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2.
Rev Panam Salud Publica ; 45: e14, 2021.
Article in Spanish | MEDLINE | ID: covidwho-1812002

ABSTRACT

OBJECTIVE: Compare the diagnostic properties of five case definitions of suspected COVID-19 that were used or proposed in Chile during the first eight months of the pandemic. METHODS: An analysis was done of the diagnostic properties (sensitivity, specificity, and positive and negative predictive values) of three case definitions of suspected COVID-19 used in Chile between March and October 2020, as well as two alternative proposed definitions. The sample was 2,019 people with known results for the polymerase chain reaction (PCR) test for SARS-CoV-2. Stepwise logistic regression was used to develop criterion 5, optimizing sensitivity and specificity values. Multifactor logistic regression was used to explore the association between demographic variables, symptoms and signs, and PCR positivity. Different positivity scenarios were analyzed and ROC curves were compared. RESULTS: The presence of anosmia (OR = 8.00; CI95%: 5.34-11.99), fever (OR = 2.15; CI95%: 1.28-3.59), and having been in close contact with a person sick with COVID-19 (OR = 2.89; CI95%: 2.16-3.87) were associated with a positive PCR result. According to the analysis of the ROC curve, criterion 5 had the highest capacity for discrimination, although there were no significant differences with the other four criteria. CONCLUSIONS: Criterion 5-based on anosmia, close contact with people with COVID-19, and fever as sufficient unique elements-was the most sensitive in identifying suspected cases of COVID-19, a key aspect in controlling the spread of the pandemic.


OBJETIVO: Comparar as características diagnósticas de cinco critérios das definições de caso suspeito de COVID-19 usados ou propostos no Chile nos oito primeiros meses de pandemia. MÉTODOS: Foram avaliadas as características diagnósticas (sensibilidade, especificidade e valores preditivos positivo e negativo) de três critérios das definições de caso suspeito de COVID-19 usados no Chile entre março e outubro de 2020 e de duas alternativas propostas para definição de caso. A amostra do estudo consistiu 2 019 pessoas com resultados conhecidos no exame de reação em cadeia da polimerase (PCR) para SARS-CoV-2. Para elaborar o critério 5, uma regressão logística com método stepwise foi realizada otimizando os valores de sensibilidade e especificidade. A associação entre variáveis demográficas, sintomas e sinais e resultado positivo no exame de PCR foi testada em um modelo de regressão logística multifatorial. Situações diferentes de resultado positivo foram testadas com uma análise comparativa das curvas ROC. RESULTADOS: Presença de anosmia (OR 8,00; IC95% 5,34­11,99), febre (OR 2,15; IC95% 1,28­3,59) e contato próximo anterior com uma pessoa com COVID-19 (OR 2,89; IC95% 2,16­3,87) foram associados a um resultado positivo no exame de PCR. De acordo com a análise das curvas ROC, o critério 5 demonstrou maior capacidade discriminatória, apesar de não existir diferença significativa com os outros quatro critérios. CONCLUSÃO: O critério 5 ­ presença de anosmia, febre e contato próximo com uma pessoa com COVID-19 como elementos únicos e suficientes ­ demonstrou maior sensibilidade para identificar casos suspeitos de COVID-19, o que é fundamental para controlar a disseminação da pandemia.

