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1.
Front Med (Lausanne) ; 9: 849222, 2022.
Article in English | MEDLINE | ID: covidwho-1952369

ABSTRACT

Apha-1-adrenergic receptor antagonists (α1-blockers) can suppress pro-inflammatory cytokines, thereby potentially improving outcomes among patients with COVID-19. Accordingly, we evaluated the association between α1-blocker exposure (before or during hospitalization) and COVID-19 in-hospital mortality. We identified 2,627 men aged 45 or older who were admitted to Mount Sinai hospitals with COVID-19 between February 24 and May 31, 2020, in New York. Men exposed to α1-blockers (N = 436) were older (median age 73 vs. 64 years, P < 0.001) and more likely to have comorbidities than unexposed men (N = 2,191). Overall, 777 (29.6%) patients died in hospital, and 1,850 (70.4%) were discharged. Notably, we found that α1-blocker exposure was independently associated with improved in-hospital mortality in a multivariable logistic analysis (OR 0.699; 95% CI, 0.498-0.982; P = 0.039) after adjusting for patient demographics, comorbidities, and baseline vitals and labs. The protective effect of α1-blockers was stronger among patients with documented inpatient exposure to α1-blockers (OR 0.624; 95% CI 0.431-0.903; P = 0.012). Finally, age-stratified analyses suggested variable benefit from inpatient α1-blocker across age groups: Age 45-65 OR 0.483, 95% CI 0.216-1.081 (P = 0.077); Age 55-75 OR 0.535, 95% CI 0.323-0.885 (P = 0.015); Age 65-89 OR 0.727, 95% CI 0.484-1.092 (P = 0.124). Taken together, clinical trials to assess the therapeutic value of α1-blockers for COVID-19 complications are warranted.

2.
Interact J Med Res ; 11(2): e36102, 2022 Jul 18.
Article in English | MEDLINE | ID: covidwho-1952032

ABSTRACT

The use of photography in routine clinical practice has the potential to increase the efficiency of overall patient care as well as improve clinical documentation and provider-to-provider communication. This is particularly important in the setting of provider burnout in the electronic health record era and during the COVID-19 pandemic. Despite the potential of photographs to enhance workflows and patient care, challenges remain that hinder the successful incorporation of medical photography into clinical practice, often because of inconsistent structure and implementation. Our proposed consolidated framework for clinical photography consists of five key aspects: appropriate informed consent; proper preparation and positioning; image acquisition with consideration of the field of view, orientation, focus, resolution, scale, and color calibration; streamlined and secure image storage and documentation; and interoperable file exchange. Overall, this viewpoint is a forward-looking paper on leveraging medical photography as an electronic health record tool for clinical care, research, and education.

3.
Journal of Adolescent Health ; 70(4):S25, 2022.
Article in English | EMBASE | ID: covidwho-1936664

ABSTRACT

Purpose: The demand for pediatric gender-affirming care has increased throughout the COVID-19 pandemic, highlighting the need for telehealth-based specialist-to-primary care provider (PCP) consultative support. Accordingly, the purpose of this study was to identify PCPs’ perspectives on receiving training and consultation in pediatric gender-affirming care using three telehealth modalities, with the larger goal of informing the development of future consultative support offerings. Methods: PCPs who had previously reached out to the Seattle Children’s Gender Clinic for a gender care consultation were invited to participate in a semi-structured, one-hour Zoom interview. During the interview, three different telehealth modalities (tele-education, electronic consultation, telephonic consultation) were described and participants were asked to share their perspectives on 1) the benefits and drawbacks of each modality, 2) which modality would be most effective in supporting them in providing gender-affirming care in the primary care setting, and 3) factors that would make a consultation platform successful. Interviews were transcribed and analyzed using an inductive thematic analysis framework by two authors using Dedoose qualitative analysis software. All participants provided informed consent and all study procedures were approved by the Seattle Children’s Institutional Review Board. Results: Interviews were completed with 15 PCPs. For the tele-education platform, PCPs most often identified continuing medical education (67%) and the community or network it creates (47%) as benefits and the commitment required (73%) and scheduling difficulties (40%) as drawbacks. For the electronic consultation model, timeliness of response (67%) and convenience (53%) were cited as benefits and electronic medical record system requirements (60%) and difficulty conveying the message electronically (53%) were considered the main drawbacks. For the telephonic consultation, PCPs identified the ability to have a conversation (80%) and the timeliness of response (60%) as the main benefits and phone-tag (87%) and finding time to make the initial call (40%) as the main drawbacks. Regarding the most effective platform, responses were mixed: 27% endorsed the electronic consultation, 27% the tele-education platform, and 20% the telephonic consultation, with the remaining 27% suggesting a hybrid of the three models. Finally, responses regarding what would make a platform successful were much more varied across participants, with the most common responses including being non-judgmental and supportive (33%) and flexible with the ability to pivot to other platforms as needed (27%). Conclusions: With the increasing demand to provide gender-affirming care in the primary care setting, further training and support is necessary for pediatric PCPs to deliver this time-sensitive care. The results of this study indicate the need for a more flexible suite of gender-focused specialist-to-PCP telehealth-based consultative services to facilitate the provision of pediatric gender-affirming care. Sources of Support: This project was supported by the Seattle Children's Research Institute and AHRQ (K12HS026393-03;PI: Sequeira) and a grant from Pivotal Ventures.

