This version of BIP! Finder aims to ease the exploration of COVID-19-related literature by enabling ranking articles based on various impact metrics.
Last Update: 18 - 01 - 2023 (628506 entries)
Popularity: Citation-based measure reflecting the current impact.
Influence: Citation-based measure reflecting the total impact.
Reader Attention: The current number of Mendeley readers.
Social Media Attention: The number of recent tweets related to this article.
*More details on these impact measures can be found here.
Exceptional score (in top 0.01%).
Substantial score (in top 1%).
Average score (in bottom 99%).
Score not available.
CORD-19 dataset(1) (list of papers)
LitCovid hub(2) (list of papers)
PMC & PubMed (citations)
Mendeley (number of readers)
COVID-19-TweetIDs(3) (tweets)
| Title | Venue | Year | Impact | Source | |
|---|---|---|---|---|---|
| 3301 | Digitalisierung: Welche Rolle spielen CIOs heute und in Zukunft? Many CIOs (Chief Information Officers) in companies did an excellent job during the pandemic. In the post-pandemic period, it is important to redefine the position of the CIO. Five CIOs, Hanna Hennig of Siemens AG, Andreas Maier of AXA Switzerland, Michael Müller-Wünsch of OTTO, Rolf Olmesdahl, formerly of Raiffeisen Switzerland, Ursula Soritsch-Renier of Saint-Gobain Paris, and an executive search specialist, Patrick Naef, Boyden AG, were asked how they see the future of the CIO. All six executives who took part in the dialog agree that CIOs will still exist in 2030 and that, on the one hand, they should increasingly be drivers of the digital transformation in their company and, on the other hand, they still bear responsibility for the functioning of the digital infrastructure. | N/A | 2022 | CORD-19 | |
| 3302 | Update zu: Neurologische Manifestationen bei COVID-19: Gekürzte aktualisierte Leitlinie der Deutschen Gesellschaft für Neurologie | N/A | 2022 | CORD-19 | |
| 3303 | Chief Digital Officer (CDO): Literaturanalyse und Handlungsempfehlungen für die Praxis In order to remain competitive in the age of digitalization, and to facilitate digital transformation in organizations, companies are increasingly creating the position of the Chief Digital Officer (CDO). To support companies in making decisions about the establishment and alignment of the CDO position, we have systematically analyzed the academic literature within the following areas: (1) reasons to hire a CDO, (2) CDO tasks, (3) CDO requirements, and (4) the CDO position vs. the Chief Information Officer (CIO) position. In the academic literature, the strategic management of changes is cited most frequently as the reason for hiring a CDO. In line with this, the digitalization and the implementation of digital transformation was the most frequently mentioned CDO task, and strategic and business-oriented thinking was the most frequently mentioned CDO requirement. Further, the CDO is predominantly seen as a strategist and the CIO primarily as the person responsible for the IT infrastructure. Based on the results of the literature analysis, we give recommendations for decision-makers in practice who want to get an overview of the possible establishment and alignment of the CDO position. | N/A | 2022 | CORD-19 | |
| 3304 | COVID-19 cases and their outcome among patients with uncommon co-existing illnesses: A lesson from Northern India INTRODUCTION: Newer coexisting conditions should be identified in order to modify newer risk factors. Aim was to identify patients with non-classical or less common coexisting conditions in patients infected of COVID 19. METHOD: Single centred study from June 2020 to May 2021 at a tertiary centre in North India. A preformed questionnaire was used to record clinical and laboratory parameters and to identify cases which are in addition to CDC list and Indian data. RESULTS: 0.67% (46) cases out of 6832 patients were identified to have non-classical coexisting illness. It was divided into 2 groups-infections A (60.1%) and non-infections B (39.9%). Group A included-tuberculosis- pulmonary (14.3%) & extra pulmonary (32.9%), bacterial (25.0%) viral infections [dengue, hepatitis B & C] (14.3%), HIV disease (10.7%) and malaria (3.6%). Group B included- organ transplant (27.8%), autoimmune [myasthenia gravis, polymyositis, psoriasis] (22.6%), haematologic [Haemophilia, ITP, Aplastic anaemia, APML, CML] (27.8%), uncommon malignancies [disseminated sacral chordoma and GTN] (11.1%) and snakebite (11.1%). Serum Procalcitonin was not helpful for diagnosis of bacterial infection in COVID-19 disease. Group A had significantly longer duration of illness, hepatitis and elevated CRP. The mortality in group A & B were 32.1% and 43.8% respectively. Death in non-severe COVID cases was in tetanus and snakebite. 30.7% death among tuberculosis patients. More than 70% of deaths were attributable to COVID 19 in both the groups. CONCLUSION: In Indian settings, comorbidities like tuberculosis and bacterial infections can precipitate severe COVID 19 unlike other parts of the world where tuberculosis is relatively uncommon. | Clin Epidemiol Glob Health | 2022 | CORD-19 | |
| 3305 | CT severity score: an imaging biomarker to estimate the severity of COVID-19 pneumonia in vaccinated and non-vaccinated population BACKGROUND: In India, two vaccines received emergent use authorization, namely Covishield (a brand of the Oxford—Astra Zeneca vaccine manufactured by the Serum institute of India) and Covaxin (developed by Bharat Biotech) against COVID-19 disease. Chest CT is an objective way to assess the extent of pulmonary parenchymal involvement. This study aims to estimate the disease severity and outcome due to COVID-19 among vaccinated and non-vaccinated symptomatic patients and compare the same in Covishield versus Covaxin recipients using CT severity score. RESULTS: A total of 306 patients were retrospectively evaluated. The mean age was 62.56 ± 8.9 years, and males [n-208 (67.97%)] were commonly affected. Of 306 patients, 143 were non-vaccinated (47%), 124 were partially vaccinated (40%), and 39 were completely vaccinated (13%). CT severity scores were reduced in both Covishield and Covaxin recipients in comparison with the non-vaccinated group [χ(2) (2) = 16.32, p < 0.001]. There is a reduction in LOS among the vaccinated group, predominantly among the Covishield recipients. CONCLUSION: Vaccination confers protection from severe SARS-CoV2 infection and is associated with an overall reduction in mortality. | N/A | 2022 | CORD-19 | |
| 3306 | Changes in International Lawmaking: Actors, Processes, Impact. Conference Report of the 16th Annual Meeting of the European Society of International Law (ESIL), held in Stockholm from 9 to 11 September 2021 | N/A | 2022 | CORD-19 | |
