Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 114
Filter
1.
J Infect Dis ; 2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2097372

ABSTRACT

BACKGROUND: Evaluating the performance of SARS-CoV-2 serological assays and clearly articulating the utility of selected antigen, isotypes and thresholds is crucial to understanding the prevalence of infection within selected communities. METHODS: This cross-sectional study, implemented in 2020, screened PCR-confirmed COVID-19 patients (n = 86), banked pre-pandemic and negative donors (n = 96), health care workers and family members (n = 552), and university employees (n = 327) for anti-SARS-CoV-2 receptor-binding domain (RBD), trimeric spike protein (S), and nucleocapsid protein (N) IgG and IgA antibodies with a laboratory developed Enzyme-Linked Immunosorbent Assay (ELISA) and tested how antigen, isotype and threshold choices affected the seroprevalence. The following threshold methods were evaluated: (i) mean + 3 standard deviations of the negative controls; (ii) 100% specificity for each antigen/isotype combination; and (iii) the maximal Youden index. RESULTS: We found vastly different seroprevalence estimates depending on selected antigens, isotypes and the applied threshold method, ranging from 0.0% to 85.4% . Subsequently, we maximized specificity and reported a seroprevalence, based on more than one antigen, ranging from 9.3% to 25.9%. CONCLUSIONS: This study revealed the importance of evaluating serosurvey tools for antigen, isotype, and threshold-specific sensitivity and specificity, in order to interpret qualitative serosurvey outcomes reliably and consistently across studies.

2.
Journal of Clinical Outcomes Management ; 29(5):58-64, 2022.
Article in English | EMBASE | ID: covidwho-2067256

ABSTRACT

Objective: To compare the utilization of oxygen therapies and clinical outcomes of patients admitted for COVID-19 during the second surge of the pandemic to that of patients admitted during the first surge. Design(s): Observational study using a registry database. Setting(s): Three hospitals (791 inpatient beds and 76 intensive care unit [ICU] beds) within the Beth Israel Lahey Health system in Massachusetts. Participant(s): We included 3183 patients with COVID-19 admitted to hospitals. Measurements: Baseline data included demographics and comorbidities. Treatments included low-flow supplemental oxygen (2-6 L/min), high-flow oxygen via nasal cannula, and invasive mechanical ventilation. Outcomes included ICU admission, length of stay, ventilator days, and mortality. Result(s): A total of 3183 patients were included: 1586 during the first surge and 1597 during the second surge. Compared to the first surge, patients admitted during the second surge had a similar rate of receiving low-flow supplemental oxygen (65.8% vs 64.1%, P= .3), a higher rate of receiving high-flow nasal cannula (15.4% vs 10.8%, P= .0001), and a lower ventilation rate (5.6% vs 9.7%, P< .0001). The outcomes during the second surge were better than those during the first surge: lower ICU admission rate (8.1% vs 12.7%, P< .0001), shorter length of hospital stay (5 vs 6 days, P< .0001), fewer ventilator days (10 vs 16, P= .01), and lower mortality (8.3% vs 19.2%, P< .0001). Among ventilated patients, those who received high-flow nasal cannula had lower mortality. Conclusion(s): Compared to the first surge of the COVID-19 pandemic, patients admitted during the second surge had similar likelihood of receiving low-flow supplemental oxygen, were more likely to receive high-flow nasal cannula, were less likely to be ventilated, and had better outcomes. Copyright © 2022 Turner White Communications Inc.. All rights reserved.

3.
Cardiology in the Young ; 32(Supplement 2):S183, 2022.
Article in English | EMBASE | ID: covidwho-2062120

ABSTRACT

Background and Aim: Multisystem inflammatory syndrome in chil-dren (MIS-C) is a late manifestation of SARS-CoV-2 infection. Cardiac involvement is common and presents as ventricular dys-function, shock, and coronary anomalies. The aim of the study is evaluate the influence of cardiac disfunction on clinical presen-tations and outcomes in a single center. Method(s): A retrospective study on patients diagnosed with MIS-C and referred to Buzzi Children's Hospital in Milan from November 2020 to February 2021. Patients were treated with intravenous immunoglobulins, corticosteroids and anti-throm-botic prophylaxis, in respect to our approved multidisciplinary protocol. According to the admission cardiac left ventricular ejec-tion fraction (LVEF), the patients were divided into group A (LVEF lt;45%) and group B (LVEF >=45%). Result(s): We collected 32 consecutive patients. Group A included 10 patients (9M/1F, aged 13 years [IQR 5-15]), and group B included 22 patients (15M/7M, aged 9 years [IQR 7-13]). At the presentation, significant differences were observed among shock (group A 6/10 vs group B 2/22, plt;0.01), gastrointestinal involvement (9/10 vs 11/22, p = 0.04) and duration of fever (5.3 vs 6.9 days, p = 0.02). All patients in group A required inten-sive care hospitalization (10/10 vs 12/22, p = 0.01). Interestingly, despite good cardiac function, two patients in group B presented with shock, probably due to vasoplegic/distributive cardiocircula-tory impairment secondary to the inflammatory state. Among biochemistry parameters, leukocytes, neutrophils, and CRP were significantly worse in group A (p = 0.001, p = 0.001 and p = 0.008, respectively). Pathological level of troponin T and NTproBNP were detected in all patients in group A and also in 33% and 77% of group B;with statistically significant higher median values in group A (Troponin T 72 [40-243] ng/L vs 22 [8-49] ng/L, p = 0.01;NTproBNP 14825 [11340-17810] ng/L vs 5921 [1114-11243] ng/L, p = 0.01). In group A, mitral regurgitation was more frequent (plt;0.01) and one patient had transient left main coronary dilation (Boston z-score +2.39). At the discharge, cardiac function normalized in all patients. Total length of hospital stay and cardiac recovery time were not statistically different between groups. Conclusion(s): If correctly diagnosed and early treated, all the MIS-C patients completely recovered, regardless of the initial cardiac involvement.

