Inpatient COVID-19 Research Articles

LBSUN209 A Novel Algorithm For The Management Of Inpatient Covid-19 Steroid-induced Hyperglycemia

Abstract Objective/Background Hyperglycemia in hospitalized patients with COVID-19 is linked to increased morbidity and mortality. With increasing use of glucocorticoid (GC) therapy for COVID-19 hypoxemia, clinicians are challenged with an increased prevalence of hyperglycemia. Methods We developed an insulin protocol to aid front line providers in the management of GC-induced hyperglycemia for hospitalized adults with COVID-19. The protocol was based on expert opinion and was available from March 2021 onward. Glycemic and clinical outcomes were obtained for patients treated with GC and retrospectively compared to historical controls treated with GC admitted up to 6 months prior to protocol implementation. Glycemic parameters for finger stick glucose values (FSG) were defined as hypoglycemia <70 mg/dL, euglycemia 70-180 mg/dL, mild hyperglycemia 180-250 mg/dL and severe hyperglycemia >250 mg/dL. To account for differences in the quantity of total FSG between groups, we adjusted for length of stay and calculated the proportion of FSG per patient. Results 130 patients with COVID-19 and GC induced hyperglycemia from before (n=65) and after (n=65) protocol implementation were matched 1: 1 based on age, weight, and sex. There were no significant differences in other baseline patient characteristics. Significantly more patients in the protocol group had mean FSG in the euglycemic range (16.9% vs 38.5%, p=0. 006), and there was a decrease in patients with mean glucose in the mild hyperglycemia range that trended toward significance (50.8% vs 35.4%, p=0. 076). The protocol group had a significantly lower proportion of hypoglycemic FSG per patient (0. 003 vs 0. 008, p=0. 044). Patients in the protocol group had more euglycemic FSG per patient, but this did not reach significance (0.413 vs 0.350, p=0.239). Similarly, the proportion of mild hyperglycemic FSG per patient trended lower in the protocol group (0.315 vs 0.272, p=0.291). There were no significant differences in severe hyperglycemia per patient (0.311 vs 0.328, p=0.828). The protocol group had a significantly higher utilization of basal-bolus insulin regimen (n=43 vs n=63, p<0. 0001) with an increase percentage of bolus insulin utilization in peak total daily dose (70.2% vs. 62.4%, p=0. 08). Total peak day insulin dose trended lower in the protocol group (0.25 vs 0.32 U/kg, p=0.36). Conclusion A novel insulin protocol for the management of GC-induced hyperglycemia in hospitalized COVID-19 patients is an effective tool to achieve reductions in hypoglycemic events and higher utilization of standard of care basal-bolus insulin regimens without increased hyperglycemia or total daily dose of insulin. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Is there an association between hospital staffing levels and inpatient-COVID-19 mortality rates?

ObjectiveThis study aims to investigate the relationship between RNs and hospital-based medical specialties staffing levels with inpatient COVID-19 mortality rates.MethodsWe relied on data from AHA Annual Survey Database, Area Health Resource File, and UnitedHealth Group Clinical Discovery Database. In phase 1 of the analysis, we estimated the risk-standardized event rates (RSERs) based on 95,915 patients in the UnitedHealth Group Database 1,398 hospitals. We then used beta regression to analyze the association between hospital- and county- level factors with risk-standardized inpatient COVID-19 mortality rates from March 1, 2020, through December 31, 2020.ResultsHigher staffing levels of RNs and emergency medicine physicians were associated with lower COVID-19 mortality rates. Moreover, larger teaching hospitals located in urban settings had higher COVID-19 mortality rates. Finally, counties with greater social vulnerability, specifically in terms of housing type and transportation, and those with high infection rates had the worst patient mortality rates.ConclusionHigher staffing levels are associated with lower inpatient mortality rates for COVID-19 patients. More research is needed to determine appropriate staffing levels and how staffing levels interact with other factors such as teams, leadership, and culture to impact patient care during pandemics.

COVID-19 Infection in Chronic Kidney Disease Patients in Bulgaria: Risk Factors for Death and Acute Kidney Injury.