3.
Crit Care Explor ; 2(5): e0127, 2020 May.
Article in English | MEDLINE | ID: covidwho-1795103

ABSTRACT

SETTING: The coronavirus disease 2019 pandemic has raised fear throughout the nation. Current news and social media predictions of ventilator, medication, and personnel shortages are rampant. PATIENTS: Patients with coronavirus disease 2019 are presenting with early respiratory distress and hypoxemia, but not hypercapnia. INTERVENTIONS: Patients who maintain adequate alveolar ventilation, normocapnia, and adequate oxygenation may avoid the need for tracheal intubation. Facemask continuous positive airway pressure has been used to treat patients with respiratory distress for decades, including those with severe acute respiratory syndrome. Of importance, protocols were successful in protecting caregivers from contracting the virus, obviating the need for tracheal intubation just to limit the spread of potentially infectious particles. CONCLUSIONS: During a pandemic, with limited resources, we should provide the safest and most effective care, while protecting caregivers. Continuous positive airway pressure titrated to an effective level and applied early with a facemask may spare ventilator usage. Allowing spontaneous ventilation will decrease the need for sedative and paralytic drugs and may decrease the need for highly skilled nurses and respiratory therapists. These goals can be accomplished with devices that are readily available and easier to obtain than mechanical ventilators, which then can be reserved for the sickest patients.

4.
J Clin Rheumatol ; 28(2): e623-e625, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1703382

ABSTRACT

BACKGROUND: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection produces a wide variety of inflammatory responses in children, including multisystem inflammatory syndrome in children, which has similar clinical manifestations as Kawasaki disease (KD). METHODS: We performed a chart review of all patients with KD-like illnesses from January 1, 2016, to May 31, 2020, at a tertiary care children's hospital within a larger health system. Relevant symptoms, comorbid illnesses, laboratory results, imaging studies, treatment, and outcomes were reviewed. Descriptive analyses to compare features over time were performed. RESULTS: We identified 81 cases of KD-like illnesses from January 1, 2016, to May 31, 2020. Few clinical features, such as gallbladder involvement, were more prevalent in 2020 than in previous years. A few patients in 2020 required more intensive treatment with interleukin 1 receptor antagonist therapy. There were no other clear differences in incidence, laboratory parameters, number of doses of intravenous immunoglobulin, or outcomes over the years of the study. CONCLUSIONS: There was no difference in incidence, laboratory parameters, or number of doses of intravenous immunoglobulin required for treatment of KD-like illnesses during the COVID-19 pandemic when compared with previous years at our institution. Kawasaki disease-like illnesses, including multisystem inflammatory syndrome in children, may not have changed substantially during the COVID-19 pandemic.


Subject(s)
COVID-19 , Mucocutaneous Lymph Node Syndrome , COVID-19/complications , Child , Humans , Medical Records , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/drug therapy , Mucocutaneous Lymph Node Syndrome/epidemiology , Pandemics , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
5.
PLoS One ; 16(3): e0247839, 2021.
Article in English | MEDLINE | ID: covidwho-1574949

ABSTRACT

As SARS-CoV-2 has spread quickly throughout the world, the scientific community has spent major efforts on better understanding the characteristics of the virus and possible means to prevent, diagnose, and treat COVID-19. A valid approach presented in the literature is to develop an image-based method to support COVID-19 diagnosis using convolutional neural networks (CNN). Because the availability of radiological data is rather limited due to the novelty of COVID-19, several methodologies consider reduced datasets, which may be inadequate, biasing the model. Here, we performed an analysis combining six different databases using chest X-ray images from open datasets to distinguish images of infected patients while differentiating COVID-19 and pneumonia from 'no-findings' images. In addition, the performance of models created from fewer databases, which may imperceptibly overestimate their results, is discussed. Two CNN-based architectures were created to process images of different sizes (512 × 512, 768 × 768, 1024 × 1024, and 1536 × 1536). Our best model achieved a balanced accuracy (BA) of 87.7% in predicting one of the three classes ('no-findings', 'COVID-19', and 'pneumonia') and a specific balanced precision of 97.0% for 'COVID-19' class. We also provided binary classification with a precision of 91.0% for detection of sick patients (i.e., with COVID-19 or pneumonia) and 98.4% for COVID-19 detection (i.e., differentiating from 'no-findings' or 'pneumonia'). Indeed, despite we achieved an unrealistic 97.2% BA performance for one specific case, the proposed methodology of using multiple databases achieved better and less inflated results than from models with specific image datasets for training. Thus, this framework is promising for a low-cost, fast, and noninvasive means to support the diagnosis of COVID-19.