| 3307 | Intracranial manifestations of rhinocerebral mucormycosis: a pictorial essay Rhinocerebral mucormycosis has emerged as a common coinfection in coronavirus disease 2019 (COVID-19) patients during the convalescence period. Frequent spread of disease from sinonasal mucosa to bone, neck spaces, orbit, and brain occurs along the perivascular/perineural routes or through direct invasion. Brain involvement represents severe manifestation and is often associated with poor functional outcomes and high mortality rates. Magnetic resonance imaging (MRI) is the modality of choice for the intracranial assessment of disease severity in mucormycosis. Early and accurate identification of intracranial extension is imperative to improve survival rates. With this pictorial essay, we aim to familiarize the readers with the cross-sectional imaging features of intracranial complications of mucormycosis. The radiological details in this essay should serve as a broad checklist for radiologists and clinicians while dealing with this fulminant infection. | N/A | 2022 | CORD-19 | |
| 3308 | Review of Merging the Instructional Design Process with Learner-Centered Theory: The Holistic 4D Model by Charles M. Reigeluth and Yunjo An | TechTrends | 2022 | CORD-19 | |
| 3309 | Does China's green economic recovery generate a spatial convergence trend: an explanation using agglomeration effects and fiscal instruments China’s urbanization process has entered a period of rapid development, and cities have become key to driving regional economic development. This paper uses data from 286 cities in China in the period 2005–2018 to construct an urban economic growth quality index system and examine the influence of spatial factors on the convergence trend of China’s urban economic growth quality. It is found that there is a β absolute convergence trend of economic growth quality in Chinese cities across the whole country. After controlling for the initial conditions of individual economies, spatial factors strengthen the spatial convergence trend of urban economic growth quality and significantly increase the corresponding convergence rate. Among the areas studied, the western region has the fastest convergence rate, followed by the central and eastern regions, and the convergence rates of both the central and western regions are higher than the national average. Agglomeration economies and fiscal policy tools are important for the promotion of the urban economic growth quality. The agglomeration of productive service industries significantly improves the spatial convergence rate of urban economic growth quality. This effect is mainly due to the spatial spillover of industrial agglomeration. The expansion of government fiscal expenditure also contributes to the spatial convergence trend of urban economic growth quality. Local economic growth quality is also affected by government fiscal expenditure in neighboring cities. | N/A | 2022 | CORD-19 | |
| 3310 | Freitagnachts unterwegs im ÖPNV: Muster und Motive anhand des Fallbeispiels Karlsruhe Urban centers play a central role in night-time leisure activities in the city. They combine the offerings of the night-time economies, such as bars, restaurants or clubs, which are often concentrated in separate hotspots. To get to these hotspots, routes have to be travelled and means of transport have to be used. In this context, spatial mobility at night, especially in the field of local public transport, differs in many respects from that during the day. Against this background, the article analyzes the nocturnal mobility processes that take place for leisure purposes on public transport, using Karlsruhe as an example. The basis of the analysis is a data set that was created as part of a student workshop during a nightly survey of the trains of the Karlsruhe public transport system. The results show, among other things, that stops located in the immediate vicinity of night-time economies are used more frequently than average by public transport passengers during the night. Despite some points of criticism, the public transport service at night is largely perceived positively. Nevertheless, the article identifies fundamental potential for improvement and presents suitable scope for action and optimization measures. Finally, recommendations for further research approaches to the topic of night-time mobility are given. | N/A | 2022 | CORD-19 | |
| 3311 | A discussion on the implementation of the Polar Code and the STCW Convention's training requirements for ice navigation in polar waters In 2017, the International Maritime Organization (IMO) implemented the International Code for Ships Operating in Polar Waters (Polar Code), with mandatory requirements covering the Arctic and Antarctic Oceans. In this conjunction, the International Convention on Standards of Training, Certification and Watchkeeping (STCW) were amended in 2018. New training requirements were made applicable for dedicated personnel in charge of a navigational watch on ships with a Polar Ship Certificate (PSC) operating in polar waters. In association with the new training requirements amending the STCW Convention, the IMO, and Transport Canada (flag state authority) signed a Memorandum of Understanding in 2017, for Canada to develop and deliver four regional capacity-building “train-the-trainer” workshops. The objectives of these events were to assist maritime education and training (MET) institutes in enhancing the skills and competence of instructors, to develop competence-based STCW training programs, for dedicated personnel on ships operating in polar waters. This paper examines the first workshop conducted in Canada (2019), to understand the mechanisms in the interaction taking place between the IMO and the Canadian workshop developers and instructors, using the System Theoretic Accident Model and Processes (STAMP). Individual expert interviews are performed, with the main contributors directly involved in developing and conducting the workshop, to evaluate the event’s contribution to improving and specifying the STCW Convention’s training requirements, as referenced in the Polar Code, for seafarers operating in polar waters. | N/A | 2022 | CORD-19 | |
| 3312 | Research on Optimization of Supermarket Chain Distribution Routes Under O2O Model Dealing with the store distribution problems in transformation and upgrading of supermarket chains under Online-to-Offline (O2O) e-commerce model and considering the factors that affect the distribution cost and customer satisfaction, such as distribution distance, number of distribution vehicles, and delivery time, an O2O store distribution optimization model has been constructed with the purpose of minimizing total distribution cost. Moreover, a two-stage heuristic algorithm for ordering nearest distribution and mileage saving planning has been designed. The applicability and effectiveness of the model and method have been verified by enterprise case data collected. The results have shown that the total cost of distribution is obviously reduced compared with the accounting results of related models, which is suitable for supermarket chains or single-store retail enterprises with low probability of order splitting and distribution due to the shortage of certain products. | N/A | 2022 | CORD-19 | |