Regarding COVID-19 infection, Bulgaria has one of the lowest rates of vaccination in Europe, and its COVID-19-related mortality rate has been one of the highest in the European Union. Chronic kidney disease (CKD)-COVID-19 patients are at higher risk of developing acute kidney injury (AKI) and death after hospital admission. This single-center prospective cohort study from Bulgaria included 120 in-patient COVID-19 subjects of whom 70 had CKD and 50 normal renal function. Diabetes mellitus, hypertension, obesity, and cardiovascular disease were statistically more prevalent in the CKD group as compared to the non-CKD group. At admission, D-dimer, creatinine, and urea levels were significantly higher in the CKD group, whereas estimated glomerular-filtration rate was significantly lower as compared to the non-CKD patients. During hospitalization, 23 patients (19.1%) died, of which 19 were in the CKD group (p-value = 0.0096); in addition, 38 developed AKI (31.6%), of which 31 were in the CKD group (p-value = 0.0006). Using binary logistic regression, being male, having experienced AKI, and not having been treated with remdesivir were independent risk factors for COVID-19-induced mortality. Regarding risk of AKI, having had COVID-19-related symptoms for more than 6 days before admission, having CKD at baseline, and having not received remdesivir therapy were independent predictive factors for developing AKI after admission.

The Impact of Funding Inpatient Treatments for COVID-19 on Health Equity in the United States: A Distributional Cost-Effectiveness Analysis

ObjectivesWe conducted a distributional cost-effectiveness analysis (DCEA) to evaluate how Medicare funding of inpatient COVID-19 treatments affected health equity in the United States. MethodsA DCEA, based on an existing cost-effectiveness analysis model, was conducted from the perspective of a single US payer, Medicare. The US population was divided based on race and ethnicity (Hispanic, non-Hispanic black, and non-Hispanic white) and county-level social vulnerability index (5 quintile groups) into 15 equity-relevant subgroups. The baseline distribution of quality-adjusted life expectancy was estimated across the equity subgroups. Opportunity costs were estimated by converting total spend on COVID-19 inpatient treatments into health losses, expressed as quality-adjusted life-years (QALYs), using base-case assumptions of an opportunity cost threshold of $150 000 per QALY gained and an equal distribution of opportunity costs across equity-relevant subgroups. ResultsMore socially vulnerable populations received larger per capita health benefits due to higher COVID-19 incidence and baseline in-hospital mortality. The total direct medical cost of inpatient COVID-19 interventions in the United States in 2020 was estimated at $25.83 billion with an estimated net benefit of 735 569 QALYs after adjusting for opportunity costs. Funding inpatient COVID-19 treatment reduced the population-level burden of health inequality by 0.234%. Conclusions remained robust across scenario and sensitivity analyses. ConclusionsTo the best of our knowledge, this is the first DCEA to quantify the equity implications of funding COVID-19 treatments in the United States. Medicare funding of COVID-19 treatments in the United States could improve overall health while reducing existing health inequalities.

Causes of Dispute for COVID-19 Outpatient and Inpatient Claims at the Muhammadiyah University General Hospital of Malang

Muhammadiyah University General Hospital of Malang is a COVID-19 referral hospital for Malang. Between April 2020 and June 2021, the hospital submitted 62 outpatient and 1364 inpatient cases for COVID-19 claims to the Ministry of Health of the Republic of Indonesia. The percentage of outpatient dispute claims was 25% and of inpatient dispute claims was 39%. These disputed claims disturbed the cash flow of the health facilities. The aim of our study was to describe the causes of outpatient and inpatient COVID-19 dispute claims. Our methodology was descriptive, and the secondary data were taken from claim submission documents. There were ten criteria that caused dispute claims based on KMK Number HK. 01.07/MENKES/4718/2021. This was related to administrative and medical issues. The most common cause of inpatient dispute claims (35%) was that the criteria for discharge from the hospital were not in accordance with the guarantee limit. Additionally, the most common cause of outpatient dispute claims (60%) was the management of isolation that was not related to the guidelines for management and prevention of COVID-19.
 Keywords: claim dispute criteria, hospital, COVID-19

Fluvoxamine for the treatment of COVID-19.

Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) that has been approved for the treatment of depression, obsessive-compulsive disorder, and a variety of anxiety disorders; it is available as an oral preparation. Fluvoxamine has not been approved for the treatment of infections, but has been used in the early treatment of people with mild to moderate COVID-19. As there are only a few effective therapies for people with COVID-19 in the community, a thorough understanding of the current evidence regarding the efficacy and safety of fluvoxamine as an anti-inflammatory and possible anti-viral treatment for COVID-19, based on randomised controlled trials (RCTs), is needed. To assess the efficacy and safety of fluvoxamine in addition to standard care, compared to standard care (alone or with placebo), or any other active pharmacological comparator with proven efficacy for the treatment of COVID-19 outpatients and inpatients. We searched the Cochrane COVID-19 Study Register (including Cochrane Central Register of Controlled Trials, MEDLINE, Embase, ClinicalTrials.gov, WHO ICTRP, medRxiv), Web of Science and WHO COVID-19 Global literature on COVID-19 to identify completed and ongoing studies up to 1 February 2022. We included RCTs that compared fluvoxamine in addition to standard care (also including no intervention), with standard care (alone or with placebo), or any other active pharmacological comparator with proven efficacy in clinical trials for the treatment of people with confirmed COVID-19, irrespective of disease severity, in both inpatients and outpatients. Co-interventions needed to be the same in both study arms. We excluded studies comparing fluvoxamine to other pharmacological interventions with unproven efficacy. We assessed risk of bias of primary outcomes using the Cochrane Risk of Bias 2 tool for RCTs. We used GRADE to rate the certainty of evidence to treat people with asymptomatic to severe COVID-19 for the primary outcomes including mortality, clinical deterioration, clinical improvement, quality of life, serious adverse events, adverse events of any grade, and suicide or suicide attempt. We identified two completed studies with a total of 1649 symptomatic participants. One study was conducted in the USA (study with 152 participants, 80 and 72 participants per study arm) and the other study in Brazil (study with 1497 high-risk participants for progression to severe disease, 741 and 756 participants per study arm) among outpatients with mild COVID-19. Both studies were double-blind, placebo-controlled trials in which participants were prescribed 100 mg fluvoxamine two or three times daily for a maximum of 15 days. We identified five ongoing studies and two studies awaiting classification (due to translation issues, and due to missing published data). We found no published studies comparing fluvoxamine to other pharmacological interventions of proven efficacy. We assessed both included studies to have an overall high risk of bias. Fluvoxamine for the treatment of COVID-19 in inpatients We did not identify any completed studies of inpatients. Fluvoxamine for the treatment of COVID-19 in outpatients Fluvoxamine in addition to standard care may slightly reduce all-cause mortality at day 28 (RR 0.69, 95% CI 0.38 to 1.27; risk difference (RD) 9 per 1000; 2 studies, 1649 participants; low-certainty evidence), and may reduce clinical deterioration defined as all-cause hospital admission or death before hospital admission (RR 0.55, 95% CI 0.16 to 1.89; RD 57 per 1000; 2 studies, 1649 participants; low-certainty evidence). We are very uncertain regarding the effect of fluvoxamine on serious adverse events (RR 0.56, 95% CI 0.15 to 2.03; RD 54 per 1000; 2 studies, 1649 participants; very low-certainty evidence) or adverse events of any grade (RR 1.06, 95% CI 0.82 to 1.37; RD 7 per 1000; 2 studies, 1649 participants; very low-certainty evidence). Neither of the studies reported on symptom resolution (clinical improvement), quality of life or suicide/suicide attempt. Based on a low-certainty evidence, fluvoxamine may slightly reduce all-cause mortality at day 28, and may reduce the risk of admission to hospital or death in outpatients with mild COVID-19. However, we are very uncertain regarding the effect of fluvoxamine on serious adverse events, or any adverse events. In accordance with the living approach of this review, we will continually update our search and include eligible trials as they arise, to complete any gaps in the evidence.

Inpatient COVID-19 vaccination rollout: Improving access to vaccination

We were aware of high numbers of inpatients unvaccinated against COVID-19 at Guy's and St Thomas' NHS Foundation Trust (GSTT). Due to this, an inpatient vaccination protocol was set up in July 2021, with initially limited uptake. From October 2021, a multidisciplinary team worked to improve the protocol for inpatient vaccination, with the development of a system that gave ownership to clinical teams. In 4 months (July 2021 to November 2021), 20 inpatients had been vaccinated at GSTT. Following our intervention, rates of uptake increased, and 34 patients were vaccinated in less than 2 months (November 2021 to January 2022). Forty-five patients who had been referred were discharged without vaccination; attempts were made to invite them to receive a vaccine. An improved pathway and referral process increased the number of inpatient vaccinations delivered. Further work is required in order to ensure that more patients who have been referred are vaccinated.

