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Article ; Online: Severe COVID-19 outcomes in pediatrics

Amit Bahl / Nicholas Mielke / Steven Johnson / Ankita Desai / Lihua Qu

The Lancet Regional Health. Americas, Vol 18, Iss , Pp 100405- (2023)

An observational cohort analysis comparing Alpha, Delta, and Omicron variantsResearch in context

1480

Abstract: Summary: Objective: COVID-19 can rarely lead to severe illness in pediatric patients. The aim of this study was to determine if severe outcomes in pediatric COVID-19 have changed over the course of the pandemic. Methods: This was a multicenter, ... ...

Abstract	Summary: Objective: COVID-19 can rarely lead to severe illness in pediatric patients. The aim of this study was to determine if severe outcomes in pediatric COVID-19 have changed over the course of the pandemic. Methods: This was a multicenter, observational cohort analysis from a large regional healthcare system in metro Detroit using electronic health record data to evaluate emergency visits, hospitalization, and severe COVID-19 disease in pediatric patients. Consecutive pediatric patients presenting to the emergency department with a primary diagnosis of COVID-19 were included. Outcomes data was gathered from three distinct time intervals that coincided with Alpha, Delta, and Omicron variant predominance (Time interval 1 (T1) 1/1/2021–6/30/2021: Alpha, T2 7/1/2021–12/31/2021: Delta, T3 1/1/2022–6/16/2022): Omicron. The primary outcome was severe disease inclusive of composite intensive care unit admission, mechanical ventilation, multisystem inflammatory syndrome in children (MIS-C), myocarditis, or death. Secondary outcomes included severe outcomes considering viral coinfection and vaccination status. Results: Between 1/1/2021 and 6/16/2022, there were 4517 emergency COVID-19 visits, of which 12.5% (566) of children were hospitalized. 24.4% (138), 31.6% (179), and 44.0% (249) of admissions occurred during T1, T2 and T3 respectively. Most patients were male (55.1%) and 59.9% identified as Caucasian. The median age was 5.0 (interquartile range 1.0, 13.0) with infants comprising 22.8% (129), toddlers 25.1% (142), children 23.0% (130), and teenagers 29.2% (165). Over the course of the pandemic, the proportion of infants in hospitalization increased from 16.7% in T1 to 19.6% in T2 to 28.5% in T3 (p < 0.01) while the proportion of teenagers in hospitalization decreased from 39.1% in T1 to 31.3% in T2 to 22.1% in T3 (p < 0.001). Oxygen therapy was required in a minority (29.9%) of cases with supplemental oxygen utilized the least in T3 (16.5%) and most in T2 (30.2%). Composite severe disease decreased ...
Keywords	SARS-CoV-2 ; COVID-19 ; Omicron ; Delta ; Alpha ; Viral co-infection ; Public aspects of medicine ; RA1-1270
Subject code	610
Language	English
Publishing date	2023-02-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The heterogeneous effects of social support on the adoption of Facebook’s vaccine profile frames feature

Nadav Rakocz / Sindhu Ernala / Israel Nir / Udi Weinsberg / Amit Bahl

Humanities & Social Sciences Communications, Vol 10, Iss 1, Pp 1-

2023 Volume 13

Abstract: Abstract Achieving widespread COVID-19 vaccine acceptance is a key step to global recovery from the pandemic, but hesitancy towards vaccination remains a major challenge. Social proof, where a person’s attitude towards vaccination is influenced by their ... ...

Abstract	Abstract Achieving widespread COVID-19 vaccine acceptance is a key step to global recovery from the pandemic, but hesitancy towards vaccination remains a major challenge. Social proof, where a person’s attitude towards vaccination is influenced by their belief in the attitudes of their social network, has been shown to be effective for making in-roads upon hesitancy. However, it is not easy to know the attitudes of one’s network, nor reliably signal one’s own feelings towards COVID-19 vaccines, minimizing the impact of the social influence channel. To address this issue, Facebook launched a feature that enables users to overlay a message indicating that they support vaccination upon their profile picture. To raise awareness of these vaccine profile frames (VPFs), users received a variety of promotional messages from Facebook, a subset of which contained the social context of friends who had already adopted the frame. Leveraging this variation in promotional messaging, we analyzed the adoption pattern of VPFs in the US to determine the most effective strategies to drive VPF usage. We found that adoption is driven by a pattern of complex diffusion, where multiple exposures to the adoption decisions of others increased VPF uptake, and that there is substantial heterogeneity in the adoption response associated with prior vaccine beliefs, whether the promotion had a social component and closeness of the tie included in social promotions. Specifically, we observed resistance to adoption correlated with an aversion to follow authoritative health pages and stronger adoption effects from social promotions containing close friends. We also confirmed this finding of the value of strong ties through a randomized field experiment and heterogeneous treatment effects modeling. In contrast to studies that have shown the importance of less close relationships in vaccine decision-making, we found little effect from awareness of VPF adoption by weak ties. Finally, we detected no significant backfire effect for expressing support ...
Keywords	History of scholarship and learning. The humanities ; AZ20-999 ; Social Sciences ; H
Subject code	300
Language	English
Publishing date	2023-07-01T00:00:00Z
Publisher	Springer Nature
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Vesicant infusates are not associated with ultrasound-guided peripheral intravenous catheter failure