4.
Journal of Adolescent Health ; 70(4):S68-S69, 2022.
Article in English | EMBASE | ID: covidwho-1936615

ABSTRACT

Purpose: During the COVID-19 pandemic, estimates of adolescent depression prevalence have significantly increased. Although 80% of youth with mental health problems do not access mental health (MH) services, most interact regularly with pediatricians, suggesting primary care is a promising setting for youth MH service delivery. Behavioral activation (BA) is a straightforward intervention focusing on increasing engagement in meaningful activities and has been shown to be effective in adolescent populations. This study examines the feasibility and acceptability of implementing BA delivered by nurses to adolescents with mild to moderate depressive symptoms in an ambulatory setting. Methods: We examined the feasibility and acceptability of BA to a sociodemographic-diverse adolescent population. To examine feasibility, we retrospectively analyzed the percentage of patients presenting with mild to moderate depressive symptoms on the patient health questionnaire-9 during a random four week period. We then conducted qualitative interviews with four parent-adolescent dyads, and two additional adolescents. A semi-structured interview guide was iteratively developed to assess perceived acceptability of BA and barriers and facilitators to engaging in the intervention. Interviews were recorded, transcribed, and coded by authors JDT and JF. A thematic analysis was completed to identify whether the program as designed was acceptable to the targeted population. Results: A records review found that out of 122 unique patients presenting for any clinic visit during the four week period, 44 (35%) met criteria for mild to moderate depressive symptoms. Of those who met criteria, youth were 17.45 years old (range = 12-22) with 61% identified as female. Results of the qualitative interviews suggest that participants perceived BA to be appropriate;themes emerged suggesting that both parents and youth noted nurse-delivered BA was similar to other types of therapies they had engaged with in other settings and that participants experienced nurses’ as able to protect confidentiality and someone they could be “vulnerable” with. Participants were mixed in how feasible they felt regular visits to the pediatrician’s office was, with some noting that transportation and time were major barriers for engaging in treatment. All participants noted that telehealth options (including meeting with a nurse provider over the phone or through web conferencing) were appropriate and would facilitate treatment access. Participants also noted that time, transportation and cost were significant barriers to engaging in valued activities (a central mechanism of BA), and several parents and youth noted that these barriers were exacerbated during the pandemic. Conclusions: Our data highlights the implementation potential for delivering BA by nurses in an adolescent ambulatory setting. Qualitative themes suggest this approach (especially delivered via telehealth) is feasible and acceptable for youth with mild to moderate depressive symptoms. Sources of Support: This project is supported by the Helen DeVos Children's Hospital Pediatric Research Fund.

5.
Supportive Care in Cancer ; 30:S77, 2022.
Article in English | EMBASE | ID: covidwho-1935803

ABSTRACT

Introduction Granulocyte colony stimulating factor (G-CSF) is a crucial supportive care medication, used for the prevention of febrile neutropenia in patients undergoing chemotherapy. Early in the COVID-19 pandemic, experts began discussing whether increased use of G-CSF in cancer patients and the minimization of the neutropenic period could provide benefit in that patient population. Concerns were soon raised, however, regarding the potential synergy between the pro-inflammatory COVID-19 disease process and immune stimulation from G-CSF administration. It was noted that COVID-19 patients exposed to G-CSF were developing markedly elevated Neutrophil to Lymphocyte Ratios (NLR), indicating an excessive inflammatory response and an increased risk of ARDS and inhospital mortality. The purpose of this study is to better understand the potential harm caused by this synergy. Methods We used TriNetX, a global health research network providing access to electronic medical records from approximately 85 million patients in 64 large healthcare organizations. The platform only contains de-identified data as per the de-identification standard defined in Section 164.514(a) of the HIPAA Privacy Rule. SARS-CoV-2 infection was determined by laboratory codes 9088, 94309-2, and 94500-6, indicating the presence of COVID-19 RNA. Use of G-CSF was determined by J-code J1442, indicating its administration through having been billed to the patient. Two neutropenic (ANC <1,000/microliter) cohorts were then generated, one having COVID-19 infection and G-CSF administration within the subsequent 2 weeks, and the other with COVID-19 infection and no G-CSF administration. Both cohorts were balanced for age, gender, race, and ethnicity. Most importantly, the cohorts were balanced for average initial neutrophil count to rule out the potential sampling error of more severely neutropenic patients having worse outcomes. These criteria resulted in cohorts of 715 patients each. The cohorts were then evaluated for the outcome of “ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing” via procedure code 1014859. Results Patients who received G-CSF within 2 weeks following COVID-19 infection were 3.7 times more likely to end up on a ventilator (p<0.0001), and had 3.5 times greater 60-day mortality (6.557% vs 1.878%, p<0.0001). Conclusions SARS-CoV-2 infection is associated with a significant inflammatory response, and the use of G-CSF in neutropenic patients within 2 weeks of infection is associated with a significant increased risk of need for mechanical ventilation and increased risk of 60-day mortality. Use of G-CSF in this patient population should be discouraged in favor of broadspectrum antibiotic coverage.