Improving Inpatient COVID-19 Vaccination Rates Among Adult Patients at a Tertiary Academic Medical Center

Improving Inpatient COVID-19 Vaccination Rates Among Adult Patients at a Tertiary Academic Medical Center

Costs for a hospital stay: another lesson learned from the COVID-19 pandemic

Background and aim: After two years of pandemic, planning and budgeting for use of healthcare resources and services is very important. Inpatient COVID-19 hospitalizations costs, regardless of ICD-10 procedure codes, in a Covid-19 support military hospital were analyzed. Methods: The national protocol for the treatment of Covid-19 infection was applied. The costs for laboratory tests, drugs, protection equipment and radiological investigations (imaging techniques such as computed-tomography or radiography), hospitalization days and food were assessed. Results: In our hospital, from August 2020 through June 2021, 241 patients were hospitalized with COVID-19: mean age 59.92±7.8 years, 46% men, 26% military personnel, 11.57±3 days of hospitalization; two third of patients had moderate and severe forms of COVID-19. The main manifestations were: 69% respiratory (18% with severe pneumonia), 3.3% cardiac (2.9% with pulmonary embolism, diagnosed by computed tomography angiography), 28% digestive and 33% psychiatric (most commonly anxiety). The average estimated costs were about 3000€/patient, without significant differences based on disease severity. Equipment costs were 2 times higher than for drugs and 3 times than for laboratory tests. Conclusions: In a Covid-19 support military hospital that cared for patients with predominantly moderate forms of COVID-19, the costs for equipment were much higher than those for treatment. New criteria for hospitalization of these forms of COVID-19 deserve to be analyzed in order to avoid useless costs

Disproportionate Burden of COVID-19 Infection Among Hispanic Patients During the First COVID-19 Surge in South Texas.

Introduction:The morbidity and mortality of the COVID-19 pandemic have disproportionately burdened Hispanic populations in the United States. While health equity research is typically conducted in populations where Hispanics are the minority, this project analyzes COVID-19 racioethnic transmission trends over the first 6 months of the pandemic within a large majority-minority city in South Texas.Methods:Patients diagnosed with COVID-19 across inpatient, emergency department, and outpatient settings of a large county health system were included in a clinical registry. For 4644 COVID-19-positive patients between March 16 and August 31, 2020, demographic and clinical data were abstracted from the registry. Race/ethnicity trends over time were compared for patients with and without COVID-19 diagnoses. Logistic regressions identified predictors of inpatient diagnosis by age, race/ethnicity, and testing delay.Results:The proportion of patients with COVID-19 identifying as Hispanic increased rapidly during the pandemic's first months: from 55.6% in March to 85.7% in June. A significantly greater proportion of patients identified as Hispanic within the COVID-19 cohort compared to other diagnoses cohort. Testing delay was 11.6% longer for Hispanic patients, with each day of testing delay associated with 7% increased odds of inpatient COVID-19 diagnosis.Conclusion:These findings highlight the disproportionate impact of COVID-19 on Hispanic populations even within a majority-minority community. In the United States, Hispanic persons are more likely to work frontline jobs, live in multigenerational homes in poverty, and be uninsured. The burden of COVID-19 cases within Bexar County's largest hospital system reflects this systemic inequity. Identifying racioethnic health disparities supports efforts toward mitigating structural factors that predispose minority groups to illness and death.