Amit Bahl / Mahmoud Hijazi / Nai-Wei Chen

PLoS ONE, Vol 17, Iss 1, p e

A secondary analysis of existing data.

2022 Volume 0262793

Abstract: Background Intravenous vesicants are commonly infused via peripheral intravenous catheters (PIVC) despite guidelines recommending administration via central route. The impact of these medications on PIVC failure is unclear. We aimed to assess dose- ... ...

Abstract	Background Intravenous vesicants are commonly infused via peripheral intravenous catheters (PIVC) despite guidelines recommending administration via central route. The impact of these medications on PIVC failure is unclear. We aimed to assess dose-related impact of these caustic medications on ultrasound-guided (US) PIVC survivorship. Methods We performed a secondary analysis of a randomized control trial that compared survival of two catheters: a standard long (SL) and an ultra-long (UL) US PIVC. This study involved reviewing and recording all vesicants infusions through the PIVCs. Type and number of vesicants doses were extracted and characterized as one, two or multiple. The most commonly used vesicants were individually categorized for further analysis. The primary outcome was PIVC failure accounting for use and timing of vesicant infusates. Results Between October 2018 and March 2019, 257 subjects were randomized with 131 in the UL group and 126 in the SL group. Vesicants were infused in 96 (37.4%) out of 257 study participants. In multivariable time-dependent extended Cox regression analysis, there was no significant increased risk of failure due to vesicant use [adjusted hazard ratio, aHR 1.71 (95% CI 0.76-1.81) p = 0.477]. The number of vesicant doses was not significantly associated with the increased risk of PIVC failure [(1 vs 0) aHR 1.20 (95% CI 0.71-2.02) p = 0.500], [(2 vs 0) aHR 1.51 (95% CI 0.67-3.43) p = 0.320] and [(≥ 3 vs 0) aHR 0.98 (95% CI 0.50-1.92) p = 0.952]. Conclusion Vesicant usage did not significantly increase the risk of PIVC failure even when multiple doses were needed in this investigation. Ultrasound-guided PIVCs represent a pragmatic option when vesicant therapy is anticipated. Nevertheless, it is notable that overall PIVC failure rates remain high and other safety events related to vesicant use should be considered when clinicians make vascular access decisions for patients.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Boosters reduce in-hospital mortality in patients with COVID-19

Nicholas Mielke / Steven Johnson / Amit Bahl

The Lancet Regional Health. Americas, Vol 8, Iss , Pp 100227- (2022)

An observational cohort analysis

2022

Abstract: Summary: Background: Real-world data on the effectiveness of boosters against COVID-19, especially as new variants continue to emerge, is limited. Our objective was to assess demographic, clinical, and outcome variables of patients requiring ... ...

Abstract	Summary: Background: Real-world data on the effectiveness of boosters against COVID-19, especially as new variants continue to emerge, is limited. Our objective was to assess demographic, clinical, and outcome variables of patients requiring hospitalization for severe SARS-CoV-2 infection comparing fully vaccinated and boosted (FV&B), fully vaccinated (FV), and unvaccinated (UV) patients. Methods: This multicenter observational cohort analysis compared demographic, clinical, and outcome variables in FV&B, FV, and UV adults hospitalized for COVID-19. Partially vaccinated (PV) and individuals still hospitalized beyond the designated follow-up date of February 1, 2022 were excluded. The primary endpoint was in-hospital mortality. Secondary endpoints included characteristics and outcomes in subpopulations of intensive care and geriatric (age >65) patients. Findings: Between August 12th, 2021 and January 20th, 2022, 8232 patient encounters had a primary diagnosis of COVID-19 and required inpatient treatment. Of the 8232 encounters requiring hospitalization, 448 (5.8%) were FV&B, 2257 (29.2%) were FV, and 5023 (65.0%) were UV; 357 PV and 147 still hospitalized were excluded. The median age of FV&B cohort was 73 (IQR 62, 82) compared to 70 (IQR 59, 80) for FV and 59 (IQR 45, 71) for UV (0.001). Most patients were female in both the FB&V and UV groups with 51.1% and 51.8%, respectively, while the FV group had a majority of males (51.3%). The median Elixhauser weighted score was 12 (IQR 3, 22) for FV&B, 10 (IQR 2, 20) for FV, and 9 (IQR 0, 17) for UV groups (p < 0.001). In-hospital mortality was 7.1% in the FV&B, 10.3% in the FV group, and 12.8% in the UV group (p < 0.001). The FV&B group had lower in-hospital mortality than both FV and UV groups (p = 0.045 and p = 0.001, respectively). The FV group had lower in-hospital mortality than the UV group (p = 0.004). Interpretation: Fully vaccinated and boosted patients requiring hospital-level care for breakthrough COVID-19 have lower ...
Keywords	COVID-19 ; SARS-CoV-2 ; Booster dose ; Vaccination ; Severe illness ; Mortality ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2022-04-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments.