Subject(s)
COVID-19/diagnostic imaging , Databases, Factual , Neural Networks, Computer , Pneumonia/diagnostic imaging , Algorithms , Bias , Deep Learning , Humans , Image Interpretation, Computer-Assisted , Radiography, Thoracic
6.
J Pediatric Infect Dis Soc ; 10(9): 919-921, 2021 Oct 27.
Article in English | MEDLINE | ID: covidwho-1493869

ABSTRACT

This is a single-center US retrospective study of infection patterns among household sick contacts (HHSCs) of children with confirmed severe acute respiratory syndrome-coronavirus-2 infection in an urban setting. An HHSC was identified in fewer than half (42%) of the patients, and no child-to-adult transmission was identified. This is a single center US retrospective study of infection patterns among household sick contacts of children with confirmed SARS-CoV-2 infection. A household sick contact was identified in fewer than half (42%) of patients and no child-to-adult transmission was identified.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Contact Tracing , Family Characteristics , Humans , Retrospective Studies
7.
Vaccines (Basel) ; 9(3)2021 Mar 11.
Article in English | MEDLINE | ID: covidwho-1448935

ABSTRACT

The mRNA-based vaccine approach is a promising alternative to traditional vaccines due to its ability for prompt development, high potency, and potential for secure administration and low-cost production. Nonetheless, the application has still been limited by the instability as well as the ineffective delivery of mRNA in vivo. Current technological improvements have now mostly overcome these concerns, and manifold mRNA vaccine plans against various forms of malignancies and infectious ailments have reported inspiring outcomes in both humans and animal models. This article summarizes recent mRNA-based vaccine developments, advances of in vivo mRNA deliveries, reflects challenges and safety concerns, and future perspectives, in developing the mRNA vaccine platform for extensive therapeutic use.

8.
Front Med (Lausanne) ; 7: 561168, 2020.
Article in English | MEDLINE | ID: covidwho-1389192

ABSTRACT

Providing routine healthcare to patients with serious health illnesses represents a challenge to healthcare providers amid the SARS-CoV-2 pandemic. Treating cancer patients during this pandemic is even more complex due to their heightened vulnerability, as both cancer and cancer treatment weaken the immune system leading to a higher risk of both infections and severe complications. In addition to the need to protect cancer patients from unnecessary exposure to SARS-CoV-2 infection during their routine care, interruption, and discontinuation of cancer treatment can result in negative consequences on patients' health, in addition to the ghost of rationing healthcare resources in high demand during a global health crisis. This article aims to explore the ethical dilemmas faced by decision-makers and healthcare providers caring for cancer patients during the SARS-CoV-2 pandemic. This includes setting triage criteria for non-infected cancer patients, fairly allocating limited healthcare resources between cancer patients and SARS-CoV-2 patients, prioritizing SARS-CoV-2 treatment or vaccine, once developed, for cancer patients and non-cancer patients, patient-physician communication on matters such as end-of-life and do-not-resuscitate (DNR), and lastly, shifting physicians' priorities from treating their own cancer patients to treating critically ill SARS-CoV-2 infected patients. Ultimately, no straightforward decision can be easily made at such exceptionally difficult times. Applying different ethical principles can result in very different scenarios and consequences. In the end, we will briefly share the experience of the King Hussein Cancer Center (KHCC), the only standalone comprehensive cancer center in the region.

