Faculty Bibliography

COVID-19 symptom definitions rarely include symptom severity. We collected daily nasal swabs and symptom diaries from contacts of SARS-CoV-2 cases. Requiring ≥1 moderate or severe symptom reduced sensitivity to predict SARS-CoV-2 shedding from 60.0% (CI: 52.9-66.7%) to 31.5% (CI: 25.7-38.0%), but increased specificity from 77.5% (CI:75.3-79.5%) to 93.8% (CI: 92.7-94.8%).

BACKGROUND AND OBJECTIVES/OBJECTIVE:AKI is a common complication of coronavirus disease 2019 (COVID-19) and is associated with high mortality. Palliative care, a specialty that supports patients with serious illness, is valuable for these patients but is historically underutilized in AKI. The objectives of this paper are to describe the use of palliative care in patients with AKI and COVID-19 and their subsequent health care utilization. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS/METHODS:We conducted a retrospective analysis of New York University Langone Health electronic health data of COVID-19 hospitalizations between March 2, 2020 and August 25, 2020. Regression models were used to examine characteristics associated with receiving a palliative care consult. RESULTS:=0.002). Despite greater use of palliative care, patients with AKI had a significantly longer length of stay, more intensive care unit admissions, and more use of mechanical ventilation. Those with AKI did have a higher frequency of discharges to inpatient hospice (6% versus 3%) and change in code status (34% versus 7%) than those without AKI. CONCLUSIONS:Palliative care was utilized more frequently for patients with AKI and COVID-19 than historically reported in AKI. Despite high mortality, consultation occurred late in the hospital course and was not associated with reduced initiation of life-sustaining interventions. PODCAST/UNASSIGNED:This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_02_24_CJN11030821.mp3.

We describe an educational intervention for neurology residents aimed at developing feedback skills. An objective structured clinical examination case was designed to simulate the provision of feedback to a medical student. After the simulated case session, residents received structured, individualized feedback on their performance and then participated in a group discussion about feedback methods. Survey data were collected from the standardized medical student regarding residents' performance and from residents for assessments of their performance and of the OSCE case. This manuscript aims to describe this educational intervention and to demonstrate the feasibility of this approach for feedback skills development.

PURPOSE/OBJECTIVE:Measure the effect of inhaled pulmonary vasodilators on gas exchange in mechanically ventilated patients with COVID-19. METHODS:ratio, oxygenation Index (OI), and ventilatory ratio (VR) after initiation of inhaled pulmonary vasodilators. RESULTS:, OI and VR did not significantly change over a five day period starting the day prior to drug initiation in patients who received either iNO or iEPO assessed with a fixed effects model. CONCLUSION/CONCLUSIONS:Inhaled pulmonary vasodilators were not associated with significant improvement in gas exchange in mechanically ventilated patients with COVID-19.

OBJECTIVES: We designed a prospective cohort study to systematically study patients with severe acute respiratory infection (SARI) and improve hospital preparedness (SARI-PREP). The goal of this project is to evaluate the natural history, prognostic biomarkers, and characteristics, including hospital stress, associated with SARI clinical outcomes and severity.
METHOD(S): In collaboration with the Society of Critical Care Medicine Discovery Research Network and the National Emerging Special Pathogen Training and Education Center (NETEC), SARIPREP is an ongoing, prospective, observational, multi-center cohort study of hospitalized patients with respiratory viral infections. We collected patient demographics, signs, symptoms, and medications; microbiology, imaging, and other diagnostics; mechanical ventilation, hospital procedures, and other interventions; and clinical outcomes. Hospital leadership completed a weekly hospital stress survey. Respiratory, blood, and urine biospecimens were collected from patients on days 0, 3, 7-14 after study enrollment and at hospital discharge. MEASUREMENTS AND MAIN RESULTS: SARI-PREP enrollment began on April 4, 2020 and currently includes 674 patients. Here we report results from the first 400 patients: 216 are from the University of Washington Hospitals, Seattle WA, 142 from New York University, New York NY and 42 from University of Southern California, Los Angeles, CA. Almost all tested positive for SARS-CoV-2 infection (n=397), whereas 3 patients tested positive for an alternative viral pathogen. The mean (+/-SD) age of the patients was 57+/-16 years; 72% were men, 62% were White, 14% were Asian, 12% were Black, and 31% were Hispanic. Most of the patients were admitted to the intensive care unit (96%). The median (interquartile range) hospital length of stay was 22 (9-46) days. Rates of invasive mechanical ventilation (72%) and renal replacement therapy (19%) were common and the rate of hospital mortality was 35%.
CONCLUSION(S): Initial SARI-PREP analysis indicates enrollment of a diverse population of hospitalized patients primarily with SARSCoV-2 infection. The demographics and clinical outcomes of our cohort mirror other large critically ill cohorts of COVID-19 patients. Results of a concomitant, weekly, hospital stress assessment are reported separately