4.
Chest ; 162(4 Supplement):A2650-A2651, 2022.
Article in English | EMBASE | ID: covidwho-2060977

ABSTRACT

SESSION TITLE: Late Breaking Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: The Galaxy SystemTM (Noah Medical, San Carlos, CA) is a novel robotic endoluminal platform using electromagnetic navigation combined with integrated tomosynthesis technology and augmented fluoroscopy. It provides intraprocedural imaging to correct CT-to-body divergence and novel confirmation of tool-in-lesion. The primary aim of this study was to assess the tool-in-lesion accuracy of the robotic bronchoscope with integrated digital tomosynthesis and augmented fluoroscopy. METHOD(S): Over four separate days, four operators (the authors) conducted the experiment using four pigs. Each physician performed between 4 and 6 nodule biopsies for 20 lung nodule biopsies. A porcine model (S. s. domesticus) was utilized. Each pig was anesthetized with volatile gas and underwent tracheostomy with an 8.5 endotracheal tube and bilateral chest tube thoracostomy. Anesthesia was monitored by a veterinarian with invasive hemodynamic monitoring. Under CT fluoroscopic guidance, simulated lung nodules were created by percutaneous injection of a gelatinous agar solution containing purple dye and radiopaque material into the lung periphery. A CT was then performed for pre-procedure planning. Using Galaxy's "Tool in Lesion TOMO+" with augmented fluoroscopy, the physician navigated to the lung nodules and a tool (needle) was placed into the lesion. Tool in lesion was defined by the needle in or tangential to the lesion determined by CBCT. Center strike was defined as the needle in the middle third in three orthogonal angles (axial, sagittal, and coronal) on CBCT. RESULT(S): Lung nodules' average size was 16.3+/-0.97 mm and were predominantly in the lower lobes (65%). Only 15% (3/20) had a bronchus sign and the average distance to the pleura was 6.88+/-5.5 mm. All four operators successfully navigated to all (100%) of the lesions in an average of 3 minutes and 39 seconds. The median number of tomosynthesis sweeps was 3 and augmented fluoroscopy was utilized in most cases (17/20 or 85%). Tool in lesion after final tomography sweep was 100% (20/20). Biopsy yielding purple pigmentation on microscopic or gross examination was also 100% (20/20). Center strike rate was 60%. CONCLUSION(S): The Galaxy SystemTM demonstrated successful digital tomography confirmed tool in lesion success in 100% (20/20) of lesions as confirmed by CBCT. Successful biopsy was achieved in 100% of lesions as confirmed by intralesional pigment acquisition. CLINICAL IMPLICATIONS: The combination of robotic navigation, catheter maneuverability and real-time correction for CT body divergence capitalizes on the strengths of all three technologies to improve diagnosis. Additional clinical trials are warranted to see if high success rates can be reproduced in patients. DISCLOSURES: Consultant relationship with Medtronic ILS Please note: $20001 - $100000 by Krish Bhadra, value=Consulting fee Consultant relationship with Veractye Please note: $1-$1000 by Krish Bhadra, value=Consulting fee Consultant relationship with Bodyvision Please note: $1001 - $5000 by Krish Bhadra, value=Consulting fee Consultant relationship with Merit Endotek Please note: $1001 - $5000 by Krish Bhadra, value=Consulting fee Consultant relationship with Boston Scientific Please note: $1001 - $5000 by Krish Bhadra, value=Consulting fee Human Factor Testing relationship with Auris Surgical Robotics Please note: $1001 - $5000 by Krish Bhadra, value=Consulting fee Consultant relationship with Intuitive Surgical Robotics Please note: $5001 - $20000 by Krish Bhadra, value=Consulting fee Consultant relationship with Biodesix Please note: $5001 - $20000 by Krish Bhadra, value=Consulting fee Consultant relationship with Noah Medical Please note: 5/2020 Added 06/01/2022 by Krish Bhadra, value=Consulting fee Speaker relationship with Body Vision Please note: 2015 - present Added 05/29/2022 by Douglas Hogarth, value=Ownership interest Consultant relationship with Magnisity Please note: 2021 - present Added 05/29/2022 by Douglas Hogarth, value=Ownership interest Consultant relationship with Auris (J&J Ethicon) Please note: 2014-present Added 05/29/2022 by Douglas Hogarth, value=Honoraria Consultant relationship with Boston Scientific Please note: 2008 - present Added 05/29/2022 by Douglas Hogarth, value=Consulting fee Consultant relationship with Medtronic Please note: 2010-2019 Added 05/29/2022 by Douglas Hogarth, value=Consulting fee Consultant relationship with Broncus Please note: 2017-2021 Added 05/29/2022 by Douglas Hogarth, value=Consulting fee Consultant relationship with PulmonX Please note: $5001 - $20000 by Douglas Hogarth, value=Consulting fee Removed 06/08/2022 by Douglas Hogarth Consultant relationship with Spiration Please note: $5001 - $20000 by Douglas Hogarth, value=Consulting fee Removed 06/08/2022 by Douglas Hogarth Consultant relationship with Eolo Please note: $20001 - $100000 by Douglas Hogarth, value=Ownership interest Removed 06/08/2022 by Douglas Hogarth Consultant relationship with Noah Please note: 2019 - present Added 06/08/2022 by Douglas Hogarth, value=Ownership interest Consultant relationship with Noah Please note: 2019 - present Added 06/08/2022 by Douglas Hogarth, value=Consulting fee Consultant relationship with Medtronic Corporation Please note: $5001 - $20000 by Amit Mahajan, value=Consulting fee Consultant relationship with Boston Scientific Corporation Please note: $1001 - $5000 by Amit Mahajan, value=Consulting fee Consultant relationship with Pulmonx Corporation Please note: $5001 - $20000 by Amit Mahajan, value=Consulting fee Consultant relationship with Ambu USA Please note: $1-$1000 by Amit Mahajan, value=Consulting fee Consultant relationship with Circulogene Please note: $1001 - $5000 by Amit Mahajan, value=Consulting fee Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee Copyright © 2022 American College of Chest Physicians