9.
J Travel Med ; 27(8)2020 12 23.
Article in English | MEDLINE | ID: covidwho-1387947

ABSTRACT

RATIONALE FOR REVIEW: In response to increased concerns about emerging infectious diseases, GeoSentinel, the Global Surveillance Network of the International Society of Travel Medicine in partnership with the US Centers for Disease Control and Prevention (CDC), was established in 1995 in order to serve as a global provider-based emerging infections sentinel network, conduct surveillance for travel-related infections and communicate and assist global public health responses. This review summarizes the history, past achievements and future directions of the GeoSentinel Network. KEY FINDINGS: Funded by the US CDC in 1996, GeoSentinel has grown from a group of eight US-based travel and tropical medicine centers to a global network, which currently consists of 68 sites in 28 countries. GeoSentinel has provided important contributions that have enhanced the ability to use destination-specific differences to guide diagnosis and treatment of returning travelers, migrants and refugees. During the last two decades, GeoSentinel has identified a number of sentinel infectious disease events including previously unrecognized outbreaks and occurrence of diseases in locations thought not to harbor certain infectious agents. GeoSentinel has also provided useful insight into illnesses affecting different traveling populations such as migrants, business travelers and students, while characterizing in greater detail the epidemiology of infectious diseases such as typhoid fever, leishmaniasis and Zika virus disease. CONCLUSIONS: Surveillance of travel- and migration-related infectious diseases has been the main focus of GeoSentinel for the last 25 years. However, GeoSentinel is now evolving into a network that will conduct both research and surveillance. The large number of participating sites and excellent geographic coverage for identification of both common and illnesses in individuals who have traversed international borders uniquely position GeoSentinel to make important contributions of travel-related infectious diseases in the years to come.


Subject(s)
COVID-19 , International Cooperation , Sentinel Surveillance , Travel Medicine , COVID-19/epidemiology , COVID-19/prevention & control , Centers for Disease Control and Prevention, U.S. , Geographic Information Systems , Humans , SARS-CoV-2 , Travel Medicine/methods , Travel Medicine/trends , Travel-Related Illness , United States
10.
Dermatol Ther ; 34(4): e14984, 2021 07.
Article in English | MEDLINE | ID: covidwho-1337381

ABSTRACT

Cutaneous involvement can be an important sign of both COVID-19 and rickettsioses. Rickettsial infections may be first evident as an exanthem with eschars as a key finding. In contrast, eschars and necrotic lesions can be seen in critically ill COVID-19 patients. Both illnesses share a similar mechanism of infecting endothelial cells resulting in vasculopathy. Rickettsia parkeri and Rickettsia 364D are both characterized by eschars unlike Rickettsia rickettsii. Other eschar causing rickettsioses such as Rickettsia conorii, Rickettsia africae, and Orientia tsutsugamushi are commonly diagnosed in people from or having traveled through endemic areas. While there is no consensus on treatment for COVID-19, rickettsioses are treatable. Due to possibly serious consequences of delayed treatment, doxycycline should be administered given an eschar-presenting patient's travel history and sufficient suspicion of vector exposure. The proliferation of COVID-19 cases has rendered it critical to differentiate between the two, both of which may have overlapping vasculopathic cutaneous findings. We review these diseases, emphasizing the importance of cutaneous involvement, while also discussing possible therapeutic interventions.


Subject(s)
COVID-19 , Rickettsia Infections , Endothelial Cells , Humans , Rickettsia , Rickettsia Infections/diagnosis , Rickettsia Infections/drug therapy , SARS-CoV-2
11.
BMJ Glob Health ; 5(7)2020 07.
Article in English | MEDLINE | ID: covidwho-1311109