6.
Biomedicine (India) ; 42(3):539-542, 2022.
Article in English | EMBASE | ID: covidwho-1939774

ABSTRACT

Introduction and Aim: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which rapidly evolved into a pandemic infecting humans all over the world. Whether hematologic and immunologic responses play a crucial role in progression of COVID-19 is still not clear. Increasing scientific evidence has shown that abnormalities in routine hematological tests, have the potential to diagnose SARS-CoV-2 infection in an economical way. Major laboratory changes indicating systemic inflammation and multi-organ impairment including hematopoietic system leading to lymphocytopenia, neutrophilia, eosinopenia, mild thrombocytopenia and ratios derived from these hematological parameters indicated severe disease and/or fatal outcomes. The aim was to study the hematological profile of Covid-19 patients admitted at a tertiary care hospital at Ramanagar district. Materials and Methods: This retrospective study included 260 confirmed cases of Covid-19 diagnosed at a tertiary health care centre. Demographic, clinical, laboratory, treatment, and outcome data were extracted from the institutional electronic medical records after obtaining permission from the concerned authorities. From CBC test results obtained neutrophil lymphocyte ratio was derived. Results: The present study revealed that majority of Covid positive patients presented with lymphopenia. While a significant association was observed between N/L ratio and disease severity, no significant association was seen between platelet count and severity of the disease. Conclusion: Since the results of the present study features lymphopenia among large proportion of patients and elevated N/L ratio among critically ill patients these markers could be utilized as useful prognostic indicators during the initial assessment of disease severity and thus appropriate management can be planned for such patients before the condition of the patient deteriorates.

7.
Congenital Heart Disease ; 17(4):399-419, 2022.
Article in English | EMBASE | ID: covidwho-1939710

ABSTRACT

Background: Adult patients with congenital heart disease (ACHD) might be at high risk of Coronavirus disease-2019 (COVID-19). This study aimed to report on a one-year tertiary center experience regards COVID-19 infection in ACHD patients. Methods: This is a one-year (March-2020 to March-2021) tertiary-center retrospective study that enrolled all ACHD patients;COVID-19 positive patients’ medical records, and management were reported. Results: We recorded 542 patients, 205 (37.8%) COVID-19-positive, and 337 (62.2%) COVID-19-negative patients. Palliated single ventricle and Eisenmenger syndrome patients were more vulnerable to COVID-19 infection (P < 0.05*). Cardiovascular COVID-19 complications were arrhythmias in 47 (22.9%) patients, heart failure in 39 (19.0%) patients, cyanosis in 12 (5.9%) patients, stroke/TIA in 5 (2.4%) patients, hypertension and infective endo-carditis in 2 (1.0%) patients for each, pulmonary hypertension and pulmonary embolism in 1 (0.5%) patient for each. 11 (5.4%) patients were managed with home isolation, 147 (71.7%) patients required antibiotics, 32 (15.6%) patients required intensive care unit (ICU), 8 (3.9%) patients required inotropes, 7 (3.4%) patients required mechanical ventilation, and 2 (1.0%) patients required extracorporeal membrane oxygenation (ECMO). Thromboprophylaxis was given to all 46 (22.4%) hospitalized patients. American College of Cardiology/American Heart Association classification revealed that complex lesions, and FC-C/D categories were more likely to develop severe/critical symptoms, that required mechanical ventilation and ECMO (P < 0.05*). Mortality was reported in 3 (0.6%) patients with no difference between groups (P = 0.872). 193 (35.6%) patients were vaccinated. Conclusions: COVID-19 infection in ACHD patients require individualized risk stratification and management. Eisenmenger syndrome, single ventricle palliation, complex lesions, and FC-C/D patients were more vulnerable to severe/critical symptoms that required ICU admission, mechanical ventilation, and ECMO. The vaccine was mostly tolerable.