5.
Chest ; 162(4):A2079-A2080, 2022.
Article in English | EMBASE | ID: covidwho-2060895

ABSTRACT

SESSION TITLE: Great Procedural Cases: Fire, Ice, Struts, Valves, and Glue SESSION TYPE: Case Reports PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm INTRODUCTION: Secondary spontaneous pneumothoraxes commonly occur in patients with cystic fibrosis (CF) and can be complicated by persistent air leak (PAL) due to bronchopleural or alveolopleural fistula. More recently, bronchoscopic placement of one-way endobronchial valves (EBV) for PAL have been explored. We present the first case series of patients with CF who developed secondary spontaneous pneumothoraxes and were successfully treated with EBV. CASE PRESENTATION: A 30-year-old female with CF (F508del/dupex6B-10) and history of pneumothorax, presented with acute hypoxic respiratory failure. She was found to have a right-sided pneumothorax. A chest tube was placed, with a continuous air leak for 4 days. She was a suboptimal surgical candidate given extensive apical lung disease, making localization of the air leak difficult. In addition, the increased tissue density would have made wedge resection challenging. After multidisciplinary discussion, the patient underwent placement of 5 Zephyr EBV (Pulmonx Inc., Redwood City, CA) for PAL. The lung had re-expanded, but there was still an intermittent air leak. She underwent pleurodesis with betadine. Her chest tube was removed 2 days later, and she was discharged. She was seen in the pulmonary clinic 5 days after being discharged and was noted to have recurrent right pneumothorax. She underwent chest tube placement with flutter valve. The chest tube was removed after 10 days. The patient was scheduled for removal of EBV 6 weeks after placement, but the procedure was delayed to symptomatic COVID-19 infection. EBV were eventually removed 12 weeks after placement. Pneumothorax has not recurred 6 weeks post EBV removal. A 53-year-old female with CF (394delTT/3272-26A-G) and a small right apical secondary spontaneous pneumothorax 3 months prior to hospitalization presented with progressive dyspnea. Imaging showed that the pneumothorax had enlarged. A chest tube was placed with continuous air leak. After a multidisciplinary discussion, 5 Zephyr EBV were placed 2 days later. There was immediate improvement of the pneumothorax, with almost no air leak. Her chest tube was removed 48 hours after placement of EBV, and patient was discharged on day 4. The EBV were removed 8 weeks later with no recurrence of pneumothorax 1 month after valve removal. DISCUSSION: To our knowledge this is the first case series describing the use of Zephyr EBV in CF patients with secondary spontaneous pneumothorax complicated by PAL. Although previous guidelines still recommend surgery and/or pleurodesis for PAL, this may not be the best option for patients with CF who may require lung transplantation. EBV are currently FDA approved for lung volume reduction to treat emphysema, but it is likely a viable non-surgical alternative for PAL. CONCLUSIONS: EBV is a well-tolerated treatment option for PAL due to secondary spontaneous pneumothoraxes. Reference #1: Bongers KS, De Cardenas J. Endobronchial valve treatment of persistent alveolopleural fistulae in a patient with cystic fibrosis and empyema. J Cyst Fibros. 2020 Sep;19(5):e36-e38. doi: 10.1016/j.jcf.2020.03.014. Epub 2020 Apr 18. PMID: 32312675. Reference #2: Travaline JM, McKenna RJ Jr, De Giacomo T, Venuta F, Hazelrigg SR, Boomer M, Criner GJ;Endobronchial Valve for Persistent Air Leak Group. Treatment of persistent pulmonary air leaks using endobronchial valves. Chest. 2009 Aug;136(2):355-360. doi: 10.1378/chest.08-2389. Epub 2009 Apr 6. Erratum in: Chest. 2009 Sep;136(3):950. PMID: 19349382. Reference #3: Dugan KC, Laxmanan B, Murgu S, Hogarth DK. Management of Persistent Air Leaks. Chest. 2017 Aug;152(2):417-423. doi: 10.1016/j.chest.2017.02.020. Epub 2017 Mar 4. PMID: 28267436;PMCID: PMC6026238. DISCLOSURES: No relevant relationships by Bryan Benn no disclosure on file for Julie Biller;No relevant relationships by Rose Franco Speaker/Speaker's Bureau relationship with Biodesix Please note: 2018 - present by Jonathan Kurman, value=Honoraria Consultant relationship with Level Ex Please note: 2018 - present by Jonathan Kurman, value=Consulting fee Consultant relationship with Medtronic Please note: 2020 - present by Jonathan Kurman, value=Consulting fee Consultant relationship with Pinnacle Biologics Please note: 2020 - present Added 04/01/2022 by Jonathan Kurman, value=Consulting fee Consultant relationship with Boston Scientific Please note: 2021 - present by Jonathan Kurman, value=Consulting fee Consultant relationship with Cook Medical Please note: 2021 - present by Jonathan Kurman, value=Consulting fee Speaker/Speaker's Bureau relationship with Erbe Please note: 2021 - present by Jonathan Kurman, value=Honoraria research panel relationship with Intuitive Please note: 2020 - present by Jonathan Kurman, value=Honoraria Removed 04/01/2022 by Jonathan Kurman Consultant relationship with Pulmonx Please note: 2020 - present by Jonathan Kurman, value=Consulting fee Travel relationship with Ambu Please note: 2021-present Added 04/01/2022 by Jonathan Kurman, value=Travel Removed 04/01/2022 by Jonathan Kurman Consultant relationship with Ambu Please note: 2022-present Added 04/01/2022 by Jonathan Kurman, value=Consulting fee Speaker/Speaker's Bureau relationship with Veracyte Please note: 2021-present Added 04/01/2022 by Jonathan Kurman, value=Honoraria No relevant relationships by Shreya Podder

6.
Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S174-S175, 2022.
Article in English | EMBASE | ID: covidwho-2058629

ABSTRACT

Objective: Food insecurity impacts 1 out of 6 patients with celiac disease (CD) in the United States, and rates have increased during the COVID-19 pandemic. This is particularly concerning for vulnerable populations who require specialized medical diets. State and federal resource programs do not account for the increased cost of gluten-free (GF) foods, and food pantries do not address overall health issues that often come with food insecurity. Our project aimed to provide GF food to food insecure families through a hospital-based food pantry and offer dietitian-led cooking classes to improve dietary quality and nutrition knowledge. Method(s): To address barriers to food access, Boston Children's Hospital (BCH) opened a food pantry, the Family Food Connections (FFC), in the Jamaica Plain neighborhood of Boston. FFC offers weekly food supplies to BCH patient families and community members. GF food bags are available for those who request them. Monthly virtual cooking classes led by a registered dietitian are offered free of charge to families with and without CD. All classes are held via Zoom with simultaneous translation services available in Spanish. Classes feature naturally GF recipes, and provide instructions on scratch cooking, nutrition education, and use of ingredients found in the food packages. The recipes are designed to include seasonal ingredients and are used as a platform to teach about nutrition related topics. Classes also serve as an open forum for families to ask nutrition and meal preparation related questions to the dietitian instructor. Metrics on pantry usage and class attendance were collected using Zoom analytics tools and REDCap. Result(s): Utilization of both the food pantry and cooking classes increased monthly. During the first six months of operation, an average of 500 families per week visited the FFC for food packages, totaling over 5,000 unique family visits. Of these families, 122 indicated needing all gluten-free food (64) or some gluten-free food (58). As of May 2022, 34 families attended the live virtual cooking classes, and 628 families viewed the recorded sessions. Survey questionnaire responses were limited to date (N=11) but did indicate that families previously had never attended a cooking class due to a lack of time, or they were not aware that classes were available. Conclusion(s): Initial utilization of the FFC, GF food packages, and accompanying cooking classes revealed a significant demand for the provision of GF food as well as a GF focused cooking and nutrition education program. The classes allow for processing nutrition education through non-intentional learning, and provide an opportunity to improve health and quality of life for all who attend, regardless of dietary restrictions. Future studies will evaluate changes in health outcomes, quality of life, cooking habits, and GF diet knowledge.

7.
ASAIO Journal ; 68(Supplement 3):18, 2022.
Article in English | EMBASE | ID: covidwho-2057729

ABSTRACT

Introduction: At the outset of the COVID-19 pandemic we observed an unacceptably high incidence of intracranial hemorrhage during VV ECMO support for COVID-19 related respiratory failure. The relationship between PTT and Anti-Xa values was explored by pharmacy and facility ECMO leadership, and found COVID patients to have elevated Anti-Xa levels at prescribed PTT levels. Method(s): We retrospectively analyzed data of 38 adult COVID-19 VV ECMO patients at Massachusetts General Hospital from March 18, 2020 to February 1, 2022 for incidence of ICH before and after anticoagulation protocol was changed on May 12th 2020. Result(s): Prior to change in practice, ICH was present in 33% (n = 4) of all COVID+ VV ECMO runs (n = 12). ICH was present in 57% of all deaths (n = 7) during this period. On May 12th 2020, after a pharmacy review, along with regional/international meetings among many ECMO centers MGH initiated a new protocol for COVID-19 positive ECMO patients targeting an Anti-Xa range of 0.15-0.29 with heparin titration. After this change, there were a subsequent 26 VV ECMO runs meeting the criteria for this study. ICH was present in only 3.8 % of patients (n = 1). And was present 6.3% (n = 1) of all deaths (n = 16). Conclusion(s): Anti Xa guided anticoagulation strategy resulted in a 88% decrease in the incidence of ICH in COVID-19 positive VV ECMO patients during the time of this retrospective analysis and proved a safe alternative to PTT guided heparin therapy.