ABSTRACT

INTRODUCTION: Caring for an Ebola patient is a known risk factor for disease transmission. In Sierra Leone during the outbreak in 2014/2015, isolation of patients in specialised facilities was not always immediately available and caring for a relative at home was sometimes the only alternative. This study sought to assess population-level protective caregiving intentions, to understand how families cared for their sick and to explore perceived barriers and facilitators influencing caregiving behaviours. METHODS: Data from a nationwide household survey conducted in December 2014 were used to assess intended protective behaviours if caring for a family member with suspected Ebola. Their association with socio-demographic variables, Ebola-specific knowledge and risk perception was analysed using multilevel logistic regression. To put the results into context, semi-structured interviews with caregivers were conducted in Freetown. RESULTS: Ebola-specific knowledge was positively associated with the intention to avoid touching a sick person and their bodily fluids (adjusted OR (AOR) 1.29; 95% CI 1.01 to 1.54) and the intention to take multiple protective measures (AOR 1.38; 95% CI 1.16 to 1.63). Compared with residing in the mostly urban Western Area, respondents from the initial epicentre of the outbreak (Eastern Province) had increased odds to avoid touching a sick person or their body fluids (AOR 4.74; 95% CI 2.55 to 8.81) and to take more than one protective measure (AOR 2.94; 95% CI 1.37 to 6.34). However, interviews revealed that caregivers, who were mostly aware of the risk of transmission and general protective measures, felt constrained by different contextual factors. Withholding care was not seen as an option and there was a perceived lack of practical advice. CONCLUSIONS: Ebola outbreak responses need to take the sociocultural reality of caregiving and the availability of resources into account, offering adapted and acceptable practical advice. The necessity to care for a loved one when no alternatives exist should not be underestimated.


Subject(s)
Disease Outbreaks , Hemorrhagic Fever, Ebola , Home Care Services , Family , Female , Hemorrhagic Fever, Ebola/epidemiology , Humans , Male , Risk Factors , Sierra Leone/epidemiology
12.
J Infect Dis ; 224(1): 14-20, 2021 07 02.
Article in English | MEDLINE | ID: covidwho-1294728

ABSTRACT

BACKGROUND: Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity among asymptomatic subjects reflects past or future disease may be difficult to ascertain. METHODS: We tested 9449 employees at Karolinska University Hospital, Stockholm, Sweden for SARS-CoV-2 RNA and antibodies, linked the results to sick leave records, and determined associations with past or future sick leave using multinomial logistic regression. RESULTS: Subjects with high amounts of SARS-CoV-2 virus, indicated by polymerase chain reaction (PCR) cycle threshold (Ct) value, had the highest risk for sick leave in the 2 weeks after testing (odds ratio [OR], 11.97; 95% confidence interval [CI], 6.29-22.80) whereas subjects with low amounts of virus had the highest risk for sick leave in the 3 weeks before testing (OR, 6.31; 95% CI, 4.38-9.08). Only 2.5% of employees were SARS-CoV-2 positive while 10.5% were positive by serology and 1.2% were positive in both tests. Serology-positive subjects were not at excess risk for future sick leave (OR, 1.06; 95% CI, .71-1.57). CONCLUSIONS: High amounts of SARS-CoV-2 virus, as determined using PCR Ct values, was associated with development of sickness in the next few weeks. Results support the concept that PCR Ct may be informative when testing for SARS-CoV-2. Clinical Trials Registration. NCT04411576.


Subject(s)
Asymptomatic Diseases , COVID-19/epidemiology , COVID-19/virology , Health Personnel , SARS-CoV-2 , Adult , Aged , Antibodies, Viral , COVID-19/diagnosis , Disease Progression , Female , Hospitals, University , Humans , Male , Mass Screening , Middle Aged , Polymerase Chain Reaction , RNA, Viral , SARS-CoV-2/genetics , Serologic Tests , Sick Leave/statistics & numerical data , Sweden/epidemiology , Young Adult
13.
Pilot Feasibility Stud ; 7(1): 116, 2021 May 31.
Article in English | MEDLINE | ID: covidwho-1280599