8.
Journal of the Nepal Medical Association ; 60(251):625-630, 2022.
Article in English | EMBASE | ID: covidwho-1939705

ABSTRACT

Introduction: Antimicrobial resistance is a global health problem. The widespread and improper antibiotics use is the leading cause of antimicrobial resistance. Bacterial co-infection in COVID-19 patients is the basis for the use of antibiotics in the management of COVID-19. COVID-19 pandemic has seriously impacted antibiotic stewardship and increased the global usage of antibiotics, worsening the antimicrobial resistance problem. The use of antibiotics among COVID-19 patients is high but there are limited studies in the context of Nepal. This study aimed to find out the prevalence of antibiotic use among hospitalised COVID-19 patients in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted on hospitalised COVID-19 patients from April 2021 to June 2021 in a tertiary care centre. Ethical approval was taken from the Institutional Review Committee (Reference number: 2078/79/05). The hospital data were collected in the proforma by reviewing the patient’s medical records during the study period of 2 months. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 106 hospitalised COVID-19 patients, the prevalence of antibiotics use was 104 (98.11%) (95.52-100, 95% Confidence Interval). About 74 (71.15%) of patients received multiple antibiotics. The most common classes of antibiotics used were cephalosporins, seen in 85 (81.73%) and macrolides, seen in 57 (54.81%) patients. Conclusions: The prevalence of antibiotics use among hospitalised COVID-19 patients was found to be higher when compared to other studies conducted in similar settings.

9.
Journal of Comprehensive Pediatrics ; 13(2), 2022.
Article in English | EMBASE | ID: covidwho-1939346

ABSTRACT

Background: Depending on the level of care and the availability of pediatric intensive care unit (PICU) facilities, the mortality rate of acutely ill children varies in PICUs. Referral of patients from other medical centers, admission during working or off-work hours, and nosocomial infections are the most important risk factors for the high mortality rates in PICUs. Objectives: The present study aimed to investigate the characteristics and factors related to the risk of mortality in pediatric patients admitted to the PICU of a pediatric hospital in Qazvin, Iran. Methods: This cross-sectional study was performed on children admitted to the PICU of a pediatric hospital in Qazvin, Iran, between June 2017 and June 2020. During this period, a total of 1504 children, aged one month to 13 years, were admitted to the PICU, and 106 cases expired. The patients’ clinical data (ie, demographic characteristics, underlying disease, cause of death, and length of hospital stay) was extracted from their medical records. A prolonged length of stay was defined as more than 28 days of PICU admission. Results: A total of 106 children, with a mean age of 3.89 ± 3.23 years, expired during the study, with 41 (38.7%) cases being male. Among the investigated cases, 61 (57%) were < 2 years, 18 (17%) were 2 - 5 years old, and 27 (26%) were ≥ 6 years. In these patients, sepsis (13/82, 15.85%) and pneumonia (10/82, 12.19%) were the main causes of death. Other mortalities (14/106) were due to infectious diseases (gastroenteritis, influenza, and coronavirus disease) and non-infectious diseases (aspiration, anaphylaxis, and electrocution). The majority of children with a prolonged length of stay were < 2 years (17/23, 74%). The length of PICU stay was shorter in children with a lower weight percentile (P = 0.016). Conclusions: Following infectious diseases, congenital abnormalities and genetic disorders were the most common causes of pediatric mortality. Chronically ill children were more likely to be underweight and develop nutritional disorders, leading to the deterioration of their condition.

10.
Medical Journal of Bakirkoy ; 18(2):247-251, 2022.
Article in English | EMBASE | ID: covidwho-1939263

ABSTRACT

Objective: Smoking, and also water pipe smoking (hookah), is a common method of tobacco use in Southwest Asia and Middle East countries. Although the relationship between coronavirus disease-2019 (COVID-19) infection and smoking has been evaluated in many studies, no study has been conducted to evaluate the relationship between COVID-19 infection and water pipe smoking. Methods: We enrolled 150 in-hospital patients. The severity of disease classified as mild, moderate, severe, and critically ill. The relationship between waterpipe smoker, smoker and non-smoker patients and severity of disease statistically evaluated. Results: Patients with minimal involvement (1-25%) on thorax computed tomography were found to be higher in the smoker and cigarette-hookah smoking group compared to the non-smoking group, and the patients with moderate involvement (51-75%) were found to be less in the smoking-hookah group. in terms of disease degree;It was found that there were more mild and moderate smokers in the smoking and smoking-hookah group than the non-smoking group. The C-reactive protein and sedimentation values of cigarette-waterpipe tabocco smokers were found to be lower than non-smokers. Conclusion: Waterpipe smoking does not aggravate the course of the disease in the young population, but new studies are needed for its effects on the elderly population.