Amit Bahl / Steven Johnson / Nicholas Mielke / Patrick Karabon

PLoS ONE, Vol 16, Iss 6, p e

2021 Volume 0253243

Abstract: Objective Peripheral intravenous catheter (PIVC) failure occurs frequently, but the underlying mechanisms of failure are poorly understood. We aim to identify ultrasonographic factors that predict impending PIVC failure prior to clinical exam. Methods We ...

Abstract	Objective Peripheral intravenous catheter (PIVC) failure occurs frequently, but the underlying mechanisms of failure are poorly understood. We aim to identify ultrasonographic factors that predict impending PIVC failure prior to clinical exam. Methods We conducted a single site prospective observational investigation at an academic tertiary care center. Adult emergency department (ED) patients who underwent traditional PIVC placement in the ED and required admission with an anticipated hospital length of stay greater than 48 hours were included. Ongoing daily PIVC assessments included clinical and ultrasonographic evaluations. The primary objective was to identify ultrasonographic PIVC site findings associated with an increased risk of PIVC failure. The secondary outcome was to determine if ultrasonographic indicators of PIVC failure occurred earlier than clinical recognition of PIVC failure. Results In July and August of 2020, 62 PIVCs were enrolled. PIVC failure occurred in 24 (38.71%) participants. Multivariate logistic regression demonstrated that the presence of ultrasonographic subcutaneous edema [AOR 7.37 (1.91, 27.6) p = 0.0030] was associated with an increased likelihood of premature PIVC failure. Overall, 6 (9.67%) patients had subcutaneous edema present on clinical exam, while 35 (56.45%) had subcutaneous edema identified on ultrasound. Among patients with PIVC failure, average time to edema detectable on ultrasound was 46 hours and average time to clinical recognition of failure was 67 hours (P = < 0.0001). Conclusions Presence of subcutaneous edema on ultrasound is a strong predictor of PIVC failure. Subclinical subcutaneous edema occurs early and often in the course of the PIVC lifecycle with a predictive impact on PIVC failure that is inadequately captured on clinical examination of the PIVC site. The early timing of this ultrasonographic finding provides the clinician with key information to better anticipate the patient's vascular access needs. Further research investigating interventions to ...
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A review on the techniques used in prostate brachytherapy

Yanlei Li / Chenguang Yang / Amit Bahl / Raj Persad / Chris Melhuish

Cognitive Computation and Systems, Vol 4, Iss 4, Pp 317-

2022 Volume 328

Abstract: Abstract Prostate brachytherapy is a validated treatment for prostate cancer. During the procedure, the accuracy of needle placement is critical to the treatment’s effectiveness. However, the inserted needle could deflect from the preset trajectory ... ...

Abstract	Abstract Prostate brachytherapy is a validated treatment for prostate cancer. During the procedure, the accuracy of needle placement is critical to the treatment’s effectiveness. However, the inserted needle could deflect from the preset trajectory because of the needle deflection, tissue shifting caused by the interaction between the needle and soft tissue, as well as the effects of pre‐inserted needles. There are significant challenges in needle placement areas, especially in prostate brachytherapy, because multiple needles are required for the effectiveness of radiation. To overcome these limitations, relevant research is carried out in mechanical, computer science, and material science areas. With the development of surgical robotics, researchers are also exploring the possibilities of raising the accuracy of needle placement with surgical‐assisted robotics. This study provides a review over the last 3 decades in each of the component research areas that constitutes a surgical robotics system, including needle steering approaches, needle‐tissue deformation models, path planning algorithms and different automatic level surgical robotics systems used for prostate cancer treatment, especially prostate brachytherapy. Further directions for researchers are also suggested.
Keywords	Computer engineering. Computer hardware ; TK7885-7895 ; Computer applications to medicine. Medical informatics ; R858-859.7
Subject code	629
Language	English
Publishing date	2022-12-01T00:00:00Z
Publisher	Wiley
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Transesophageal echocardiography in the emergency department