ABSTRACT

BACKGROUND: People with serious mental illnesses (SMI) such as schizophrenia often also have physical health illnesses and interventions are needed to address the resultant multimorbidity and reduced life expectancy. Research has shown that volunteers can support people with SMI. This protocol describes a feasibility randomised controlled trial (RCT) of a novel intervention involving volunteer 'Health Champions' supporting people with SMI to manage and improve their physical health. METHODS: This is a feasibility hybrid II randomised effectiveness-implementation controlled trial. The intervention involves training volunteers to be 'Health Champions' to support individual people with SMI using mental health services. This face-to-face or remote support will take place weekly and last for up to 9 months following initial introduction. This study will recruit 120 participants to compare Health Champions to treatment as usual for people with SMI using secondary community mental health services in South London, UK. We will measure the clinical and cost effectiveness including quality of life. We will measure the implementation outcomes of acceptability, feasibility, appropriateness, fidelity, barriers and enablers, unintended consequences, adoption and sustainability. DISCUSSION: There is a need for interventions to support people with SMI with their physical health. If this feasibility trial is successful, a definitive trial will follow to fully evaluate the clinical, cost and implementation effectiveness of Health Champions supporting people with SMI. TRIAL REGISTRATION: ClinicalTrials.gov, registration no: NCT04124744 .

14.
J Gastrointest Surg ; 25(12): 3092-3098, 2021 12.
Article in English | MEDLINE | ID: covidwho-1270537

ABSTRACT

BACKGROUND: Maintaining standards of living donor liver transplantation (LDLT) can be a challenge during the corona virus disease 2019 (COVID-19) pandemic. Center-specific protocols have been developed and transplant societies propose limiting elective LDLT. We have looked at outcomes of LDLT during the pandemic in an exclusively LDLT center. METHODS: Patients were grouped into pre-COVID (January 2019-February 2020) (n = 162) and COVID (March 2020-January 2021) (n = 53) cohorts. We looked at patient characteristics, 30-day morbidity, and mortality. Outcomes were also assessed in donors and recipients who underwent surgery after recovery from COVID-19. RESULTS: The average number of transplants reduced from 11.5/month to 4.8/month. Fewer patients with MELD > 20 underwent LDLT in the COVID cohort (41.3% versus 24.5%, P = 0.03). Out of nine patients with a positive pretransplant COVID-19 PCR, there were 2 (22.3%) deaths on the waiting list. Seven patients underwent LT after recovery from COVID-19 with one 30-day mortality due to biliary sepsis. Three donors with positive COVID-19 PCR underwent uneventful donation after testing negative for COVID-19. No significant difference in 30-day survival was observed in the pre-COVID and COVID cohorts (93.2% versus 90.6%) (P = 0.3). Out of two recipients who developed COVID-19 pneumonia within 30 days after LT, there was one mortality. The 1-year survival for the entire cohort with a MELD cutoff of 20 was 90% and 84% (P = 0.2). CONCLUSION: Despite comparable outcomes, fewer sick patients might undergo LDLT during the pandemic. Individuals recovered from COVID-19 might be safely considered for donation or transplantation.


Subject(s)
COVID-19 , Liver Transplantation , Graft Survival , Humans , Living Donors , Pandemics , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
15.
J Cancer Res Ther ; 17(2): 295-302, 2021.
Article in English | MEDLINE | ID: covidwho-1268380

ABSTRACT

The world is fighting the onslaught of COVID 19 for the last 10 months, ever since the first case was reported in December 2019 in Wuhan, China. Now, it has spread to over 200 countries. COVID 19-associated respiratory syndrome is causing a lot of mortality and morbidity. There are reports suggesting that the complications and ARDS associated with COVID 19 is an immune response reaction. The cytokine storm associated with severe cases of COVID 19 acts as a cause of death in many sick patients. It has been shown that COVID 19 is associated with a peculiar immune profile: Decrease in CD3, CD4, CD8, natural killer cell and B-cells; Rise in interleukin (IL)-4, IL-6 and tumor necrosis factor (TNF) alpha; Decrease in IL-10; Decrease in interferon-gamma. Low-dose radiotherapy (LDRT) immunosuppressive features resulting from M2 macrophage phenotype activation, increase in IL-10, transforming growth factor beta, a decrease in IL-6, TNF alpha and an increase in CD3, CD4, and CD8 T cell counts may negate the harmful effects of cytokine release syndrome. Literature review shows that radiation was previously used to treat viral pneumonia with a good success rate. This practice was discontinued in view of the availability of effective antibiotics and antivirals. As there are no scientifically proven treatment for severe COVID 19-associated respiratory distress today, it is prudent that we understand the benefits of LDRT at this critical juncture and take rational decisions to treat the same. This article provides an radioimmunological rationale for the treatment of immune crisis mediated complications in severe cases of COVID 19.