8.
Investigative Ophthalmology and Visual Science ; 63(7):1407-A0103, 2022.
Article in English | EMBASE | ID: covidwho-2057536

ABSTRACT

Purpose : During the COVID-19 pandemic, regulatory changes in the United States allowed physicians to practice telemedicine across state lines. Data on the use of interstate ophthalmic telemedicine during the pandemic are limited. We aimed to evaluate the geographic characteristics and interstate utilization of telemedical care as compared to in-person care at a tertiary eye care center during the pandemic. Methods : In this single-center, retrospective, cross-sectional study at Massachusetts Eye and Ear (MEE) from January 1 to December 31, 2020, clinical encounters were reviewed to extract patient and visit characteristics. In-person versus telemedical visit types were identified based on institutional categories and billing codes. Residential zip codes were used to estimate geographic characteristics of patients including distance from MEE and in-state versus out-of-state status. Pearson chi-squared tests were used to compare telemedical and in-person care groups. Results : A total of 1911 telemedical patients (2262 encounters) and 65763 in-person patients (147211 encounters) were included. The median (interquartile range;IQR) age of telemedicine patients was 61 (43-72) years, 62% of which were female. The median (IQR) age of in-person patients was 63 (49-72) years, 58% of which were female. Telemedicine patients included 14.7% (n=281) out-of-state patients, as compared to 12.0% (n=7876) out-of-state in-person patients (p<0.001). Regarding distance, 42.5% of telemedicine patients and 47.5% of in-person patients lived <10 miles (p<0.001), 41.9% and 41.3% lived 10-50 miles (p=0.611), 8.8% and 7.0% lived 51-100 miles (p=0.002), 3.9% and 2.5% lived 101- 250 miles (p<0.001), and 3.0% and 1.8% lived >250 miles (p<0.001) away from MEE, respectively. Conclusions : A significantly greater proportion of telemedical care, as compared to in-person care, was provided to out-of-state patients at a large eye care center during the pandemic. Moreover, a significantly greater proportion of telemedical care was utilized by patients living further away from the eye center. Proposals to revert to pre-pandemic policies requiring in-state telemedicine could set back forward progress made during the pandemic, including negative impacts on access to care and continuity of care for established patients. Expanded telemedicine licensure and scope could help advance the efficiency and deployment gains seen during the pandemic.

9.
American Journal of Public Health ; 112:S478-S483, 2022.
Article in English | ProQuest Central | ID: covidwho-2047025

ABSTRACT

Upstream selected clinical sites for recruitment based on patient volume, current state of contraceptive care, regional variation, patient demographics, and health center buy-in to implement Upstream's program with fidelity. Programming content for both teams included the following: 1. educating and coaching clinicians and support staff on how to provide patient-centered contraceptive counseling that is free of bias or coercion;2. providing technical assistance to stock the full range of contraceptive methods;3. supporting billing and coding to optimize reimbursement ofcontraceptive services and methods;4. revising or creating department or agency policies to enable highquality, sustainable practice change related to contraceptive care;5. incorporating a pregnancy intention screening or contraceptive needs assessment question, contraceptive counseling, and documentation of contraceptive method use into clinical workflows, often including the hospital's or agency's electronic health record (EHR) system;6. establishing strategies to ensure that a patient can receive their desired contraceptive method on the same day as their visit, including long-acting reversible contraceptive (LARC) methods;and 7. enhancing emergency contraception services. The additional programming areas and technical assistance of the Upstream intervention with partner health practices included: (1) training all agency staff on current best practices and clinical knowledge of high-quality contraceptive care;(2) coordinating clinician precepting for LARC placement and removal;(3) where necessary, providing funding to stock the full range of contraceptive methods;and (4) providing patient education materials for use during clinical visits. EVALUATION STRATEGIES AND EARLY FINDINGS At the outset of the Massachusetts initiative, both teams and representatives from the Massachusetts Department of Public Health and Massachusetts' Medicaid program worked collaboratively to design an evaluation plan for the fiveyear project.

10.
129th ASEE Annual Conference and Exposition: Excellence Through Diversity, ASEE 2022 ; 2022.
Article in English | Scopus | ID: covidwho-2045963

ABSTRACT

Present-day higher education institutions offering undergraduate engineering programs need to prepare their students for a world filled with complex global challenges. Such preparation requires the acquisition of multidisciplinary knowledge and the application of multidisciplinary methodologies. A pilot initiative was launched in Fall 2017 for an elective three-year (sophomore to senior year) cross-departmental multi-disciplinary undergraduate engineering program at the Massachusetts Institute of Technology (MIT) named New Engineering Education Transformation (NEET). The program has three cross-departmental pathways across STEM disciplines and technical domains. The program has completed its fourth year of operation and has grown to become the fourth-largest undergraduate academic cohort at MIT. This paper is divided into two parts: the first part describes the revision of program requirements and their implementation during Fall 2019-Fall 2020. The second part describes the launching of a new single-themed program titled Climate & Sustainability Systems, which took place and was implemented during Summer-Fall 2021. Both initiatives responded to issues and changing circumstances raised by students, faculty, and instructional staff, with the aim of affording students more flexibility, reducing the additional workload beyond their chosen majors, enhancing their educational experience, and increasing their engagement with the program-wide community. In January 2020, following feedback collected from MIT students, faculty, instructional staff, and senior administration, we began a systematic process of reviewing the program's academic requirements. Data collected includes student questionnaires and specifications of program requirements throughout the study period. The revised requirements were published toward the end of the Spring 2020 semester, serendipitously around the same time as the COVID-19 mandated university-wide pivot from in-person on-campus teaching to emergency remote teaching and were implemented in Fall 2020. Since the publication of these new requirements, enrollment in the program has increased substantially year-on-year across all program threads. Subsequent data collection during Spring 2020 and Spring 2021 showed that word-of-mouth about the program has grown stronger, with 'current students' and 'other first-years' being two of the most-cited sources as to how first-years get to know about NEET. This paper explains the impetus for changing the program requirements, describes how the new requirements were formulated and implemented, and outlines what we have learned from implementing the revised requirements. We also describe how we collaborated with various stakeholders in the planning, design, and implementation of the revised requirements. For the second part of the paper, we describe how we launched a new climate and sustainability pathway based on our three-year experience of introducing pathways connected to energy, manufacturing ands materials, and sustainable development of cities, and on the growing interest amongst students in combating climate change in a sustainable manner. We describe how the process of consolidation was planned out and designed, how we collaborated with various stakeholders and how initial implementation has undergone. It should be emphasized that the approach we have taken here is largely qualitative and based primarily on how students and other key stakeholders responded to, engaged with the NEET program, and helped to evolve it. NEET leadership commissioned a systematic programmatic evaluation starting from Spring 2021, and we will be guided by their assessment of the changes as we look to the future. This paper is intended for institutional leadership, departmental leadership, faculty, and academic staff seized by the need to create and implement relevant and engaging cross-departmental multi-disciplinary undergraduate engineering programs. © American Society for Engineering Education, 2022.