11.
Indian Journal of Transplantation ; 16(2):155-157, 2022.
Article in English | EMBASE | ID: covidwho-1939190

ABSTRACT

Introduction: The coronavirus pandemic has restricted access to health-care services for kidney transplant patients because of concerns of COVID-19 infection. This single-center prospective study was done to assess the feasibility, acceptability, and effectiveness of telemedicine services for regular follow-up of kidney transplant patients as well as for triaging patients for admission. Methods: The study was undertaken during the lockdown period in India from March 23, 2020 to June 30, 2020. A formatted message seeking all relevant information was sent before teleconsultation. WhatsApp/email using smartphones and Electronic Medical Records system were used to provide telemedicine services. At the end of the e-consult, the patient was asked to rate his experience on a scale of 0-10. Results: A total of 296 consults for 122 patients were given. Of these, 239 (80.7%) consults (96 patients) were for domestic patients and 57 (19.3%) consults (26 patients) were for international patients. The mean age of the patients was 43 ± 15 years. The mean patient satisfaction score for e-consults was 9.5 ± 0.7. Four (3.3%) patients were seen for the first time after transplant via teleconsultation. Nine (7.4%) patients were advised admission and the rest were advised follow-up teleconsultation. Among those admitted, 6 (4.9%) were COVID positive and 1 (0.8%) patient died of COVID-19 pneumonia. Conclusions: Telemedicine offers a viable modality for health-care delivery when access to health care is restricted for transplant patients. Our model of telemedicine can be replicated easily without the burden of high cost for infrastructure.

12.
Open Access Macedonian Journal of Medical Sciences ; 10:971-974, 2022.
Article in English | EMBASE | ID: covidwho-1939103

ABSTRACT

BACKGROUND: In December 2019, the world was shocked by a respiratory infectious disease caused by the novel coronavirus which was later referred to as COVID-19. This virus is transmitted from human to human very quickly through droplets, aerosols, and direct contact with COVID-19 patients. One of the health services suspected of playing a role in the spread of this virus is surgery. Surgical procedures involve much medical personnel and direct contact with patients causes surgery to be considered. In addition, surgery is also prone to causing nosocomial infections because generally post-operative patients have an increased inflammatory process and decreased immune response. In contrast to elective surgery, emergency surgery has a higher risk of post-operative morbidity and mortality than elective surgery because of the limited time to prepare and assess the patient. AIM: To find out the number of positive cases of COVID-19 after emergency surgery at our institution. METHODS: The type of research conducted is descriptive where this study uses secondary data in the form of medical records of post-operative emergency patients who meet the inclusion and exclusion criteria. RESULTS: A total of 741 medical records were obtained, with 691 of them being COVID-19 negative and 50 being COVID-19 positive. CONCLUSION: We found 93.3% of negative post-operative COVID-19 cases and 6.7% of positive post-operative COVID-19 cases in patients underwent emergency surgery procedures.

13.
Open Access Macedonian Journal of Medical Sciences ; 9:1338-1344, 2021.
Article in English | EMBASE | ID: covidwho-1939087

ABSTRACT

BACKGROUND: The Corona Virus Disease 2019 (COVID-19) pandemic has affected public health services, including routine immunization services. If this condition continues, the national immunization coverage will decrease, thereby potentially increasing the risk of immunization preventable diseases. AIM: This study aims to determine the coverage of complete basic immunization services in Semarang before (December 2019) and during the pandemic (May 2020) and the factors that affect the coverage of complete basic immunization services. METHODS: This study describes complete basic immunization based on data taken in June-August 2021 at three health centers in Semarang. The data used were the number of visits and the type of immunization obtained from the medical records of the Health Center Management Information System. In addition, in-depth interviews were conducted with the person in charge of the immunization program at the Public Health Center (Puskesmas) to determine the influence factors of the immunization coverage.. The data from the interviews were then analyzed thematically. RESULTS: There were 3594 infants who received immunization services, consisting of 2401 before the pandemic and 1193 during the pandemic. The average decrease in the number of basic immunization services was 50.31%. The decrease in the number of basic immunization services occurred in all network public health centers with an average of Puskesmas Genuk (−36.63%), Halmahera (−40%), and Pandanaran (−26.35%). The mother’s fear of COVID-19 contagious, service time and patients restrictions by the PHC, and IPV vaccine stock out have reduced the basic vaccination coverage in all public health centers. CONCLUSION: There was a decline in basic immunization coverage during the pandemic, so it is necessary to fulfill basic immunization needs and service innovations including the use of virtual engagement and optimization of social media for basic immunization campaigns.