Duncan McGuire / Steven Johnson / Nicholas Mielke / Amit Bahl

Journal of the American College of Emergency Physicians Open, Vol 3, Iss 3, Pp n/a-n/a (2022)

A comprehensive guide for acquisition, implementation, and quality assurance

2022

Abstract: Abstract Echocardiography is an essential tool in emergency medicine, yielding valuable information for physicians that directly affects diagnostic and management strategies. Emergency department (ED) transesophageal echocardiography (TEE) is an ... ...

Abstract	Abstract Echocardiography is an essential tool in emergency medicine, yielding valuable information for physicians that directly affects diagnostic and management strategies. Emergency department (ED) transesophageal echocardiography (TEE) is an increasingly common procedure performed in a variety of institutions, allowing for ongoing cardiac imaging during cardiopulmonary resuscitation as well as providing high‐resolution assessment of both cardiac and aortic anatomy. However, despite the numerous benefits of ED TEE, the process of implementing this modality within a department is difficult because of unique process and cost considerations. This paper serves to provide an updated and in‐depth description of these processes to assist with the initiation of such a program, including a detailed discussion of budgetary considerations, physician credentialing, and device use and maintenance protocols.
Keywords	credentialing ; emergency medicine ; quality assurance ; resuscitation ; transesophageal echocardiography ; transthoracic echocardiography ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9
Language	English
Publishing date	2022-06-01T00:00:00Z
Publisher	Wiley
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Single Versus Double Tourniquet Technique for Ultrasound-Guided Venous Catheter Placement

Jacob Price / Jane Xiao / Katie Tausch / Bophal Hang / Amit Bahl

Western Journal of Emergency Medicine, Vol 20, Iss

2019 Volume 5

Abstract: Introduction: Peripheral, ultrasound-guided intravenous (IV) access occurs frequently in the emergency department, but certain populations present unique challenges for successfully completing this procedure. Prior research has demonstrated decreased ... ...

Abstract	Introduction: Peripheral, ultrasound-guided intravenous (IV) access occurs frequently in the emergency department, but certain populations present unique challenges for successfully completing this procedure. Prior research has demonstrated decreased compressibility under double tourniquet technique (DT) compared with single tourniquet (ST). We hypothesized that catheters inserted under DT method would have a higher first-stick success rate compared with those inserted under ST method. Methods: We randomized 100 patients with a history of difficult IV access, as defined by past ultrasound IV, prior emergency visit with two or more attempts required for vascular access, history of IV drug abuse, history of end stage renal disease on hemodialysis or obesity, to ultrasound-guided IV placement under either DT or ST method. We measured the vein characteristics measured under ultrasound, and recorded the number of attempts and location of attempts at vascular access. Results: Of an initial 100 patients enrolled, we analyzed a total of 99 with 48 placed under ST and 51 placed under DT. Attending physicians inserted 41.7% of ST and 41.2% of DT, with non-attending inserters (including residents, nurses, and technicians) inserted the remainder. First-stick success rate was observed at 64.3% in ST and 66.7% in DT (p=0.93). Attendings had an overall higher first-stick success rate (95.1%) compared to non-attending inserters (65.5%) (p=<0.001). The average vein depth measured in ST was 0.73 centimeters (cm) compared with 0.87 cm in DT (p=0.02). Conclusion: DT technique did not produce a measureable increase in first-stick success rate compared to ST, including after adjusting for level of training of inserter. However, a significant difference in average vein depth between the study arms may have limited the reliability of our overall results. Future studies controlling for this variable may be required to more accurately compare these two techniques.
Keywords	Medicine ; R ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9
Language	English
Publishing date	2019-07-01T00:00:00Z
Publisher	eScholarship Publishing, University of California
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Vaccination reduces need for emergency care in breakthrough COVID-19 infections

Amit Bahl / Steven Johnson / Gabriel Maine / Martha Hernandez Garcia / Srinivasa Nimmagadda / Lihua Qu / Nai-Wei Chen

The Lancet Regional Health. Americas, Vol 4, Iss , Pp 100065- (2021)

A multicenter cohort study

2021

Abstract: Background: While recent literature has shown the efficacy of the SARS-CoV-2 vaccine in preventing infection, it's impact on need for emergency care/hospitalization in breakthrough infections remain unclear, particularly in regions with a high rate of ... ...