11.
Annals of Oncology ; 33:S798-S799, 2022.
Article in English | EMBASE | ID: covidwho-2041537

ABSTRACT

Background: Dostarlimab is a programmed death 1 (PD-1) inhibitor approved in the EU as a monotherapy in patients (pts) with dMMR/MSI-H AR EC that has progressed on or after platinum-based chemotherapy;and in the US as a monotherapy in pts with dMMR AR EC that has progressed on or after platinum-based chemotherapy or dMMR solid tumors that have progressed on or after prior treatment, with no satisfactory alternative treatment options. We report on PFS and OS in 2 expansion cohorts of the GARNET trial that enrolled pts with EC. Methods: GARNET is a multicenter, open-label, single-arm phase 1 study. Pts were assigned to cohort A1 (dMMR/MSI-H EC) or A2 (MMRp/MSS EC) based on local immunohistochemistry assessment. Pts received 500 mg of dostarlimab IV every 3 weeks for 4 cycles, then 1000 mg every 6 weeks until disease progression, discontinuation, or withdrawal. PFS and OS are secondary efficacy endpoints. Results: 153 pts with dMMR/MSI-H and 161 pts with MMRp/MSS EC were enrolled and treated. The efficacy-evaluable population included 143 pts with dMMR/MSI-H EC and 156 pts with MMRp/MSS EC with measurable disease at baseline and ≥6 mo of follow-up. Median follow-up was 27.6 mo for dMMR/MSI-H and 33.0 mo for MMRp/MSS EC (Table). For pts with dMMR/MSI-H EC, median PFS (mPFS) was 6.0 mo, with 3-year estimated PFS rate of 40.1%. With 37.3% of pts experiencing an event, mOS was not reached;estimated 3-year OS was >50%. For pts with MMRp/MSS EC, mPFS was 2.7 mo. mOS was 16.9 mo with 68.9% of pts experiencing an event. Safety has been previously reported. [Formula presented] Conclusions: Dostarlimab demonstrated durable antitumor activity in dMMR/MSI-H and MMRp/MSS AR EC. dMMR/MSI-H was associated with longer PFS and OS than MMRp/MSS as expected. Clinical trial identification: NCT02715284. Editorial acknowledgement: Writing and editorial support, funded by GlaxoSmithKline (Waltham, MA, USA) and coordinated by Heather Ostendorff-Bach, PhD, of GlaxoSmithKline, was provided by Shannon Morgan-Pelosi, PhD, and Jennifer Robertson, PhD, of Ashfield MedComms, an Ashfield Health company (Middletown, CT, USA). Legal entity responsible for the study: GlaxoSmithKline. Funding: GlaxoSmithKline. Disclosure: A.V. Tinker: Financial Interests, Institutional, Sponsor/Funding: AstraZeneca;Financial Interests, Personal, Other: AstraZeneca, Eisai, GlaxoSmithKline. B. Pothuri: Financial Interests, Institutional, Funding: AstraZeneca, Celsion, Clovis Oncology, Eisai, Genentech/Roche, Karyopharm, Merck, Mersana, Takeda Pharmaceuticals, Tesaro/GSK;Financial Interests, Personal, Other: Arquer Diagnostics, AstraZeneca, Atossa, Clovis Oncology, Deciphera, Elevar Therapeutics, Imab, Mersana, Tesaro/GSK, Merck, Sutro Biopharma, Tora, GOG Partners;Financial Interests, Personal, Advisory Board: Arquer Diagnostics, AstraZeneca, Atossa, Deciphera, Clovis Oncology, Eisai, Elevar Therapeutics, Imab, Merck, Mersana, Sutro Biopharma, Tesaro/GSK, Toray;Financial Interests, Personal, Leadership Role: GOG Partners, NYOB Society Secretary, SGO Clinical Practice Committee Chair, SGO COVID-19 Taskforce Co-Chair. L. Gilbert: Financial Interests, Institutional, Funding: Alkermes, AstraZeneca, Clovis, Esperas, IMV, ImmunoGen Inc, Karyopharm, Merck Sharp & Dohme, Mersana, Novocure GmbH, OncoQuest Pharmaceuticals, Pfizer, Roche, Tesaro;Financial Interests, Personal, Other: Merck, Alkermes, AstraZeneca, Eisai, Eisai-Merck, GlaxoSmithKline. R. Sabatier: Financial Interests, Institutional, Funding: AstraZeneca, Eisai;Financial Interests, Personal, Other: AstraZeneca, GlaxoSmithKline, Novartis, Pfizer, Roche;Non-Financial Interests, Personal, Other: AstraZeneca, Bristol Myers Squibb, GlaxoSmithKline, Pfizer, Roche. J. Brown: Financial Interests, Personal, Advisory Role: Caris, Clovis, Eisai, GlaxoSmithKline;Financial Interests, Personal, Funding: GlaxoSmithKline, Genentech. S. Ghamande: Financial Interests, Personal, Advisory Role: Seattle Genetics;Financial Interests, Personal, Speaker’s Bureau: GlaxoSmithKline;Financial Interests, Institutional, Funding: Abbv e, Advaxis, Bristol Myers Squibb, Clovis, Genentech, GlaxoSmithKline, Merck, Roche, Seattle Genetics, Takeda. C. Mathews: Financial Interests, Institutional, Research Grant: Astellas, AstraZeneca, Deciphera, Moderna, GSK, Regeneron, Seattle Genetics;Financial Interests, Personal, Advisory Board: IMAB biopharma. D. O'Malley: Financial Interests, Personal, Advisory Board: AstraZeneca, Tesaro/GSK, Immunogen, Ambry, Janssen/J&J, Abbvie, Regeneron, Amgen, Novocure, Genentech/Roche, GOGFoundation, Iovance, Eisai, Agenus, Merck, SeaGen, Novartis, Mersana, Clovis, Elevar, Takeda, Toray, INXMED, SDP Oncology (BBI), Arquer Diagnostics, Roche Diagnostics MSA, Sorrento, Corcept Therapeutics, Celsion Corp;Financial Interests, Personal, Funding: AstraZeneca, Tesaro/GSK, Immunogen, Janssen/J&J, Abbvie, Regeneron, Amgen, Novocure, Genentech/Roche, VentiRx, Array Biopharma, EMD Serono, Ergomed, Ajinomoto Inc, Ludwig Cancer Research, Stemcentrx, Inc, Cerulean Pharma, GOGFoundation, Bristol-Myers Squibb Co, Serono Inc, TRACON Pharmaceuticals, Yale University, New Mexico Cancer Care Alliance, INC Research, Inc, inVentiv Health Clinical, Iovance, PRA Intl, Eisai, Agenus, Merck, GenMab, SeaGen, Mersana, Clovis, SDP Oncology (BBI);Financial Interests, Personal, Other: Myriad Genetics, Tarveda. V. Boni: Financial Interests, Personal, Advisory Board: OncoArt, Guidepoint Global;Financial Interests, Personal, Speaker’s Bureau: Solti;Financial Interests, Personal, Other: START, Loxo, IDEAYA Biosciences;Financial Interests, Institutional, Research Grant: Sanofi, Seattle Genetics, Loxo, Novartis, CytomX Therapeutics, Pumo Biotechnology, Kura Oncology, GlaxoSmithKline, Roche/Genentech, Bristol-Myers Squibb, Menarini, Synthon, Janssen Oncology, Merck, Lilly, Merus, Pfizer, Bayer, Incyte, Merus, Zenith Epigenetics, Genmab, AstraZeneca, Seattle Genetics, Adaptimmune, Alkermes, Amgen, Array BioPharma, Boehringer Ingelheim, BioNTech AG, Boston Biomedical. A. Gravina: Financial Interests, Personal, Other: Gentili, Pfizer. S. Banerjee: Financial Interests, Personal, Advisory Board: Amgen, Genmab, Immunogen, Mersana, Merck Sereno, MSD, Roche, Tesaro, AstraZeneca, GSK, Oncxerna;Financial Interests, Personal, Invited Speaker: Clovis, Pfizer, Tesaro, AstraZeneca, GSK, Takeda, Amgen, Medscape, Research to Practice, Peerview;Financial Interests, Personal, Stocks/Shares: PerciHealth;Financial Interests, Institutional, Research Grant: AstraZeneca, GSK, Tesaro;Non-Financial Interests, Principal Investigator, Phase II clinical trial Global lead, ENGOTov60/GOG3052/RAMP201: Verastem;Non-Financial Interests, Principal Investigator, ENGOT-GYN1/ATARI phase II international trial (academic sponsored): Astrazeneca;Non-Financial Interests, Advisory Role: Epsilogen;Non-Financial Interests, Other, Member of membership committee: ESGO;Non-Financial Interests, Advisory Role, Medical advisor to UK ovarian cancer charity: Ovacome Charity;Non-Financial Interests, Other, Received research funding from UK based charity I have provided medical advice (non-remunerated): Lady GardenFoundation Charity. R. Miller: Financial Interests, Personal, Other: AZD, Clovis Oncology, Ellipses, GlaxoSmithKline, MSD, Shionogi, AZD, GlaxoSmithKline;Financial Interests, Personal, Speaker’s Bureau: AZD, Clovis Oncology, GSK, Roche. J. Pikiel: Financial Interests, Personal, Other: Amgen, Clovis Oncology, GlaxoSmithKline, Incyte, Novartis, Odonate Therapeutics, Pfizer, Regeneron, Roche. M.R. Mirza: Financial Interests, Personal, Advisory Board: AstraZeneca, Biocad, GSK, Karyopharm, Merck, Roche, Zailab;Financial Interests, Personal, Invited Speaker: AstraZeneca, GSK, Karyopharm;Financial Interests, Personal, Stocks/Shares: Karyopharm;Financial Interests, Institutional, Research Grant: GSK, AstraZeneca, ultimovacs, Apexigen;Financial Interests, Institutional, Invited Speaker: Deciphera;Non-Financial Interests, Advisory Role: Ultimovacs, Apexigen. T. Duan: Financial Interests, Personal, Full or part-time Employment: GlaxoSmithKline. G. Antony: Financial Interests, Personal, Fu l or part-time Employment: GlaxoSmithKline. S. Zildjian: Financial Interests, Personal, Full or part-time Employment: GlaxoSmithKline. E. Zografos: Financial Interests, Personal, Full or part-time Employment: GlaxoSmithKline. J. Veneris: Financial Interests, Personal, Full or part-time Employment: GlaxoSmithKline. A. Oaknin: Financial Interests, Personal, Advisory Board: AstraZeneca, Clovis Oncology, Deciphera Pharmaceuticals, Genmab, GSK, Immunogen, Mersana Therapeutics, PharmaMar, Roche, Tesaro, Merck Sharps & Dohme de España, SA, Agenus, Sutro, Corcept Therapeutics, EMD Serono, Novocure, prIME Oncology, Sattucklabs, Itheos, Eisai, F. Hoffmann-La Roche,;Financial Interests, Personal, Other, Travel and accomodation: AstraZeneca, PharmaMar, Roche;Financial Interests, Institutional, Funding: Abbvie Deutschland, Advaxis Inc., Aeterna Zentaris, Amgen, Aprea Therapeutics AB, Clovis Oncology Inc, EISAI limited LTD, F. Hoffmann –La Roche LTD, Regeneron Pharmaceuticals, Immunogen Inc, Merck, Sharp & Dohme de España SA, Millennium Pharmaceuticals Inc, PharmaMar SA, Tesaro Inc., Bristol Myers Squibb;Non-Financial Interests, Leadership Role, Executive Board member as a Co-Chair: GEICO;Non-Financial Interests, Leadership Role, Phase II Committee and Cervix Cancer Committee Representative on behalf of GEICO: GCIG;Non-Financial Interests, Officer, Chair of Gynaecological Track ESMO 2019. Scientific Track Member Gynaecological Cancers ESMO 2018, ESMO 2020, ESMO 2022. Member of Gynaecological Cancers Faculty and Subject Editor Gyn ESMO Guidelines.: ESMO;Non-Financial Interests, Member: ESMO, ASCO, GCIG, SEOM, GOG.