Subject(s)
COVID-19/radiotherapy , Cytokine Release Syndrome/radiotherapy , SARS-CoV-2/immunology , COVID-19/complications , COVID-19/immunology , COVID-19/virology , Clinical Decision-Making , Cytokine Release Syndrome/immunology , Cytokine Release Syndrome/virology , Humans , Radiotherapy Dosage , Severity of Illness Index , Treatment Outcome
16.
Front Robot AI ; 8: 652685, 2021.
Article in English | MEDLINE | ID: covidwho-1266693

ABSTRACT

The Coronavirus disease 2019 (Covid-19) pandemic has brought the world to a standstill. Healthcare systems are critical to maintain during pandemics, however, providing service to sick patients has posed a hazard to frontline healthcare workers (HCW) and particularly those caring for elderly patients. Various approaches are investigated to improve safety for HCW and patients. One promising avenue is the use of robots. Here, we model infectious spread based on real spatio-temporal precise personal interactions from a geriatric unit and test different scenarios of robotic integration. We find a significant mitigation of contamination rates when robots specifically replace a moderate fraction of high-risk healthcare workers, who have a high number of contacts with patients and other HCW. While the impact of robotic integration is significant across a range of reproductive number R0, the largest effect is seen when R0 is slightly above its critical value. Our analysis suggests that a moderate-sized robotic integration can represent an effective measure to significantly reduce the spread of pathogens with Covid-19 transmission characteristics in a small hospital unit.

17.
Psychiatr Serv ; 72(12): 1467-1470, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1262437

ABSTRACT

Individuals with serious medical illnesses experience high rates of comorbid behavioral health conditions. Behavioral health comorbidity affects outcomes in serious illness care. Despite this consequence, behavioral health remains siloed from serious illness care. Prior to the COVID-19 pandemic, the authors presented a conceptual model of behavioral health integration into serious illness care. In this column, the authors reflect on this model in the context of the challenges and opportunities posed by COVID-19.


Subject(s)
COVID-19 , Critical Care , Critical Illness , Humans , Pandemics , SARS-CoV-2
18.
Clin Teach ; 18(4): 424-430, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1261166

ABSTRACT

BACKGROUND: Communication between clinicians, patients, and families is a core component of medical care that requires deliberate practice and feedback to improve. In March 2020, the COVID-19 pandemic caused a sudden transformation in communication practices because of new physical distancing requirements, necessitating physicians to communicate bad news via telephone and video-mediated communication (VMC). This study investigated students' experience with a simulation-based communications training for having difficult conversations using VMC. METHODS: Thirty-eight fourth-year medical students preparing for their surgical residency participated in a simulated scenario where students discussed a new COVID-19 diagnosis with a standardised family member (SFM) of a sick patient via VMC. Learners were introduced to an established communications model (SPIKES) by an educational video. After the simulation, SFM and course facilitators guided a debrief and provided feedback. Learners completed surveys evaluating reactions to the training, preparedness to deliver bad news, and attitudes about telehealth. RESULTS: Twenty-three students completed evaluation surveys (response rate=61%). Few students had prior formal training (17%) or experience communicating bad news using telehealth (13%). Most respondents rated the session beneficial (96%) and felt they could express empathy using the VMC format (83%). However, only 57% felt ready to deliver bad news independently after the training and 52% reported it was more difficult to communicate without physical presence. Comments highlighted the need for additional practice. CONCLUSION: This pilot study demonstrated the value and feasibility of teaching medical students to break bad news using VMC as well as demonstrating the need for additional training.