Abstract	Background: While recent literature has shown the efficacy of the SARS-CoV-2 vaccine in preventing infection, it's impact on need for emergency care/hospitalization in breakthrough infections remain unclear, particularly in regions with a high rate of variant viral strains. We aimed to determine if vaccination reduces hospital visits in breakthrough COVID-19. Methods: This observational cohort analysis compared unvaccinated (UV), partially vaccinated (PV), and fully vaccinated (FV) adult patients with SARS-CoV-2 infection requiring emergency care(EC)/hospitalization within an eight-hospital system in Michigan. Demographic and clinical variables were obtained from the electronic record. Vaccination data was obtained from the Michigan Care Improvement Registry and Centers for Disease Control vaccine tracker. Primary endpoint was rate of emergency care/hospitalization encounters among patients diagnosed with COVID-19. Secondary outcome was severe disease-composite outcome (ICU, mechanical ventilation, or in-hospital death). Findings: Between December 15,2020 and April 30,2021, 11,834 EC encounters were included:10,880 (91.9%) UV, 825 (7%) PV, 129 (1.1%) FV. Average age was 53.0 ± 18.2 and 52.8% were female. Accounting for the SARS-CoV-2 vaccination population groups in Michigan, the ED encounters/hospitalizations rate relevant to COVID-19 was 96% lower in FV versus UV (multiplicative effect:0.04, 95% CI 0.03 to 0.06, p < 0.001) in negative binomial regression. COVID-19 EC visits rate peaked at 22.61, 12.88, and 1.29 visits per 100000 for the UV, PV, and FV groups, respectively. In the propensity-score matching weights analysis, FV had a lower risk of composite disease compared to UV but statistically insignificant (HR 0.84, 95% CI 0.52 to 1.38). Interpretation: The need for emergency care/hospitalization due to breakthrough COVID-19 is an exceedingly rare event in fully vaccinated patients. As vaccination has increased regionally, EC visits amongst fully vaccinated individuals have remained low and occur much less frequently than unvaccinated individuals. If hospital-based treatment is required, elderly patients with significant comorbidities are at high-risk for severe outcomes regardless of vaccination status.
Keywords	COVID-19 ; SARS-CoV-2 ; vaccination ; coronavirus ; variants ; mortality ; Public aspects of medicine ; RA1-1270
Subject code	610
Language	English
Publishing date	2021-12-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Using the AR-V7 biomarker to determine treatment in metastatic castrate resistant prostate cancer, a feasibility randomised control trial, conclusions from the VARIANT trial [version 2; peer review

NIHR Open Research, Vol

2 approved]

2023 Volume 2

Abstract: Background: Prostate cancer is the most commonly diagnosed malignancy in the UK. Castrate resistant prostate cancer (CRPC) can be difficult to manage with response to next generation hormonal treatment variable. AR-V7 is a protein biomarker that can be ... ...

Abstract	Background: Prostate cancer is the most commonly diagnosed malignancy in the UK. Castrate resistant prostate cancer (CRPC) can be difficult to manage with response to next generation hormonal treatment variable. AR-V7 is a protein biomarker that can be used to predict response to treatment and potentially better inform management in these patients. Our aim was to establish the feasibility of conducting a definitive randomised controlled trial comparing the clinical utility of AR-V7 biomarker assay in personalising treatments for patients with metastatic CRPC within the United Kingdom (UK) National Health Service (NHS). Due to a number of issues the trial was not completed successfully, we aim to discuss and share lessons learned herein. Methods: We conducted a randomised, open, feasibility trial, which aimed to recruit 70 adult men with metastatic CRPC within three secondary care NHS trusts in the UK to be run over an 18-month period. Participants were randomised to personalised treatment based on AR-V7 status (intervention) or standard care (control). The primary outcome was feasibility, which included: recruitment rate, retention and compliance. Additionally, a baseline prevalence of AR-V7 expression was to be estimated. Results: Fourteen participants were screened and 12 randomised with six into each arm over a nine-month period. Reliability issues with the AR-V7 assay meant prevalence was not estimated. Due to limited recruitment the study did not complete to target. Conclusions: Whilst the trial did not complete to target, we have ascertained that men with advanced cancer are willing to take part in trials utilising biomarker guided treatment. A number of issues were identified that serve as important learning points in future clinical trials.
Keywords	prostatic neoplasms ; castration-resistant ; biomarkers ; feasibility studies ; male ; eng ; Medicine ; R
Subject code	610
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	F1000 Research Ltd
Document type	Article ; Online
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