12.
Telehealth and Medicine Today ; 6(3), 2021.
Article in English | ProQuest Central | ID: covidwho-2026480

ABSTRACT

Importance: This three-part study characterizes the widespread implementation of telehealth during the first year of the COVID-19 pandemic, giving us insight into the role of telehealth as we enter a stage of “new normal” healthcare delivery in the U.S. Objective: The COVID-19 Telehealth Impact Study was designed to describe the natural experiment of telehealth adoption during the pandemic. Using a large claims data stream and surveys of providers and patients, we studied telehealth in all 50 states to inform healthcare leaders. Design, Setting, Participants: In March 2020, the MITRE Corporation and Mayo Clinic founded the COVID-19 Healthcare Coalition (C19HCC), to respond to the pandemic. We report trends using a dataset of over 2 billion healthcare claims covering over 50% of private insurance activity in the U.S. (January 2019-December 2020), along with key elements from our provider survey (July-August 2020) and patient survey (November 2020 - February 2021). Main Outcomes and Measures: There was rapid and widespread adoption of telehealth in Spring 2020 with over 12 million telehealth claims in April 2020, accounting for 49.4% of total health care claims. Providers and patients expressed high levels of satisfaction with telehealth. 75% of providers indicated that telehealth enabled them to provide quality care. 84% of patients agreed that quality of their telehealth visit was good. Results: Peak levels of telehealth use varied widely among states ranging from 74.9% in Massachusetts to 25.4% in Mississippi. Every clinical discipline saw a steep rise with the largest claims volume in behavioral health. Provision of care by out-of-state provider was common at 6.5% (October-December 2020). Providers reported multiple modalities of telehealth care delivery. 74% of patients indicated they will use telehealth services in the future. Conclusions and Relevance: Innovation shown by providers and patients during this period of rapid telehealth expansion constitutes a great natural experiment in care delivery with evidence supporting widespread clinical adoption and satisfaction on the part of both patients and clinicians. The authors encourage continued broad access to telehealth over the next 12 months to allow telehealth best practices to emerge, creating a more effective and resilient system of care delivery.

13.
Psychiatric Annals ; 52(9):351-351, 2022.
Article in English | ProQuest Central | ID: covidwho-2024409
14.
AANA Journal ; 90(2):141-147, 2022.
Article in English | ProQuest Central | ID: covidwho-2011823

ABSTRACT

This study examined the relationship between demographic factors, job characteristics, relations between Certified Registered Nurse Anesthetists (CRNAs) and administration, and conflict between work and personal responsibilities using structural equation modeling to determine levels of burnout, job satisfaction, and turnover intention among CRNAs during COVID-19 surges. Survey data were collected from CRNAs practicing in Massachusetts and Texas through an email link distributed by their respective state associations of nurse anesthetists. Results of the structural equation modeling showed a decrease in feedback, low CRNA-administration relations scores, and prioritizing work over personal responsibilities were predictive of CRNA burnout. In addition, burnout levels were correlated with job satisfaction and turnover intention. Based on these findings, employers could decrease CRNA burnout and turnover by creating organizational strategies focused on improving job feedback, relationships between CRNAs and administrators, and work-life integration. Through these approaches, healthcare managers and leaders may support CRNA resiliency and retention, particularly during times of professional change, such as the COVID-19 pandemic.

15.
XIV. Simpozij peradarski dani ; 11(14):71-77, 2022.
Article in English | CAB Abstracts | ID: covidwho-2011268

ABSTRACT

Avian infectious bronchitis (IB) is an economically important, highly contagious, acute disease of Chickens caused by a single-stranded positive RNA Virus that belongs to the Coronaviridae family. The Virus can replicate in the oviduct and cause permanent damage in young hens resulting in the false layer occurrence. In laying hens, infectious bronchitis Virus (IBV) infections can cause a severe decline in egg production and a number of effects on egg quality and reduced hatchability. The most effective means of controlling IB in poultry is vaccination. In the areas with increased pressure of circulating field challenge Virus, live attenuated vaccines are also used during the laying period with the intention of keeping local protection of the respiratory tract at a high level. The vaccine strain IB V-173/11 contained in Avishield IB GI-13 vaccine is a strain that genetically (S1 gene) belongs to GI-13 lineage and antigenically to 793B IBV serotype. Viral infections of this serotype occur frequently in Europe and therefore most vaccination programs in broilers, layers and breeders along a live IBV vaccine of the Massachusetts serotype also include a live vaccine of the 793B serotype, GI-I3 lineage. In this paper, results of a safety evaluation of live attenuated IB vaccine strain V-173/11, when administered by spray method in a ten-fold maximum dose repeated by one maximum dose in 28-week-old specific pathogen free (SPF) layer Chickens are presented. As a control, non-vaccinated SPF layer chickens were included in the study. The vaccine is considered to be safe when used in laying period because no vaccinated chicken showed abnormal local or systemic reactions or signs of IB related disease, no chicken died from the causes attributable to the vaccine, egg quality was not altered, and there was no statistically significant difference in. egg production between the vaccinated and non-vaccinated group.

16.
Rhode Island Medical Journal ; 105(7):77-78, 2022.
Article in English | ProQuest Central | ID: covidwho-2010951

ABSTRACT

[...]on Saturday afternoon, a troubleshooter from the help desk at Genesis Systems called me on my cell phone. Because of this error, my help desk friend was unable to complete the program, and so, after 3 days and rising tensions, it was referred to someone at the state level, who sent me an automatic reply that he was unavailable. First used to describe veterans returning from the Vietnam War, moral injury has been extended to the health care field to help further explain and refine causes of burnout.2 Burnout suggests individual deficit.

17.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009578

ABSTRACT

Background: The COVID-19 pandemic has presented various challenges for the healthcare system. This study aims to estimate the impact of the COVID-19 pandemic on Lung Cancer Screening (LCS), Lung Resections (LR), and Outpatient Visits (OPV). Methods: This is a longitudinal quasi-experimental time-series analysis using data from the institutional electronic medical records (EMR) from January 2018 to December 2021, considering the first and second waves of COVID-19 cases in Massachusetts;March, and November 2020, respectively. The main outcomes were (A) Monthly LCS exams, (B) Monthly LR surgeries, (C) Monthly Overall-cancer-OPV. Results: 9,057 LSC exams, 333 LR surgeries, and 5,918 outpatient visits were analyzed. The average patient age that underwent LCS was 64;48.9% were female and 91.4% White. LR was performed in patients 67 years old on average, 67.7% female and 93.6% White. The Overall-cancer-OPV was 58.1% for female patients, 89.4% for White patients, and the overall average patient age was 68 years. The monthly number of LCS (A) presented a statistically significant reduction in the first wave (p = 0.001) with a significant recovery in the following months with a monthly increase rate of 26 exams per month (p = 0.002). The second wave did not represent a sharp reduction in the LCS. Nevertheless, a significant monthly reduction of 44 exams was found. There was no statistical decline for the monthly LR surgeries (B). However, an increase in time from the first visit to the surgery was observed. The COVID-19 surges did not significantly impact the (C) Monthly Overall-cancer-OPV, and it was due to the implementation of telehealth services. The use of telehealth prevented a decline in OPV of 59% (p = 0.001) overall and 40% (p = 0.0190) for cancer. Telehealth visits accounted for 27.7% of cancer-related visits. Female patients were more likely to have a telehealth appointment. White, Black, and Asian patients presented with a similar percentage of telehealth use (26.3%, 25.0%, and 26.8%), while Latinos were less likely to have a telehealth appointment when compared with non-Latinos (18%, p < 0.02). Age was not significantly different between telehealth and non-telehealth appointments. However, for those who preferred a phone appointment, the average age was 67 years old, while for those who used video appointments, the age was 63 (p-value < 0.05). Conclusions: The COVID-19 pandemic affected significantly LCS while lung resections were stable over time;nonetheless, the time from the first visit to surgery increased. The use of telehealth technology allowed patients with cancer to safely receive care throughout the COVID-19 Pandemic. The adoption of telehealth can expand access to care in the pandemic context in low-resource areas. Still, future studies should assess the impact of the COVID-19 pandemic on staging at diagnosis, time to treatment initiation, and survival, especially for the underserved population.

