nadim Islam No relevant relationships by Alyssa Weyer
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Background: In the UK, 38% of people residing in care homes are estimated to be at high risk of malnutrition1 and it is known now that nutritional status can further be negatively affected by COVID-19 not only directly through medical complications but also social factors such as social isolation, staffing issues, increased anxiety and low mood2. Our aim is to evaluate the clinical and cost effectiveness of direct dietetic input (Rapid Access Dietetic Service) to care homes during the COVID-19 pandemic. Methods: During the first wave of the Covid-19 pandemic, a rapid access service to support care homes was set up, accepting referrals directly from the care home staff and offering a remote dietetic assessment within 1 week of referral. Patients at high risk of malnutrition / on ONS were followed up as part of a 12-week care pathway. The 12-week pathway consisted of initial and last telephone/video consultation by the dietitian and monthly telephone follow ups in between by the dietetic assistant. Care home staff were provided remote training on ‘Food First’ malnutrition management and ONS prescribing. Outcomes audited were MUST, clinical outcomes (number of falls, pressure sores, chest and UTI infections, hospital admissions, A&E attendance in the last 3 months) pre and after 12-week pathway. Cost benefit analyses were performed on both clinical outcomes and ONS changes. Service evaluation was done by requesting GP / care staff and community dietitians’ feedback. Results: 54 patients were referred by the care homes staff/GP, 24 of those because of medium/high risk of malnutrition, 30 referred for ONS review. Out of the patients who were medium/high risk (n = 24) and were onboarded onto the 12-week care pathway, the number of patients with MUST of 0 (low risk) increased 8-fold, patients with MUST of 1 (medium risk) increased 2.3 times and patients with MUST of 2 or above (high risk) declined by half after the 12-week care pathway. Cost benefit analysis on clinical outcomes showed combined estimated cost savings of £26,061 (Table 1). Out of the patients on ONS, 11 prescriptions were changed, 5 were stopped, 13 were continued resulting in a total ONS annualised savings of £12,753 / £425 per patient. The service was evaluated by the community dietitians, care staff and GPs and positive feedback was provided. [Formula presented] Discussion: Despite being an existing service, significant adaptations were made in order to continue providing care throughout the COVID-19 pandemic. All interactions and engagement with GPs and care home staff were conducted remotely in place of the usual in-person service. Despite this change, marked improvements in patient malnutrition status were seen during the 12-week care pathway. Cost benefit analysis show a combined annualised cost saving of £38,814 during the 6-month intervention from the ONS changes and clinical outcomes. This equates to an annualised cost saving of £77,628 and £718.7 per person referred. The service was highly valued by the care home staff, GPs and community dietitians as evidenced by the positive feedback received. Limitations include other possible factors may have influenced the results e.g. medications/other HCP involvement. Annualized savings for ONS changes and clinical outcomes were estimated based on savings achieved in the 6 months over the service was running. The cost of dietitian was not included as a pre-existing service was altered during the pandemic months prioritizing care homes. Conclusion: The new rapid access service for care homes resulted in residents being seen quickly and appropriately treated for malnutrition where identified. The service also resulted in significant cost savings for ONS prescriptions and avoidance of healthcare costs associated with malnutrition. Continuation of this new service model should be considered to reduce the incidence of malnutrition and effectively manage those identified as malnourished. References 1. Nutrition Screening Survey in care Homes in the UK: A report based on the amalgamated data from the four Nutrition Screening Week surveys undertaken by BAPEN in 2007, 2008, 2010 and 2011 C A Russell and M Elia on behalf of BAPEN and collaborators 2. Azzolino D, Saporiti E, Proietti M, Cesari M. Nutritional considerations in frail older patients with COVID-19. The journal of nutrition, health & aging. 2020 Jul;24:696-8. 3. National Schedule of Reference Costs 2017/2018 4. Dealey C, Posnett J, Walker A. The cost of pressure ulcers in the United Kingdom. J Wound Care. 2012 Jun;21(6):261-2, 264, 266. 5. British National Formulary – National Institute for Health and Care Excellence -
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The proceedings contain 79 papers. The topics discussed include: the junior doctor shadow board, lessons learned from the corporate sector;workplace wellness: the impact of a series of trainee wellbeing workshops in the north east;the effectiveness of social media during the COVID-19 pandemic in engaging students and clinicians in medical leadership and management topics;use of simulation to develop leadership;quality improvement project on pediatric antibiotic prescription writing;standardizing wellbeing for junior doctors- the wellbeing checklist;the Headstart project - a peer-led introduction to the NHS for international medical graduates;navigating the storm: structuring and supporting junior doctor wellbeing during the covid-19 pandemic;and pelvic osteomyelitis complicating pressure ulcers - prevalence and management evaluation study in a district general hospital in surrey.