| 3313 | Sensitivity Enhancement of Dual Gate FET Based Biosensor Using Modulated Dielectric for Covid Detection This paper presents a dual gate dielectric modulated FET (DGDMFET) biosensor with enhanced sensitivity for covid detection. In earlier literature, the biosensors are operated using the surface interaction with the virus biomolecules that are reflected through a channel or gate. The downside of these types of sensors has limited sensitivity. In this paper, we have considered that the change in the dielectric constant due to virus proteins results in a significant shift in the threshold voltage of FET. Enhancement of sensitivity is done by using the novel dual metal gate arrangement with different work functions (higher at the source end and lower at the drain end) and the chromic oxide (Cr(2)O(3)) layer, which is carved out vertically to form nanogap. At the same time, interface charge density is maintained nearly equal to 1.0 × 10(11) cm(−2) at the Si-SiO(2) layer. To demonstrate the proposed biosensor, electrical parameters (electron concentration, surface potential, energy band distribution, and electric field) and the absolute percentage sensitivity of threshold voltage, subthreshold slope, ON current, and transconductance are evaluated and compared with related literature. The ATLAS device simulator is used for the simulation of the proposed device. | N/A | 2022 | CORD-19 | |
| 3314 | A Proposed Framework for Evaluating the Academic-failure Prediction in Distance Learning Academic failure is a crucial problem that affects not only students but also institutions and countries. Lack of success in the educational process can lead to health and social disorders and economic losses. Consequently, predicting in advance the occurrence of this event is a good prevention and mitigation strategy. This work proposes a framework to evaluate machine learning-based predictive models of academic failure, to facilitate early pedagogical interventions. We took a Brazilian undergraduate course in the distance learning modality as a case study. We run seven classification models on normalized datasets, which comprised grades for three weeks of classes for a total of six weeks. Since it is an imbalanced-data context, adopting a single metric to identify the best predictive model of student failure would not be efficient. Therefore, the proposed framework considers 11 metrics generated by the classifiers run and the application of exclusion and ordering criteria to produce a list of best predictors. Finally, we discussed and presented some possible applications for minimizing the students’ failure. | N/A | 2022 | CORD-19 | |
| 3315 | Ritual Revision During a Crisis: The Case of Indian Religious Rituals During the COVID-19 Pandemic Rituals, particularly religious rituals, may play a significant role in times of crises. Often, these rituals undergo revision to adapt to the changing needs of the time. This article investigates recent unofficially revised Hindu religious rituals as performed during the COVID-19 pandemic. The multifarious creative interplay between Hindu tradition and change is illustrated through four cases: the religious festival of Durga Puja, the devotional songs or bhajans, the ritual of lighting lamps or diyas, and the fire rituals or havans. The authors offer a systematic discourse analysis of online news articles and YouTube posts that illuminate several aspects of ritual revision during unsettled times. They focus on the changes that were made to ritual elements: who controlled these alterations, how these modifications were made, and what potential benefits these revisions offered to the community of ritual participants. The authors highlight public policy implications regarding the involvement of diverse social actors, the creation of faith in science, the creation of feelings of unity and agency, and the amplification of local ritual modifications on a national scale. | J Public Policy Mark | 2022 | CORD-19 | |
| 3316 | The gender and sexual politics of the COVID-19 pandemic | Eur J Womens Stud | 2022 | CORD-19 | |
| 3317 | Extremely urgent public procurement under Directive 2014/24/EU and the COVID-19 pandemic The COVID-19 pandemic swept throughout the European Union swiftly and led to significant changes in how we live and operate. Some of those changes occurred in public procurement as well, with Member States struggling to react to the dissemination of the virus. The purpose of this paper is to assess what scope the EU's public procurement legal framework provides to deal with a crisis, and how the rules should be interpreted. This paper will show how the EU public procurement legal framework deals with extreme urgency situations and how it has been intentionally designed to allow Member States flexibility within very clearly defined boundaries. This means that the path to award contracts without competition on the grounds of extreme urgency is narrow due to Article 32(2)(c) of Directive 2014/24/EU() and the case law from the CJEU. The narrowness of this path is due to the exceptional nature of procedure and the obligation for the contracting authority to discharge the tight grounds for use in full for every contract. Therefore, this paper concludes that the view exposed by the European Commission on its guidance from April 2020 that the pandemic is a single unforeseeable event amounts to an incorrect reading on how the grounds for the use of Article 32(2)(c) operate. If such interpretation was already too broad in April 2020, it certainly is no longer in line with the transition from an unfolding crisis into a new and more permanent equilibrium. In the context of COVID-19, particularly the need for the crisis to be unforeseeable and the extreme urgency not being attributable to the contracting authority raise significant difficulties for some contracting authorities to discharge the grounds for use of the negotiated procedure without prior notice. This is particularly the case in those situations where governments centralized pandemic-related procurement. As such, the paper concludes that existing substantive rules for extremely urgent procurement are adequate and, albeit sufficient to respond to crisis situations, that does not entail that the wholesale use of the negotiated procedure without prior notice is necessarily legal. | Maastrich J Eur Comp Law | 2022 | CORD-19 | |