International electronic health record-derived post-acute sequelae profiles of COVID-19 patients

The risk profiles of post-acute sequelae of COVID-19 (PASC) have not been well characterized in multi-national settings with appropriate controls. We leveraged electronic health record (EHR) data from 277 international hospitals representing 414,602 patients with COVID-19, 2.3 million control patients without COVID-19 in the inpatient and outpatient settings, and over 221 million diagnosis codes to systematically identify new-onset conditions enriched among patients with COVID-19 during the post-acute period. Compared to inpatient controls, inpatient COVID-19 cases were at significant risk for angina pectoris (RR 1.30, 95% CI 1.09–1.55), heart failure (RR 1.22, 95% CI 1.10–1.35), cognitive dysfunctions (RR 1.18, 95% CI 1.07–1.31), and fatigue (RR 1.18, 95% CI 1.07–1.30). Relative to outpatient controls, outpatient COVID-19 cases were at risk for pulmonary embolism (RR 2.10, 95% CI 1.58–2.76), venous embolism (RR 1.34, 95% CI 1.17–1.54), atrial fibrillation (RR 1.30, 95% CI 1.13–1.50), type 2 diabetes (RR 1.26, 95% CI 1.16–1.36) and vitamin D deficiency (RR 1.19, 95% CI 1.09–1.30). Outpatient COVID-19 cases were also at risk for loss of smell and taste (RR 2.42, 95% CI 1.90–3.06), inflammatory neuropathy (RR 1.66, 95% CI 1.21–2.27), and cognitive dysfunction (RR 1.18, 95% CI 1.04–1.33). The incidence of post-acute cardiovascular and pulmonary conditions decreased across time among inpatient cases while the incidence of cardiovascular, digestive, and metabolic conditions increased among outpatient cases. Our study, based on a federated international network, systematically identified robust conditions associated with PASC compared to control groups, underscoring the multifaceted cardiovascular and neurological phenotype profiles of PASC.

RWD57 Emergency and Inpatient COVID-19 Service Utilization and Its Stratification Based on Comorbid Conditions

ObjectiveInsights on COVID-19 Inpatient and Emergency Utilization and To Stratify them Based on Comorbid Conditions in the US.BackgroundEver since the very first case of COVID-19 was detected, many studies have been carried out to identify the various aspects of this multifaceted challenging disease. The disease has infected humans of all ages, gender, race and ethnicity. It was observed that the disease manifested differently in individuals with different comorbid conditions. This study was intended to identify emergency and inpatient healthcare service utilization in COVID-19 patients based on underlying Comorbid conditions.MethodIn this study, the total number of patients diagnosed with COVID-19 from March 2020 to March 2021 were identified using Optum’s de-identified administrative claims database and the percentage utilization was calculated. Further stratification of utilization of emergency and inpatient services will be done based on comorbid conditions.ResultA total of 750,612 patients diagnosed with COVID-19 from March 2020 to March 2021 were included in the analysis. Out of these 187,389 and 120,709 patients utilized the emergency and inpatient services amounting to 24.96% and 16.08% respectively. We would further see which comorbid conditions lead to maximum utilization of these services.ConclusionThe study observed that around one fourth of the population infected required emergency services and there was also a substantial increase in inpatient service utilization. Further analysis is to be done to see how the underlying comorbid conditions influenced the percentage utilization of these services. ObjectiveInsights on COVID-19 Inpatient and Emergency Utilization and To Stratify them Based on Comorbid Conditions in the US. Insights on COVID-19 Inpatient and Emergency Utilization and To Stratify them Based on Comorbid Conditions in the US. BackgroundEver since the very first case of COVID-19 was detected, many studies have been carried out to identify the various aspects of this multifaceted challenging disease. The disease has infected humans of all ages, gender, race and ethnicity. It was observed that the disease manifested differently in individuals with different comorbid conditions. This study was intended to identify emergency and inpatient healthcare service utilization in COVID-19 patients based on underlying Comorbid conditions. Ever since the very first case of COVID-19 was detected, many studies have been carried out to identify the various aspects of this multifaceted challenging disease. The disease has infected humans of all ages, gender, race and ethnicity. It was observed that the disease manifested differently in individuals with different comorbid conditions. This study was intended to identify emergency and inpatient healthcare service utilization in COVID-19 patients based on underlying Comorbid conditions. MethodIn this study, the total number of patients diagnosed with COVID-19 from March 2020 to March 2021 were identified using Optum’s de-identified administrative claims database and the percentage utilization was calculated. Further stratification of utilization of emergency and inpatient services will be done based on comorbid conditions. In this study, the total number of patients diagnosed with COVID-19 from March 2020 to March 2021 were identified using Optum’s de-identified administrative claims database and the percentage utilization was calculated. Further stratification of utilization of emergency and inpatient services will be done based on comorbid conditions. ResultA total of 750,612 patients diagnosed with COVID-19 from March 2020 to March 2021 were included in the analysis. Out of these 187,389 and 120,709 patients utilized the emergency and inpatient services amounting to 24.96% and 16.08% respectively. We would further see which comorbid conditions lead to maximum utilization of these services. A total of 750,612 patients diagnosed with COVID-19 from March 2020 to March 2021 were included in the analysis. Out of these 187,389 and 120,709 patients utilized the emergency and inpatient services amounting to 24.96% and 16.08% respectively. We would further see which comorbid conditions lead to maximum utilization of these services. ConclusionThe study observed that around one fourth of the population infected required emergency services and there was also a substantial increase in inpatient service utilization. Further analysis is to be done to see how the underlying comorbid conditions influenced the percentage utilization of these services. The study observed that around one fourth of the population infected required emergency services and there was also a substantial increase in inpatient service utilization. Further analysis is to be done to see how the underlying comorbid conditions influenced the percentage utilization of these services.