INTRODUCTION: Hospitals experienced substantial stress during the COVID-19 pandemic-threats to standard operations- but it is not well known how this stress manifested at individual hospitals. We aimed to understand patterns of hospital stress over time, where stress was located within hospitals, and correlations between individual stress measures.
METHOD(S): We conducted a weekly hospital stress survey from November 2020 through May 2021 among site leaders from the SCCM Discovery Severe Acute Respiratory Infection - Preparedness (SARI-PREP) multicenter prospective cohort study. The survey assessed hospital stress ordinally and also assessed ED and ICU stress and deviations from standard operating procedures. Pairwise comparisons of strain measures were calculated by Pearson's correlation coefficients (r).
RESULT(S): Eight hospitals across three health systems in New York, California, and Washington contributed 190 hospital-weeks of data. Sites reported unavailability of some hospital resources resulting in potentially avoidable patient harm during 3.5% of hospital-weeks (with at least one such week at four hospitals); alterations in care processes and/or staffing which were fully compensated for during 57.9% of weeks; and no stress during 38.6% of weeks. During one December 2020 week, hospital stress, ICU stress, and care deviations were all present at 100% of reporting sites. The most common care deviations were increased hospital staffing (39.5%) and cancelling elective surgeries (18.6%). Hospital stress and care deviations were highly correlated (r = 0.81, p < 0.0001). Stress was more common in ICUs (72.4%) than EDs (14.3%), and ICU and ED stress were not correlated (r = 0.19, p = 0.05). While ED stress rose and abated earlier, ICU stress and care deviations persisted (range 2-13 weeks longer) as local case rates declined.
CONCLUSION(S): Hospital stress during the pandemic varied in degree and type both within and among hospitals over time. Care deviations were common but potentially avoidable patient harm was rare. Systematic national assessments of hospital stress, both during and between pandemics, could inform more rapid, proactive public health responses to novel threats. Areas for further study include impacts from persistent low-level stress and longer-term consequences for hospitals and their communities

Rationale: Allergic and non-allergic adverse reactions (ARs) to Covid-19 vaccine (Cov19V) have been reported. Understanding the characteristics of Cov19V ARs, particularly those that are allergic in nature, may help us to better counsel patients who are at risk of developing a vaccine AR.
Method(s): We performed a retrospective chart review of ARs voluntarily reported to our Occupational Health Services following Cov19V at a multi-site academic medical center between December 2020-June 2021.
Result(s): 464 Cov19V ARs among 71,281 vaccine doses given (0.65%) were reported. 57 ARs (12.3%) were determined to be allergic (10 after the second dose), 356 were nonallergic, and 51 (11.0%) were undetermined. Of the 47 first-dose allergic ARs, 30 (63.8%) received a second dose, 16 did not complete the vaccine series, and 1 had no data. 3 employees received an alternative Cov19V. Of the 356 nonallergic ARs, 110 were following second dose, 2 were following Janssen, and 4 had no data. 228 of first dose reactions (95.0%, 228/240) completed the vaccine series. 22/57 (38.6%) allergic ARs versus 38/356 (10.7%) nonallergic ARs required ER transfer. More allergic ARs were categorized as moderate/severe (80.7%, 46/57) than nonallergic ARs (66.3%, 236/356).
Conclusion(s): Cov19V ARs are extremely uncommon with nonallergic AR more common than allergic. A vast majority of ARs, allergic or nonallergic, are able to receive subsequent Cov19V. Employees with allergic ARs were less likely to receive a second Cov19V and more frequently required emergent medical evaluation compared to those with nonallergic ARs.
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INTRODUCTION: In patients with septic shock, the diastolic shock index (DSI), defined as the ratio of heart rate to diastolic blood pressure, has been shown to correlate with mortality. This is thought to be due to the underlying vasodilation and compensatory increases in heart rate. Although infection with COVID-19 frequently presents with sepsis-like symptoms and changes in blood pressure, the role of the DSI in these patients has not been studied. Our study sought to explore if the DSI may be similarly used in patients with COVID-19 to identify individuals with an elevated mortality risk.
METHOD(S): This was an IRB approved retrospective cohort study at a large academic hospital in New York City (NYC). Data was extracted from the electronic medical record by a trained analyst. Inclusion criteria were age 18 or older, admitted from the emergency department (ED) to the intensive care unit (ICU) between 01/01/2020 and 06/30/2020 with a positive test for COVID-19. We excluded individuals who were transferred from the floor or an outside hospital to the ICU and those with incomplete data. Our final cohort included 360 patients from NYC. The heart rate and diastolic blood pressure used to calculate the DSI were based on the first recorded vitals upon presentation to the ED. This was done in conjunction with a study at a University (ICESI) hospital in Cali, Colombia, with a combined cohort of 655 patients.
RESULT(S): The 28-day mortality rate for the combined study population was 24.9%. Descriptive statistics demonstrated a DSI of >= 1.6 was correlated with elevated 28 day mortality. Cox regression controlling for age, body mass index, respiratory rate, and systolic blood pressure, demonstrated that a DSI of >= 1.6 had a hazard ratio of 1.98 (p-value < 0.01, 95% CI 1.40-2.81).
CONCLUSION(S): In our study population, the DSI that correlated with an elevated risk of mortality was considerably lower than was seen in patients with septic shock, underscoring the physiologic differences between patients with septic shock and COVID-19. Further analysis of the data will be aimed at revealing the etiology of these differences