14.
Circulation: Cardiovascular Quality and Outcomes ; 15, 2022.
Article in English | EMBASE | ID: covidwho-1938109

ABSTRACT

Heart failure is a leading diagnosis for hospitalization with a high risk of readmission. Despite robust data and recommendations by professional societies, there is a well-documented gap in delivering guideline-directed medical therapy (GDMT) known to reduce hospitalizations and improve mortality for patients with heart failure with reduced ejection fraction (HFrEF). The Dashboard Activated Services and Telehealth for HF (DASH-HF) is a quality improvement initiative to evaluate the effectiveness of proactive population management clinics to optimize use and dosing of GDMT for patients with HFrEF relative to usual care. The study utilizes the existing Veterans Affairs Academic Detailing HF Dashboard to target actionable patients (n=300) with a low optimization potential score (OPS) (Table 1). The intervention clinics utilize multidisciplinary providers (e.g., physicians, pharmacists) to perform chart review and telemedicine visits to address opportunities to optimize GDMT. The primary outcome of the study is the OPS 6 months after the end of the intervention, defined by active prescriptions and prescribed doses for each class of GDMT. Secondary outcomes include differences in hospitalizations and mortality and measures of health service efficiency such as patients contacted per clinic. The intervention duration was September to December 2021, and analysis is planned for June 2022. This is a unique study to systematically identify HFrEF patients with the largest gaps in GDMT and proactively engage with this group. We describe the study design for identifying target patients, logistics of the intervention, patient characteristics, and an overview of barriers faced during the intervention. The Coronavirus disease 2019 pandemic has led to a marked increase in telehealth services. If successful, this study may serve as a key pilot trial for more robust telehealth delivery, targeting patients at highest risk for HF-related hospitalizations and mortality.

15.
Alcoholism: Clinical and Experimental Research ; 46:283A, 2022.
Article in English | EMBASE | ID: covidwho-1937898

ABSTRACT

Alcohol misuse is associated with the development of respiratory failure, including the acute respiratory distress syndrome (ARDS), with attendant poorer outcomes. Epidemiologic data suggest that alcohol consumption increased during the COVID-19 pandemic;however, consumption habits among critically ill patients are not well-described. We hypothesized that the prevalence of alcohol consumption and misuse among patients with respiratory failure would be greater during the pandemic relative to years prior. Patients with respiratory failure requiring mechanical ventilation in a single academic hospital were enrolled from 2015-19 (pre-pandemic) and 2020-21 (pandemic). Data regarding demographics and alcohol use were obtained from the medical record. Phosphatidylethanol (PEth) was measured in a subset of patients in red blood cells collected within 48 hours of intubation. Patients were characterized as follows: (1) likely drinking: patient or proxy endorsed any drinking on the Alcohol Use Disorders Identification Test (AUDIT) or in social history;or patient was admitted for an alcohol-related diagnosis;or patient had detectable blood alcohol or PEth;(2) likely alcohol misuse: PEth ≥ 250;or AUDIT-C ≥3 (women) or ≥4 (men);or AUDIT ≥5 (women) or ≥ 8 (men);or patient was admitted for an alcohol-related diagnosis;(3) likely severe alcohol misuse: PEth ≥400. Univariable statistics were utilized as appropriate (Fisher's Exact Test, Kruskal- Wallis Test). The prevalence of likely drinking in the study population (n = 195) varied over time (p <0.0001). When pandemic (n = 67) and pre-pandemic patients (n = 128) were compared, the prevalence of likely drinking (93% vs 58%, p <0.0001), likely alcohol misuse (49% vs 33%, p <0.03) and likely severe alcohol misuse (32% vs 10%, p <0.003) were all greater during the pandemic. Among likely drinking patients with available PEth data (n = 97), median PEth was significantly higher during the pandemic compared to pre-pandemic years (251 [135-702] versus 87 [16-374], p = 0.002). Among the subset of patients enrolled during the pandemic, the prevalence of likely current drinking was 100% in those with COVID-19 compared to 76% among non-COVID patients (p = 0.002), but alcohol misuse did not differ. We conclude that alcohol consumption, and alcohol misuse, have increased during the pandemic in this patient cohort. These changes in drinking patterns are concerning and warrant additional research regarding their impact on susceptibility and outcomes for respiratory failure.