Evaluation of the models generated from clinical features and deep learning-based segmentations: Can thoracic CT on admission help us to predict hospitalized COVID-19 patients who will require intensive care?

BackgroundThe aim of the study was to predict the probability of intensive care unit (ICU) care for inpatient COVID-19 cases using clinical and artificial intelligence segmentation-based volumetric and CT-radiomics parameters on admission.MethodsTwenty-eight clinical/laboratory features, 21 volumetric parameters, and 74 radiomics parameters obtained by deep learning (DL)-based segmentations from CT examinations of 191 severe COVID-19 inpatients admitted between March 2020 and March 2021 were collected. Patients were divided into Group 1 (117 patients discharged from the inpatient service) and Group 2 (74 patients transferred to the ICU), and the differences between the groups were evaluated with the T-test and Mann–Whitney test. The sensitivities and specificities of significantly different parameters were evaluated by ROC analysis. Subsequently, 152 (79.5%) patients were assigned to the training/cross-validation set, and 39 (20.5%) patients were assigned to the test set. Clinical, radiological, and combined logit-fit models were generated by using the Bayesian information criterion from the training set and optimized via tenfold cross-validation. To simultaneously use all of the clinical, volumetric, and radiomics parameters, a random forest model was produced, and this model was trained by using a balanced training set created by adding synthetic data to the existing training/cross-validation set. The results of the models in predicting ICU patients were evaluated with the test set.ResultsNo parameter individually created a reliable classifier. When the test set was evaluated with the final models, the AUC values were 0.736, 0.708, and 0.794, the specificity values were 79.17%, 79.17%, and 87.50%, the sensitivity values were 66.67%, 60%, and 73.33%, and the F1 values were 0.67, 0.62, and 0.76 for the clinical, radiological, and combined logit-fit models, respectively. The random forest model that was trained with the balanced training/cross-validation set was the most successful model, achieving an AUC of 0.837, specificity of 87.50%, sensitivity of 80%, and F1 value of 0.80 in the test set.ConclusionBy using a machine learning algorithm that was composed of clinical and DL-segmentation-based radiological parameters and that was trained with a balanced data set, COVID-19 patients who may require intensive care could be successfully predicted.

Mapping of SARS-CoV-2 IgM and IgG in gingival crevicular fluid: Antibody dynamics and linkage to severity of COVID-19 in hospital inpatients

Mapping of SARS-CoV-2 IgM and IgG in gingival crevicular fluid: Antibody dynamics and linkage to severity of COVID-19 in hospital inpatients

Postpartum Depression, Catatonia and Covid-19 Infection: One Case, Different Clinical Presentations