| 3318 | Conjunctions of resilience and the Covid-19 crisis of the creative cultural industries This article compares the conjunctions of emergency resilience and ecological resilience that underpin the creative cultural industry (CCI) crisis. It first introduces three characteristics that socially construct the CCI crisis and its hegemonic practice of emergency resilience (time, disaster discourse, and the adaptation of aesthetic digitalization) and exposes multiple discourses – from the technologies of cultural statistics to corporate financial modelling – that construct an ideology of ‘resilience-as-deficit’. In contrast to this approach, the article develops three characteristics of ecological resilience: a focus on transition and the long term; resilience as a decentred strategy and networked resource; and aesthetic digitization as a radical praxis of adaptability. Examining arts impact and cultural policy reports, drawing on ecological, feminist and cultural resilience studies, and analysing a digital cultural event in Asia (the Singapore LGBT cultural festival, Pink Dot), the article argues that ecological resilience offers new capacities towards a cultural ecology that can nurture fair work, artistic innovation, economic growth and cultural vitality. | N/A | 2022 | CORD-19 | |
| 3319 | How are tourism businesses adapting to COVID-19? Perspectives from the fright tourism industry The COVID-19 pandemic has seriously impacted the global tourism industry, effecting the livelihoods of millions of tourism workers and disrupting host communities. Current research in tourism management has focused on understanding the economic, social and political impacts of the pandemic. This professional perspective aims to examine operational adaptations that businesses in the fright tourism industry have adopted under the COVID-19 pandemic circumstances. The study collated industry association press releases, undertaking content analysis to examine the changes businesses employed to adapt during the pandemic. Findings suggest that businesses made a variety of operational changes, such as changing queueing, diversification of props and changes to make-up hygiene, allowing these businesses to survive pandemic imperatives. | N/A | 2022 | CORD-19 | |
| 3320 | "Shoot from the Hip": What Patients with Cancer Want from Communication About Serious Illness During COVID-19 (S526) Outcomes 1. Describe what patients with cancer and caregivers value in communication about serious illness 2. Examine strategies that model these values Original Research Background When asked to share recommendations for providers and health systems to foster high-quality care during COVID-19, patients with cancer and their caregivers recommended providers to “communicate proactively and effectively” about serious illness. Research Objective In this secondary analysis of participant responses, we aimed to identify patient and caregiver perspectives on what it means to “communicate proactively and effectively” about serious illness. Methods Content analysis of communication-related output from 15 semistructured interviews of diverse patients with cancer and caregivers of patients with serious illness. Results Theme 1: Transparency: Clinicians share the medical rationale for recommendations: “If what's explained to me is that my chance of recovery … is minimal, and I'm just going to increase my suffering, well, then that feels like a chance for acceptance.” Theme 2: Proactivity: Clinicians facilitate conversations about care preferences in advance: “Right now, you guys have this incredible opportunity to have these conversations. To enable—you know, oncologists to have these conversations with their patients while they're as an outpatient, before they get COVID?” Theme 3: Coordination: Clinicians integrate with the interdisciplinary palliative care team to communicate serious news: “I would ask that [what] be done a little bit better is the integration of the social worker with the doctor, especially in the palliative and hospice care. We know that not every doctor has got a good bedside manner… it's hard to tell someone you're going to die.” Theme 4: Respect for autonomy: Patients and caregivers feel empowered by clinicians to make informed decisions: “You're still in control of your decision-making, given the parameters, even though you're not in control of the parameters.” Conclusion Patients with serious illness and caregivers of patients with serious illness value transparent, proactive, and coordinated communication that respects their autonomy. Implications for Research, Policy, or Practice Efforts to make serious illness communication more patient-centered during COVID-19 will target these areas that align with established patient-centered communication theories. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3321 | Goals of Care Rapid Response Team at a Comprehensive Cancer Center: Feasibility and Preliminary Outcomes (S537) Outcomes 1. Describe an approach to supporting goal-concordant care for critically ill hospitalized patients with cancer 2. Identify areas for improvement in the Goals of Care Rapid Response Team process 3. Discuss potential implications for use in other settings Original Research Background The COVID-19 pandemic placed the issue of resource utilization front and center. Our comprehensive cancer center developed a Goals of Care Rapid Response Team (GOCRRT) to optimize resource utilization with goal-concordant patient care. Research Objectives 1. Evaluate feasibility of GOCRRT by number of consultations that occurred for referred patients. 2. Describe adherence to GOCRRT processes: core team member participation (clinical ethics, medical oncology, supportive care, and social work) and advance care planning (ACP) template use for easily retrievable documentation. 3. Explore preliminary efficacy of GOCRRT consultations in limiting goal-concordant care escalation (change of resuscitation status to DNR, location change from ICU to regular nursing unit, or withdrawal of life-sustaining treatment). Methods We conducted a retrospective chart review of patients referred to GOCRRT from 3/23/2020 to 9/30/2020. Analysis was descriptive. Categorical variables were compared with Fisher's exact or chi-square tests and continuous variables with Mann-Whitney U tests. Results Eighty-nine patients were referred. 76 (85%) underwent a total of 95 consultations. Mean (SD) patient age was 60 (14) years, 54% male, 19% Hispanic, 48% White, 72% married, and 66% of Christian faith traditions. There were slightly more hematologic malignancies than solid (53% vs 47%). The majority (77%) had metastatic disease or relapsed leukemia. 7% had confirmed COVID-19 at referral. 69% expired during the index hospitalization. There was no statistically significant difference in demographic or clinical characteristics between groups (no consultation, 1 consultation, >1 consultation). All core team members were present at 64% of consultations. Consultations were documented in ACP templates in 33%. Care de-escalation occurred in 45% of patients. Conclusion GOCRRT consultations are feasible and associated with care de-escalation. Adherence to core team participation was good, but documentation in ACP templates was uncommon. Implications for Research, Policy, or Practice Research to confirm efficacy and components critical to success and to evaluate outcomes in different patient populations and care settings is needed. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3322 | Utilization of Palliative Care for Patients with Acute Kidney Injury and COVID-19 (S541) Outcomes 1. Understand the historical use of palliative care for patients with acute kidney injury (AKI) 2. Describe the use of palliative care for patients with AKI and COVID-19 during the surge at our institution 3. Describe the associations of palliative care with subsequent health care utilization such as hospice use, ICU time, and mechanical ventilation Original Research Background Acute kidney injury (AKI) is a common morbidity seen in patients with COVID-19 and is associated with high mortality. Palliative care is valuable for these patients yet is historically underused in AKI. Research Objectives To describe the use of palliative care and subsequent health care utilization by COVID-19 patients with AKI. Methods A retrospective analysis of NYU's electronic health data of COVID-19 hospitalizations between March 2, 2020 and August 25, 2020. AKI was defined by the AKI Network creatinine criteria. Regression models examined characteristics associated with a receiving palliative care and discharge to hospice versus death in the hospital. Results Patientswith COVID-19 and AKI were more likely than those without AKI to receive palliative care (42% vs 7%, p < 0.001); however, consults came significantly later (10 days from admission vs 5 days, p < 0.001). 66% of patients initiated on renal replacement therapy (RRT) received palliative care versus 37% (p < 0.001) of those with AKI not on RRT, also later in timing (12 days from admission vs 9 days, p = 0.002). Patients with AKI had a significantly longer stay, more ICU admissions, use of mechanical ventilation, discharges to hospice (6% vs 3%), and changes in code status (34% vs 7%, p < 0.001) than those without AKI. Among those who received palliative care, AKI both without RRT (adjusted odds ratio [aOR] 0.51, 95% confidence interval [CI] 0.27-0.95) and with RRT (aOR 0.18, 95% CI 0.04-0.67) was associated with a lower likelihood of discharge to hospice versus hospital death compared to those without AKI. Conclusion Palliative care was used more for patients with AKI and COVID-19 than historically reported, yet this consultation came later in the hospital course and did not avoid invasive interventions despite high mortality. Implications for Research, Policy, or Practice These data can lead to further exploration of earlier timing of palliative care consultation in AKI. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3323 | We Are Not Heroes; Elevating the Discourse of Burnout in Hospice and Palliative Care Nurses (HPCNs) in the Pre/Post COVID Era: A Scoping Review (S504) Outcomes 1. Describe results from a scoping review related to personal factors, organizational and workplace factors, and nursing professional development factors related to hospice and palliative care nurses 2. Recognize characteristics of hospice and palliative care nurses (HPCNs) that are associated with burnout and strategies to mitigate burnout Background and Objective Burnout among HPCNs has been rising throughout the COVID-19 pandemic and threatens patient safety and quality of care. The extant literature provides insight into burnout within the interdisciplinary hospice and palliative care team, but little attention has been given among HPCNs specifically. We conducted a scoping review to examine burnout among HPCNs and unify disparate findings. Study Identification Using the Arksey and O'Malley framework, we systematically searched 8 major databases from 2015 to 2020. Studies were included if they focused on HPCN experiences of burnout, were published in English within the last 5 years with the exception of seminal works, and were discoverable in electronic databases. Exclusion factors included articles that were not focused solely on hospice and palliative nursing, specifically focused on burnout (ie, depression, compassion fatigue, workplace environment), or research articles. Data Extraction and Synthesis Two authors extracted data from the full-text inclusion studies. Results were presented in tabular summary and descriptive summary of quantitative findings. Results Among 1,893 studies, 8 met inclusion criteria. All studies were quantitative, classified as level IV within the rating system for hierarchy of evidence for literature, and spanned across 6 countries. HPCNs working across settings such as inpatient, outpatient, community, and inpatient hospice were represented. Results of studies were coalesced into 3 overarching categories: personal factors, organizational or workplace factors, and nursing professional development factors. Each of these categories was then divided into three cross-cutting subcategories: contributory and noncontributory factors, mitigating factors, and workplace issues. Conclusions and Implications for Practice, Policy, and Research Burnout among HPCNs may not be entirely preventable, but the recognition of contributory and mitigating factors should be taken into consideration by professional nurses and organizations. Additional research is needed to test workplace interventions suggested in the literature, including whether resilience or self-care measures affect burnout in HPCNs. Qualitative research is needed to capture HPCN experiences of burnout, especially in a post-COVID-19 era. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3324 | Advance Care Planning for Emergency Department Patients with COVID-19 Infection: An Assessment of a Physician Training Program (QI411) Outcomes 1. Describe the components of an educational toolkit to improve advance care planning in the emergency department for patients with COVID-19 2. Appraise the effectiveness of an educational toolkit to improve advance care planning in the emergency department for patients with COVID-19 Background The sudden emergence of coronavirus disease 2019 (COVID-19) heightened the importance of advance care planning (ACP) conversations, particularly in the emergency department (ED). The objective of this quality improvement project was to determine the effect of an educational training program (“toolkit”) for emergency providers on ACP conversations in the ED during the COVID-19 pandemic. Aim Statement We sought to examine the efficacy of an emergency provider–facing educational intervention, led by palliative care physicians, on the initiation of ED-based ACP for patients with COVID-19. Methods This was an evaluation of a quality improvement project at an