16.
Alcoholism: Clinical and Experimental Research ; 46:147A, 2022.
Article in English | EMBASE | ID: covidwho-1937885

ABSTRACT

Purpose: FASD is a highly prevalent disorder where the majority of affected individuals remain undiagnosed. Reliance on multidisciplinary diagnostic models hold little hope of meeting needed diagnostic capacity, creating barriers to care. Therefore, a new clinical model aiming to optimize access to diagnostic evaluation was tested. In this model, referred children with symptoms of FASD needing evaluation were triaged into a single discipline model (Nurse Practitioner (NP) or physician (MD)) or a multidisciplinary model (NP + neuropsychologist), depending on factors including age, results of past psychoeducational testing, alcohol confirmation, and growth data. The purpose of this study was to evaluate the impact of this new model utilizing clinical data. Methods: Retrospective review and analysis of clinical data extracted from the billing and electronic medical records for the time period between April, 2014 and November, 2021. Data: During the 6.5 year time period studied, 402 patients received a FASD diagnosis. Of these, 196 (48.8%) were diagnosed using the multidisciplinary model, and 206 (51.2%) were diagnosed using the single discipline model. There was steady growth in diagnostic capacity from initiation through 2019, with an almost 6-fold increase in diagnosed patients. Patients came from a wide geographic region, including 34 NYS counties, and 2 bordering states. Diagnosed children ranged from <1 - 20 years of age (m = 7.19), with 140 (36.5%) female and 244 (63.5%) male. Of single discipline evaluations, 205 (89.1%) were conducted in person and 25 (10.9%) by telemedicine, primarily during peak periods of the Covid-19 pandemic. MDs and NPs had roles in both models, with team medical examinations completed by NPs for 192 (98%), MDs, 4 (2%) and single discipline evaluations by NPs in 105 (51%), and MDs 101 (49%). Results: Use of a tiered model of FASD diagnostic evaluation more than doubled diagnostic capacity in the studied clinical setting, and allowed continued evaluation during pandemic conditions. Conclusions: Use of a tiered model of evaluation, in which evaluation of more straight forward cases are provided by a physician or nurse practitioner utilizing psychoeducational testing completed in the school setting, and evaluation of children with more a more complex diagnostic presentation utilizing an interdisciplinary team, has the potential to expand diagnostic capacity.

17.
Journal of Hypertension ; 40:e229, 2022.
Article in English | EMBASE | ID: covidwho-1937754

ABSTRACT

Objective: Characterize patients with hypertensive crisis and evaluate occurrences 30 days after the hypertensive event. Design and method: Cohort study was performed with 583 patients treated between August 2020 and July 2021, from an Emergency Unit in a Hospital specializes in cardiology in São Paulo, Brazil. Inclusion criteria: 18 years old, systolic pressure > 180 mmHg and/or diastolic pressure > 120 mmHg, have telephone contact. A consulting on the electronic medical record was made to identify the elegible patients, whom after were included on the REDCap platform, and 30 days of the hypertensive event, an interview by telephone was made to investigate cardiovascular events. Results: The sample characteristics were: women (53%), 66.24(13.89) years, white ethnicity (78.7%), married (50.5%), high school (27.9%), retired people (77.5%), average [(mean(SD)] monthly income R$2384.6 (R$3438). The mean(SD) systolic/diastolic blood pressure, respectively, in emergency department was 189.74(17.46)/99.28(19.89) mmHg. Hypertensive emergencies were 63.8%, urgencies 27.4% and 8.7% were not possible to classify. The prevalent symptoms in the emergency department were: chest pain (41.2%), dyspnea (34.3%), nausea (11.7%), dizziness (10,4%), radiating pain (10.1%). The most used treatments were: anticoagulant (35.1%), diuretic (28.1%), analgesic (25.3%), ACE inhibitor (23.8.7%). Regarding the performance of tests: 85.6% underwent laboratory tests, 71% electrocardiogram, 36.3% echocardiogram and 30.5% computed tomography. After being treated at the emergency department, 60.1% of patients were discharged, 35.8% hospitalized, 3.8% transferred to other hospitals and 0,3% died. Regarding comorbidities, 97.7% had hypertension, 68.7% high cholesterol, 48.4% diabetes, 34.1% acute myocardial infarction, 25.1% heart failure, 19.6% kidney disease and 12% stroke. Regarding outcomes 30 days after the hypertensive event, 1.4% had some type of stroke, being 85.7% ischemic and 14.3% hemorrhagic, 2.3% had acute infarction of the myocardium, and 2% cardiorespiratory arrest. Also, 14.5% returned to a health service for high blood pressure, and 23.1% for others reasons like angina, bradycardia, aortic aneurysm, covid-19, acute pulmonary edema, epigastric pain, dyspnea. Besides we identify that 4.7% died within 30 days. Conclusions: The findings indicate the need for tertiary systematization, through outpatient follow-up programs for people with hypertensive crisis in emergencies units.