IntroductionPost-partum depression may occur in the first year after childbirth in approximately 25% of women, at times presenting with psychotic symptoms and catatonic states. Catatonia is a psychomotor syndrome that occurs in association with various neuropsychiatric disorders and can be described according to the characteristics of its manifestation in types such as retarded or agitated.ObjectivesWe report the case of a patient with postpartum depression and catatonic syndrome who, after a session of electroconvulsive therapy, was infected with Sars-COV-2, suspended treatment, and had her condition aggravated with distinct clinical manifestations.MethodsClinical case report and non-systematic review of articles consulted in the PubMed platform.ResultsA 24-year-old patient develops depressive symptoms and obsessive behaviour 6 months after delivery and deteriorates with mutism, stupor and motor immobility. She was hospitalised and medicated with lorazepam, with no improvement. One session of electroconvulsive therapy was carried out with improvement of the symptoms. Due to an inpatient Covid-19 outbreak, in which the patient was infected, treatment was suspended. During isolation, deterioration of the patient’s condition was observed with psychomotor agitation, bizarre behaviour, and perseverative speech. The patient resumed treatment with ECT, with total remission of the catatonic syndrome and improvement of the affective symptoms.ConclusionsCatatonic syndromes are relatively rare, but its association with post-partum depression is not so uncommon. The occurrence of different presentations of catatonia, although described as possible in the same episode in the literature, were not found in any clinical studies reviewed, which leads us to conclude that it is an uncommon situation.DisclosureNo significant relationships.

Differences in End-of-Life Care between COVID-19 Inpatient Decedents with English Proficiency and Limited English Proficiency.

Background: Patients with limited English proficiency (LEP) experience lower quality end-of-life (EOL) care. This inequity may have been exacerbated during the COVID-19 pandemic. Objective: Compare health care utilization, EOL, and palliative care outcomes between COVID-19 decedents with and without LEP during the pandemic's first wave in Massachusetts. Methods: Retrospective cohort study of adult inpatients who died from COVID-19 between February 18, 2020 and May 18, 2020 at two academic and four community hospitals within a greater Boston health care system. We performed multivariable regression adjusting for patient sociodemographic variables and hospital characteristics. Primary outcome was place of death (intensive care unit [ICU] vs. non-ICU). Secondary outcomes included hospital and ICU length of stay and time to initial palliative care consultation. Results: Among 337 patients, 89 (26.4%) had LEP and 248 (73.6%) were English proficient. Patients with LEP were less often white (24 [27.0%] vs. 193 [77.8%]; p < 0.001); were more often Hispanic or Latinx (40 [45.0%] vs. 13 [5.2%]; p < 0.001); and less often had a medical order for life-sustaining treatment (MOLST) on admission (15 [16.9%] vs. 120 [48.4%]; p < 0.001) versus patients with English proficiency. In the multivariable analyses, LEP was not independently associated with ICU death, ICU length of stay, or time to palliative care consultation, but was independently associated with increased hospital length of stay (mean difference 4.12 days; 95% CI, 1.72-6.53; p < 0.001). Conclusions: Inpatient COVID-19 decedents with LEP were not at increased risk of an ICU death, but were associated with an increased hospital length of stay versus inpatient COVID-19 decedents with English proficiency.

Clinical Characteristics and Outcome of Pediatric COVID-19 Patients in Ethiopia During the Early COVID-19 Pandemic: A Prospective Cohort Study.

IntroductionMost previous pediatric COVID-19 studies reported milder disease in children. However, there are limited pediatric data from low-income settings. We aimed to assess the characteristics and outcomes of pediatric COVID-19 in Ethiopia.SettingSt. Paul’s COVID-19 treatment center; a tertiary COVID-19 center. Pediatric care was provided in a dedicated ward but with a common ICU.MethodsSt. Paul’s Hospital COVID-19 cohort (SPC-19) included inpatient COVID-19 RT-PCR confirmed cases from August 2020 to January 2021. Data were extracted from case report forms attached to patient charts and completed by the clinicians. Data were uploaded into the Redcap database and exported to SPSS 20 for analysis. Binary logistic regression and chi-square test were used in the analysis.ResultsSeventy-nine patients 0–19 years were included from the SPC-19 cohort over 6 months. Pediatric admissions accounted for 11% of cases in the cohort. The mean age (SD) was 6.9 (±6.36) years and 40 (50.6%) were female. The disease was asymptomatic or mild in 57 (72.2%), moderate in 15 (19%), and severe or critical in 7 (8.8%). The commonest presentations in symptomatic children were prostration (26.6%) followed by vomiting (12.7%), fever and cough (11.4% each), and dyspnea (10%). About 53 (67%) children had multimorbidity, and 14 (17.7%) children died. All deaths were in children with comorbidities with tuberculosis and malignancy being associated with 43% of deaths. Nearly 5% of children reported long-COVID symptoms highlighting the need for prolonged follow-up in those children.ConclusionDespite lower admissions and severity, high mortality and morbidity was documented in our pediatric cohort. The presence of comorbidity and inadequate care organization likely contributed to high mortality. COVID-19 centers of low-income settings should emphasize optimizing the care of children with COVID-19 and multimorbidity, and vaccination should be considered in those children to prevent high morbidity and mortality.