18.
Annals of the Rheumatic Diseases ; 81:949-950, 2022.
Article in English | EMBASE | ID: covidwho-2008979

ABSTRACT

Background: Systemic autoimmune rheumatic disease (SARD) patients may be at risk for disease fare and prolonged symptom duration after COVID-19, perhaps related to DMARD disruption and immune activation. Objectives: To describe DMARD disruption and identify differences in SARD activity among patients with and without prolonged COVID-19 symptom duration. Methods: We identifed all SARD patients with confrmed COVID-19 at the Mass General Brigham healthcare system in Boston, USA;prospective recruitment is ongoing. Surveys were used to collect demographics, clinical characteristics, DMARD disruption, COVID-19 course, and SARD disease activity before and after COVID-19. The survey included validated instruments measuring disease activity, pain, fatigue, functional status, and respiratory quality of life. Prolonged symptom duration was defned as COVID-19 symptoms lasting ≥28 days. We compared differences in patient-reported measures between those with and without prolonged symptoms. Results: We analyzed survey responses from 174 COVID-19 survivors with SARDs (mean age 52±16 years, 81% female, 80% White). The most common SARDs were RA (40%) and SLE (14%). Fifty-one percent of the 127 respondents on any DMARD reported a disruption to their regimen at COVID-19 onset (Figure 1). Among individual DMARDs, 56-77% were reported to have any change, except for hydroxychloroquine (23%) and rituximab (46%). SARD fare after COVID-19 was reported by 41% of respondents (Table 1). Patient global assessment of SARD activity was worse after COVID-19 (mean 7.6±2.3 before vs. 6.6±2.9 after COVID-19, p<0.001). Prolonged symptom duration was reported by 45% of participants. Those with prolonged symptoms had a higher initial COVID-19 symptom count (median 7 vs. 4, p<0.001) and were more likely to be hospitalized for COVID-19 (28% vs. 17%, p=0.001). Respondents experiencing prolonged symptom duration had higher disease activity on RAPID3 (p=0.007) as well as more pain (p<0.001) and fatigue (p=0.03) compared to those without prolonged symptoms. Conclusion: DMARD disruption, SARD fare, and prolonged symptoms were common in this prospective study of COVID-19 survivors with SARDs. Those with prolonged COVID-19 symptom duration, defned as ≥28 days, had higher SARD activity, more pain, and more fatigue compared to those without prolonged symptoms. These fndings suggest that post-acute sequelae of COVID-19 may have a large impact on underlying SARD activity and quality of life.

19.
Archives of Razi Institute ; 77(5):1611-1619, 2022.
Article in English | CAB Abstracts | ID: covidwho-2002783

ABSTRACT

Infectious bronchitis (IB) disease, avian Infectious Bronchitis disease in one of the major cause of respiratory problems and economic loss in poultry industry, even in developed countries with good biosecurity practice. Since the first isolation of the virus in 1931, a lot of serotypes and genotypes of the virus have been reported around the world. The GI-1 lineage, including Massachusetts (Mass) serotype viruses, is one of the most widely spread types worldwide. Moreover, the GI-23 lineage with a growing incidence rate was reported approximately 20 years ago in the Middle East, with no or little homologues vaccine use. The genotype was previously restricted to the Middle East;now, there is evidence that it has spread to European countries, raising concerns regarding potential outbreaks. In the present study, our attempt was to phylogenetically analyze the S1 gene of six isolates from Massachusetts and variant 2 genotypes, which were isolated from broiler and broiler breeder flocks in Iran. The variant 2 viruses were compared to other reported variant 2 viruses from neighboring countries and they had more than 98% identity with the latest reported Iranian variant 2. In addition, Three Mass type viruses were similar to vaccine strains which may be shows continuous circulation of vaccine viruses in the field. This event can cause increasing the risk of their mutation or even reversion to virulence after several passages in natural host, furthermore circulating viruses may recombinant with virulent field viruses and cause emergence of new variants. Considering the variable nature of IB viruses in which few changes lead to important differences, continuous epidemiological surveillance along with clinical studies of new isolates, are crucial to a better understanding of their pathogenicity and subsequent disease control.

20.
Journal of General Internal Medicine ; 37:S624-S625, 2022.
Article in English | EMBASE | ID: covidwho-1995865

ABSTRACT

SETTING AND PARTICIPANTS: The curriculum was offered to Internal Medicine (IM) residents and took place in Boston and surrounding communities. DESCRIPTION: This program was developed by IM residents in collaboration with clinical education faculty, physician leaders in health equity, and community partners. It identifies and enhances multiple aspects of residency training to reinforce learning on Social Determinants of Health (SDH). Our curriculum offers four key components. 1) Dedicated discussion of health disparities and institutional/community resources incorporated into existing ambulatory curriculum modules. 2) Resident-led walking tours of neighborhoods around Health Centers focused on the history, health disparities, and resources unique to each community. 3) Residency-wide conferences featuring healthcare innovations that address social determinants of health, including a community health van delivering COVID-19 tests and vaccines. 4) A novel resident-designed, two week elective incorporating patient-centered work with community based initiatives to allow identification of social determinants and tangible work to reduce their adverse effects on health. EVALUATION: Quantitative evaluations are assessed via pre- and postinnovation surveys. Sixty-nine of 85 (81%) interns completed the preinnovation survey. Only 56% felt that their prior SDH education was adequate and 25% felt that they had a good understanding of health disparities in Boston. Merely 4% were familiar with resources available in the local healthcare system. Over 98% of responders indicated interest in learning more about health disparities in Boston and available resources to address SDH needs. A post-innovation survey will be distributed after the first year of the curriculum. One of three planned community walking tours has been piloted with positive feedback. Further qualitative feedback will be collected as more walking tours and ambulatory lectures are completed. Feedback on conferences by guest speakers will be collected by the residency via focus groups. DISCUSSION / REFLECTION / LESSONS LEARNED: The environment in which individuals live, work, and build community;access to adequate housing, healthy food, living wages, social support, and healthcare;language and marginalization affect health. Understanding how these social determinants impact health outcomes, leveraging community resources to address them, and advocating for health equity are essential elements of the practice of medicine and residency training. This sentiment is reflected in our survey of interns and in the ACGME Guidelines. An effective way of incorporating SDH education into residency training is via a multimodal resident-led initiative that helps residents identify social determinants and describe programs that reduce their adverse impact on health. This initiative began as two residents' interest in learning more about their community and patients. It now serves as a model for weaving SDH into GME curriculum through didactics, conferences, community focused tours, and a clinical elective.

SELECTION OF CITATIONS
SEARCH DETAIL