18.
Journal of Hypertension ; 40:e175, 2022.
Article in English | EMBASE | ID: covidwho-1937725

ABSTRACT

Objective: Cardiovascular diseases including hypertension are common comorbidities in patients hospitalized due to COVID-19. We assessed the impact of hypertension on in-hospital mortality in patients hospitalized due to COVID-19. Design and method: We retrospectively analyzed the medical records of all consecutive patients who were admitted to the University Hospital in Krakow, Poland, due to confirmed SARS-CoV2 infection from March 2020 to May 2021. Results: Overall, data of 5191 patients (mean age 61.9 ± 16.7 years) were available for analysis. Patients with preexisting hypertension (58.3% of the study population) were older and had more comorbidities than patients without hypertension (p < 0.05). In-hospital mortality was significantly higher in patients with hypertension compared to those without hypertension also after adjustment for age (22.2% vs 12.9%;P = 0.02). Age above median (64 years, odds ratio [OR] 3.93;95% confidence interval [CI] 3.23-4.83), male gender (OR 1.19;CI 1.01-1.40), a history of heart failure (OR 2.01;CI 1.58-2.56) or chronic kidney disease (OR 2.35;CI 1.86-2.96) and increased C-reactive protein levels (OR 1.09;CI 1.08-1.10), but not preexisting hypertension (OR 0.90;CI 0.74-1.09) were significantly associated with a higher risk of in-hospital death after multivariate logistic regression analysis. However, hypertension (OR 1.45;CI 1.06-1.97) was an independent predictor of in-hospital death in patients without established cardiovascular disease and antihypertensive treatment. Treatment with any first-line antihypertensive drug class in patients with hypertension at the time of hospitalization was associated with a lower risk of in-hospital death (beta-blockers OR 0.52;CI 0.41-0.65;angiotensin converting enzyme inhibitors OR 0.52;CI 0.38-0.68;angiotensin receptor blockers OR 0.24;CI 0.12-0.41;calcium channel blockers OR 0.61;CI 0.44-0.84;thiazide diuretics OR 0.40;CI 0.24-0.64). Conclusions: Besides the high prevalence, hypertension was not an independent risk factor of in-hospital death in the overall group of hospitalized COVID-19 patients. Treatment with all first-line antihypertensive medications was associated with significant reduction of in-hospital death in patients with hypertension.

19.
British Journal of Neurosurgery ; 36(1):146, 2022.
Article in English | EMBASE | ID: covidwho-1937540

ABSTRACT

Objectives: The National Institute of Health and Care Excellence (NICE) has set standards for TBI patients' initial assessment and management. This study assessed respect for NICE TBI guidelines in patients referred to an English trauma centre during the Covid-19 pandemic. Design: A cross-sectional study. Subjects: TBI patients who presented to a District General Hospital between 1st December 2020 and 12th August 2021 and were referred to the tertiary neurosurgical centre. Methods: Data were collected from the electronic medical records of our subjects. Descriptive statistical analysis of the time between patients presenting to the emergency department, being reviewed by a trained member of staff, request for cranial CT imaging, and response to neurosurgical referral was done with SPSS version 27.0. Results: We collected data on 115 patients, and the TBI frequency peaked in the 60-99 age range. Most patients were men (55.9%, n = 65), and 77% had a frailty score of 5 or less, with 90% presenting with a GCS range of 13-15. At the referring hospital, twenty-eight percent (n = 32) of the patients were evaluated by a trained member of staff within 15 min of admission, and only 30% (n = 35) had cranial CT imaging within an hour of the assessment. Only half of the referrals (n = 58) were reviewed by Neurosurgeons within an hour. The most common lesion on cranial CT imaging was a subdural haemorrhage (34%, n = 40).

20.
Stud Health Technol Inform ; 290: 952-956, 2022 Jun 06.
Article in English | MEDLINE | ID: covidwho-1933585

ABSTRACT

Telehealth has evolved as a very comprehensive tool for treating patients with mild to moderate symptoms across the globe during the global pandemic. Adoption of Telehealth in India posed special challenges because of its diversity in languages. Lack of proper healthcare infastructure and especially poor network connectivity have affected pre-hospitalisation care. We have developed an easy to use replicable tool and shown the path to succesful telecare for affected communities. Methods MedicAidTM - an EMR software has been used along with Zoom® to quickly provide online consultations for COVID patients, individually and in groups. Results A total of 60 COVID patients were given online consultation and provided support with recovery in all. Conclusion Group based community care is safe for mass treatment of COVID.


Subject(s)
COVID-19 , Telemedicine , COVID-19/epidemiology , Hospitalization , Humans , Pandemics , Referral and Consultation
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