Agilitas Organisasi: Meningkatkan Kepuasan Kerja Dan Komitmen Organisasi Tenaga Keperawatan Di Ruang Rawat Inap Pasien Covid-19

The Covid-19 pandemic has affected all aspects of people's lives and the world in a short time. The medical work environment dealing directly with patients is very stressful, especially for nurses who have to be in the inpatient room for 24 hours continuously. The purpose of this study was the extent to which hospital organizational agility could increase job satisfaction and organizational commitment of nurses working in inpatient room COVID-19 patients. This research method is a quantitative research method with data processing tools using the SmartPLS version 3.0. The research data was obtained from an online questionnaire using google form with a non-probability sampling technique, namely a convenience sampling technique (accidental sampling). The respondents of this study were 110 nurses who served in the Covid-19 inpatient service section at the Sentra Medika Group Hospital domiciled in West Java province which was appointed as a Covid-19 referral hospital by the Governor of West Java. The results showed that the direct effect coefficient of organizational agility on organizational commitment was 0.207, job satisfaction on organizational commitment was 0.484, and the indirect effect coefficient of organizational agility on organizational commitment through job satisfaction was 0.234. Thus, it can be concluded that organizational agility has a positive and significant effect on organizational commitment mediated by job satisfaction.

Gestational diabetes is associated with SARS-CoV-2 infection during pregnancy: A case-control study

AimIndividuals with SARS-CoV-2 infection and (pre-existing) diabetes, including pregnant women, present with more severe morbidity, as compared to non-diabetic subjects. To date, evidence is limited concerning the role of gestational diabetes (GDM) in severity of SARS-CoV-2 infection during pregnancy, or vice versa. The aim of our study was to investigate the prevalence of GDM in a SARS-CoV-2 infected pregnant population and evaluate risk factors for and from severe infection in these patients. MethodsA case-control study with prospective data collection for the case group and 1:2 matching with historical controls based on parity, BMI and ethnicity was conducted (n = 224). GDM screening was performed at 26 weeks’ gestation. Multivariate binary logistic regression analysis was performed to assess risk factors for GDM and inpatient COVID-19 management. Results34.6% of the patients in the case group suffered from GDM, vs. 16.1% in the control group (p = 0.002). 35.7% patients were diagnosed with GDM after, vs. 33.3% before SARS-CoV-2 infection (OR (95%CI) 1.11(0.40–3.08), p = 0.84), with no correlation between time point of infection and GDM diagnosis. SARS-CoV-2 (OR (95%CI) 2.79 (1.42, 5.47), p = 0.003) and BMI (OR (95%CI) 1.12 (1.05, 1.19), p = 0.001) were significant independent risk factors for GDM. ConclusionData suggests that GDM increases the risk of infection in SARS-CoV-2 infected pregnant women. Meanwhile, SARS-CoV-2 during pregnancy might increase the risk of developing GDM.Vaccination and caution in using protective measures should be recommended to pregnant women, particularly when suffering from GDM.

Notes From the Field: A Voice-Activated Video Communication System for Nurses to Communicate With Inpatients With COVID-19.

With the relaxing of telehealth regulations through the Health Insurance Portability and Accountability Act (HIPAA) waiver notification for Telehealth Remote Communications during the COVID-19 Nationwide Public Health Emergency, our organization had the opportunity to pilot an innovative virtual care solution using a modified consumer-grade voice-activated video communication system (Amazon Echo Show 8) within one inpatient COVID-19 unit. In this brief report, we describe our experiences with implementing the system and general feedback from clinicians, and discuss areas for future development required to enable future scaling of this solution. Our pilot demonstrates the feasibility of deploying a consumer-grade voice assistant device in COVID-19 patient rooms. We found the devices engaging due to the voice technologies and Alexa functionalities for both clinician and patient entertainment. To enable future deployment at scale, enhancements to the Echo Show and data analytics will need to be further explored.