Subject(s)
COVID-19 , Pandemics , COVID-19 Testing , Communication , Humans , Physician-Patient Relations , Pilot Projects , SARS-CoV-2 , Truth Disclosure
19.
Front Med (Lausanne) ; 8: 656405, 2021.
Article in English | MEDLINE | ID: covidwho-1247875

ABSTRACT

Background: COVID-19 is a newly recognized illness with a predominantly respiratory presentation. It is important to characterize the differences in disease presentation and trajectory between COVID-19 patients and other patients with common respiratory illnesses. These differences can enhance knowledge of pathogenesis and help in guiding treatment. Methods: Data from electronic medical records were obtained from individuals admitted with respiratory illnesses to Rambam Health Care Campus, Haifa, Israel, between October 1st, 2014 and October 1st, 2020. Four groups of patients were defined: COVID-19 (693), influenza (1,612), severe acute respiratory infection (SARI) (2,292), and Others (4,054). The variable analyzed include demographics (7), vital signs (8), lab tests (38), and comorbidities (15) from a total of 8,651 hospitalized adult patients. Statistical analysis was performed on biomarkers measured at admission and for their disease trajectory in the first 48 h of hospitalization, and on comorobidity prevalence. Results: COVID-19 patients were overall younger in age and had higher body mass index, compared to influenza and SARI. Comorbidity burden was lower in the COVID-19 group compared to influenza and SARI. Severely- and moderately-ill COVID-19 patients older than 65 years of age suffered higher rate of in-hospital mortality compared to hospitalized influenza patients. At admission, white blood cells and neutrophils were lower among COVID-19 patients compared to influenza and SARI patients, while pulse rate and lymphoctye percentage were higher. Trajectories of variables during the first 2 days of hospitalization revealed that white blood count, neutrophils percentage and glucose in blood increased among COVID-19 patients, while decreasing among other patients. Conclusions: The intrinsic virulence of COVID-19 appeared higher than influenza. In addition, several critical functions, such as immune response, coagulation, heart and respiratory function, and metabolism were uniquely affected by COVID-19.

20.
Nature ; 594(7862): 265-270, 2021 06.
Article in English | MEDLINE | ID: covidwho-1246377

ABSTRACT

Fast and reliable detection of patients with severe and heterogeneous illnesses is a major goal of precision medicine1,2. Patients with leukaemia can be identified using machine learning on the basis of their blood transcriptomes3. However, there is an increasing divide between what is technically possible and what is allowed, because of privacy legislation4,5. Here, to facilitate the integration of any medical data from any data owner worldwide without violating privacy laws, we introduce Swarm Learning-a decentralized machine-learning approach that unites edge computing, blockchain-based peer-to-peer networking and coordination while maintaining confidentiality without the need for a central coordinator, thereby going beyond federated learning. To illustrate the feasibility of using Swarm Learning to develop disease classifiers using distributed data, we chose four use cases of heterogeneous diseases (COVID-19, tuberculosis, leukaemia and lung pathologies). With more than 16,400 blood transcriptomes derived from 127 clinical studies with non-uniform distributions of cases and controls and substantial study biases, as well as more than 95,000 chest X-ray images, we show that Swarm Learning classifiers outperform those developed at individual sites. In addition, Swarm Learning completely fulfils local confidentiality regulations by design. We believe that this approach will notably accelerate the introduction of precision medicine.


Subject(s)
Blockchain , Clinical Decision-Making/methods , Confidentiality , Datasets as Topic , Machine Learning , Precision Medicine/methods , COVID-19/diagnosis , COVID-19/epidemiology , Disease Outbreaks , Female , Humans , Leukemia/diagnosis , Leukemia/pathology , Leukocytes/pathology , Lung Diseases/diagnosis , Machine Learning/trends , Male , Software , Tuberculosis/diagnosis
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