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Introductions: Pressure ulcers (PUs) represents an undesirable complication during hospitalization. Aim: Retrospective data analysis to verify the prevalence of PUs since 2015 (since the mandatory registration of the PUs an adverse event) by principal diagnosis, type of surgery and length of hospital stay in the period 2015–2021. Sample and methods: Retrospective analysis of data from the hospital information system (HIS), at 0.05 level of significance (T-Test) with the variables: age, number of pressure ulcers, principal diagnosis, operation, length of hospitalization and prevalence of COVID-19 to length of hospitalization. Results: A total of 2,350 PU cases in 1,539 patients (1.52 PUs/patient) were registered in the HIS, and 930 (40%) patients were admitted to hospital with PUs. The most common locations of PUs were: heel (33%), sacrum 6% less, buttocks (17%). Between 2015 and 2021;17,247 patients were operated on, of whom 289 had a Pus. The most common principal diagnosis in the occurrence of PUS was femoral neck fracture (14.35%) and neurological (9.09%) or oncological disease (12.03%). The incidence of PUs was surprising in patients with ileal conditions (11.57%). COVID-19 was found in 163 patients in 2020 and 2021, six of whom had PUs and prolonged hospitalization. Conclusion: It is important to view the health status of people with chronic wounds and PUs in a comprehensive manner and to develop an individualized care plan to improve patients‘ lives and chances of recovery.
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Objective: To ascertain the extent of nasogastric tube (NGT) dislodgment in COVID-19 intensive care unit (ICU) patients after the introduction of NGT bridle kits as a standard of practice, to see whether this would reduce the number of NGT insertions, patient irradiation, missed feeds, and overall cost. Background: Nasogastric feeding is the mainstay of enteral feeding for ICU patients. The usual standard of practice is to secure the tube using adhesive tape. Studies show this method has a 40% to 48% dislodgment rate. The COVID-19 ICU patient population may be at even greater risk due to the need for proning, long duration of invasive ventilation, and emergence delirium. Design: This was a 2-cycle quality improvement project. The first cycle was done retrospectively, looking at the contemporaneous standard of practice where bridle kits were not used. This gave an objective measure of the extent of NGT displacement, associated costs, and missed feeds. The second cycle was carried out prospectively, with the use of NGT bridle kits as the new standard of practice. Setting: A large United Kingdom teaching hospital with a 100-bed, single-floor ICU. Participants: Patients admitted to the ICU with COVID-19 who subsequently required sedation and invasive ventilation. Measurements: Measurements included days of feeding required, hours of feeding missed due to NGT dislodgment, total number of nasogastric tubes required per ICU stay, and number of chest radiographs for NGT position confirmation. NGT-related pressure sores were also recorded. Results: When compared to the bridled group, the unbridled group required a higher number of NGTs (2.5 vs 1.3;P< .001) and chest radiographs (3.4 vs 1.6;P< .001), had more hours of feeding missed (11.8 vs 5.0), and accumulated a slightly higher total cost (cost of NGT, chest radiographs +/- bridle kit: £211.67 vs £210, [US $284.25 vs US $282.01]). Conclusions: The use of NGT bridle kits reduces the number of NGT insertions patients require and subsequently reduces the number of chest radiographs for each patient. These patients also miss fewer feeds, with no appreciable increase in cost.