academic ED using observational pre-/post-interventional data. Palliative care physicians delivered a 60-minute ACP educational intervention for emergency medicine providers in conjunction with release of reference documents as part of an educational toolkit. Initial training occurred on April 1, 2020. Measured outcomes for each patient included identification of a healthcare decision maker (HCDM), an order for a code status, or a documented goals-of-care (GOC) conversation. Results In total, 143 charts of patients with confirmed COVID-19 presenting for ED care between March 26 and May 25, 2020 were reviewed. There was exceptional representation in gender, race, and ethnicity, with 58% of participants being female, 29% Black, and 49% Hispanic/Latino. There was a 25.4% (95% CI, 7.0-43.9) increase in ED-based ACP, as measured by documentation of at least an HCDM, code status, or GOC conversation. Even after adjustment for patient demographics, a trend toward increased ACP activity was observed (OR = 2.71, 95% CI, 0.93-8.64). Conclusions and Implications In response to a pandemic threat, we found that a rapid and simple provider-facing educational toolkit was associated with increased ED-based ACP activities for patients with COVID-19. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3325 | Health Professionals' Perceptions of the Contributions of Palliative Care Consultation for Patients with COVID-19 (S503) Outcomes 1. Discuss health professionals’ perceptions of the contributions of palliative care consultation in COVID-19 inpatient care 2. Recognize the effect of palliative care consultation on health professionals’ self-reported psychological distress Original Research Background Palliative care (PC) programs worldwide became immediately involved in caring for patients with COVID-19 together with other health professionals. Research Objectives The study aimed to determine health professionals’ perceptions of the contributions and helpfulness of PC consultation for COVID-19 care and describe its effect on their own psychological distress. Methods This was a survey-based cross-sectional study of physicians, nurses, advance practice providers, and case managers at two acute care hospitals in a large hospital system in the midwestern United States. Eligible participants completed a 17-item questionnaire on demographic and work-related information, contributions and helpfulness of PC consultation, self-reported psychological distress, and likelihood of working with PC in the future. Results Of 427 health professionals invited to participate, 76 responded (18%). Among 64 eligible respondents, 72% were female, 56% were under the age 40, 40.6% were nurses, 28.1% were physicians, and 66% worked in the intensive care unit. The PC team was perceived as helpful in managing pain and other symptoms, coordinating care between providers, discussing end-of-life preferences, communicating with patients and families, and supporting the care team. Median self-reported psychological distress was 7 (range, 2-10). Twenty-five (39%) participants agreed that PC eased distress by communicating with patients, families and other professionals, providing guidance in difficult conversations, and offering companionship. Among respondents, 84% would probably work with PC in the future. Conclusion During the COVID-19 pandemic, health professionals perceived working with the PC team as helpful in caring for patients and families and in easing their own psychological distress. Implications for Research, Policy, or Practice During the COVID-19 pandemic, health professionals perceived working with the PC team as helpful in caring for patients and families and in easing their own psychological distress. As the pandemic persists and professionals from various fields continue to care for patients, PC appears to be a valuable resource that they can call on. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3326 | Prevalence, Predictors and Outcomes of Documented DNR and/or DNI Orders in COVID-19 Patients (S522) Outcomes 1. Understand the prevalence, predictors, and outcomes associated with DNR and DNI orders for hospitalized patients with COVID-19 throughout the pandemic 2. Understand the reasons for differences in code status order utilization for hospitalized patients with COVID-19 throughout the pandemic Original Research Background The COVID-19 pandemic created complex challenges regarding timing and appropriateness of do not resuscitate (DNR) and do not intubate (DNI) orders. Research Objectives This study sought to determine the prevalence, predictors, timing, and outcomes associated with having a documented DNR or DNI order for hospitalized patients with COVID-19. Methods A retrospective multisite chart review of hospitalized patients with COVID-19 was performed to determine characteristics, medical treatments received, and outcomes associated with having a documented DNR or DNI order. Patients were divided into two cohorts (early and late) by timing of hospitalization during the pandemic. Results Among 1,358 hospitalized patients with COVID-19, 19% (n = 259) had a documented DNR or DNI order. In multivariate analysis, age (older) (p < .01, OR 1.13), race (White) (p = .01, OR 0.55), and hospitalization during the early half of the pandemic (p = .02, OR 1.8) were associated with having a DNR or DNI order. Palliative care consultation occurred more often in the early cohort (p < .01). Medical treatments, including ICU (p = .31) and level of ventilator support (p = .32) did not differ between cohorts. Hospital mortality was similar between the early and late cohorts (p = .27); however, among hospital decedents median hospital day from DNR or DNI order to death differed between cohorts (p < .01) (6 days from order to death in early vs 2 days in the late cohort). Conclusion More frequent use of DNR orders and orders written farther from death in decedents characterized the early pandemic phase. White patients were more likely to have DNR or DNI orders, consistent with prior research. Implications for Research, Policy, or Practice Uncertainty in prognosis may have played a role in the frequency and timing of DNR and DNI orders early in the pandemic. Additional factors, such as fear of resource shortage and transmission of COVID-19 to healthcare workers, may have also played a role. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3327 | COVID-19 and Advance Care Planning: A Unique Opportunity (QI429) Outcomes 1. Apply process for completing advance care planning 2. Evaluate process for efficacy of document completion Background Advance care planning (ACP) is a process to document patient preferences for future healthcare. Conversations between healthcare providers, patients, and loved ones are needed to reflect a patient's values, goals, and choices for life-sustaining treatments (LSTs). The COVID-19 pandemic highlighted the critical importance of these discussions and the need for improved patient engagement. Aim Statement To improve ACP documentation for patients at high risk for COVID-19 complications and death. Methods As COVID-19 surged, the VA Northern California Health Care System Hospice and Palliative Care Section (HPCS)partnered with patient aligned care teams to expand outreach to high-risk patients needing LST documentation. High risk was defined as age >80, COPD or asthma, or Care Assessment Need Score >80 (which models risk of hospitalization or death within 1 year). An experienced HPCS nurse practitioner contacted these identified patients to provide COVID-19 education, conduct a high-quality goals-of-care conversation, and complete LST documentation and other ACP needs. A representative cohort was followed up to evaluate concordance of treatment with documented preferences. Results Between March and September 2020, 910 patients were identified as high risk, of which 294 agreed to participate in the telehealth visit and complete LST documentation. Importantly, 108 (37%) patients chose DNR and other LST limitations. Additionally, 142 (48%) patients created POLST documentation and 128 (43%) completed advance directives. Over 70% of patients hospitalized received care concordant with the documented LST preferences. A follow-up survey found the outreach impactful, with LST preferences documented correctly. Conclusions and Implications Prior studies have demonstrated success at training primary providers to conduct ACP discussions, but given the limitations imposed by COVID-19 restrictions, this novel and highly cost-effective process of coupling a highly trained HPCS NP with multiple primary care teams to perform ACP was piloted with success. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3328 | The Quality of Telehealth-Delivered Palliative Care During the Initial COVID-19 Pandemic Surge (S530) Outcomes 1. Describe the use of telehealth-delivered palliative care at one of the largest hospitals in New England during peak COVID-19 infection rates 2. Compare differences in care quality provided by in-person and telehealth-delivered palliative care Original Research Background In March 2020, in response to rapidly increasing COVID-19 infection rates, the palliative care (PC) service at one of the largest hospitals in New England quickly shifted from in-person to telehealth-delivered PC (TPC). Research Objectives We compared the quality of TPC relative to in-person PC during peak COVID-19 rates in the setting of high clinical demands for PC, requiring rapid implementation of TPC. Methods We reviewed electronic health records of TPC and in-person consultation modalities of patients hospitalized between 3/2020 and 6/2020. We assessed established quality measures, including time from admission to inpatient PC consultation, interdisciplinary care, documented assessment at initial consultation of patient and family understanding of serious illness, and discussion of goals of care. Descriptive and bivariate statistics were used to describe differences by modality. Results Among 272 patients, mean age was 69.3 years (standard deviation = 18.3); 53% were male, 65% white, and 24% Black; 33% had primary cancer diagnoses; and 39% had COVID-19. Eighty percent of patients received TPC, and 20% received in-person PC. Median time from admission to PC consultation was 4.5 days (interquartile range 2-11). There were no differences between modalities by race, sex, or time from admission to PC consultation. Patients who received TPC were less likely to have cancer (25% vs 69%; p < 0.01). Patients who received TPC were slightly less likely to encounter more than 1 interdisciplinary PC team member (56% vs 61%) or to have a documented assessment of patient and family understanding of serious illness (60% vs 73%) or discussion of goals of care (71% vs 82%), though not statistically significant (p > 0.05). Conclusion Although PC quality measures varied by modality, the PC service demonstrated the ability to provide high-quality TPC, even under significant strain during the early COVID-19 pandemic. Implications for Research, Policy, or Practice Future work will evaluate opportunities to increase the quality of TPC beyond the initial pandemic surge and for sustained provision of TPC. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3329 | Virtual Palliative Care Is Inclusive Care (QI408) Outcomes 1. Describe a national virtual palliative care approach to increasing access to services for patients living with serious illness during the COVID-19 pandemic 2. Examine virtual palliative care utilization patterns in the inpatient and outpatient setting as well as the adoption of telephonic or video-based platforms 3. Recognize palliative care clinician perspectives and willingness to adopt virtual visits across the care continuum Background The number of Americans who are living with serious illness without adequate access to palliative care services is growing. Virtual palliative care offers an inclusive solution that enhances the patients’ quality of life and addresses complex patient centric needs. Aim Statement This project was developed during the COVID-19 pandemic to investigate telehealth utilization and engagement as well as clinician perceptions and experiences using the virtual platform. Methods We evaluated the use of telephone and video visits in 7 states from May 2020 to April 2021. Of the 84 palliative care clinicians (physicians and APPs) practicing in those states, 35 clinicians (42%) conducted virtual visits. A total of 1,816 virtual visits were completed based on claims analysis. We conducted a clinician experience survey that was completed via Google forms by 15 physicians (44% response rate), which provided qualitative feedback. Results Of the 1,816 visits completed, 332 were telephonic and 1,484 video. 30% of the visits were from the inpatient setting, 19% nursing facility, and 51% outpatient. Top diagnoses were respiratory failure, neuro/Parkinson's, dementia, CHF, and cancer. 37% of the patients lived in disadvantaged zip codes. 93% of the clinicians who responded to the survey were open to having a video visit with their patients with reported benefits such as improved access to care, more efficient use of time, and enhanced clinician-patient relationship. The barriers reported by clinicians included patients having limited availability to a device with a camera and inadequate internet bandwidth. Conclusions and Implications Clinicians find virtual palliative care to be beneficial to patients for goals-of-care conversations, frequent symptom assessment, and engaging multiple family members. Despite a perception that video visits have low adoption in older populations, more than 68% of the virtual visits were with patients 65 years+. These findings have strong implications for clinical practice transformation and further study in the field of virtual palliative care. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3330 | Code Status Decisions: Did the Pandemic Change Patients' and Families' Preferences? (S519) Outcomes 1. Understand influence of a public health emergency on goal-concordant hospital care based on pre-admission treatment preferences 2. Recognize the critical role of palliative care in navigating goal-concordant care for seriously ill patients hospitalized during the pandemic Original Research Background One measure of goal-concordant care is whether patients’ informed decisions on code status are honored. Public health emergencies, such as the COVID-19 pandemic, may create an environment of fear and confusion that could influence prior treatment decisions upon hospitalization. Research Objectives Evaluate whether code status decisions on preadmission Massachusetts Orders on Life Sustaining Treatment (MOLST) orders matched the admission orders to acute care units during first surge of the COVID-19 pandemic. Methods We did a retrospective chart review of patients admitted with severe COVID-19 infection and seen by the palliative care (PC) team between March and May 2020 at a tertiary care center in Massachusetts. The charts were evaluated for presence or absence of MOLST forms before admission, code status decisions on these MOLST forms and initial admission orders, and changes to code status after PC consult. Results The PC team had 92 patient encounters during the span of 2 months. 52 patient charts (57%) had a pre-admission MOLST form; among these, 24 patients had elected DNR/DNI, 2 elected DNR only, and 25 elected full code. Of note, 4/24 patients with DNR/DNI preference also had “do not hospitalize” orders. On admission, most prior DNR/DNI decisions carried forward except for 5 patients (3 changed to DNR only and 2 to full code). Most prior decisions for full code carried forward except for 7 patients, as limitations were added after goals-of-care discussions between families and frontline clinicians. After PC consult, 7/92 encounters had limitations of DNI/DNR or DNR only. Conclusion Our study demonstrated that most clinicians, patients, and families honored prior code status decisions, made by seriously ill patients and their surrogates, during the pandemic. This study sheds light on the critical role of MOLST/POLST in frontline goals-of-care conversations and the indispensable role of PC specialists during a public health emergency. Implications for Research, Policy, or Practice This study may inform further acceptance of MOLST/POLST to document patient preferences. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3331 | Project ECHO in Hospice and Palliative Care: Interdisciplinary Virtual Meeting to Address Needs and Critical Gaps in Our Field (FR218) Outcomes 1. Compare and contrast the Project ECHO model with other forms of education, mentoring, and support for practitioners in our field 2. Assess practice needs and gaps in your organization or in our field and develop interdisciplinary techniques and curricula to address those concerns As a response to the COVID-19 pandemic we created and executed an 18-month nationwide, interdisciplinary, virtual meeting project for hospice and palliative medicine team members. Through team expertise and collaboration, experience with the use of Project ECHO, and close monitoring of the impact the pandemic was disproportionately having on underserved communities and communities of color, we decided upon our focus areas for the project. We chose areas we thought were critical to the overall support of providers, patients, and our larger hospice and palliative medicine community. Areas to be addressed included knowledge gaps in treating people with COVID-19; advanced communication skillset needs with the rapid pivot to telehealth; and equity, diversity, inclusion, and racism in our field. Additionally, we wanted to build in techniques and methods we could use to foster strong interdisciplinary interactions toward building resilience and community in the face of the many unknowns of treating patients and caring for ourselves through the pandemic. We chose the model offered by Project ECHO, at the University of New Mexico School of Medicine, as the structure upon which we would build our project and to meet our objectives. The ECHO model uses virtual gathering to support mentorship, welcomes all levels of training with an “all teach, all learn” focus, and offers patient case–based learning in a way so as to democratize specialty knowledge. The virtual setting allows for participation regardless of location. We have gathered post-session survey data, participant data on moral distress, and data on provider views of their ability to affect equity, diversity, inclusion, and racism in our field. Our project is ongoing. Presenters are members of our project's interdisciplinary expert team, including MDs, an MSW/LCSW, a PharmD, and a PhD palliative care researcher. We will present data gathered thus far and will use interactive methods to teach and to elicit audience participation. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3332 | Mass Production of Compassionate Communication in the Era of COVID-19: A How-To Guide from Parkland Hospital's COVID ICU Team (TH105) Outcomes 1. Describe and analyze a blueprint for rapid upscaling of inpatient palliative care services in the ICU, both in the context of normal operations and in the context of mass casualties, natural disasters, pandemics, and other events 2. Describe the natural history, prognosis, morbidity, and mortality associated with acute respiratory distress syndrome due to COVID-19 3. Review and simulate use of novel communication tools and scripts for communication with families of critically ill patients In March 2020, Parkland Memorial Hospital, Dallas County's safety net hospital and one of the busiest hospitals in the nation, opened its Tactical Care Unit, a surgical space converted into a 100-bed unit for patients suffering from the novel and rapidly spreading COVID-19. At the outset of the pandemic, the team committed to expanding access to specialty-level palliative care and maintaining a pipeline of high-quality daily communication for all families of critically ill patients admitted to the COVID ICU. In this session, members of the multispecialty and multidisciplinary Parkland COVID ICU team will present a blueprint for the novel care model that allowed them to meet these goals, even in the midst of massive surges in the summer and winter. The following components of this care model will be reviewed in detail: a clearly defined structure for efficient co-management and co-rounding between palliative care and critical care specialists; the use of volunteer communication extenders; detailed data analysis regarding natural history, prognosis, morbidity, and mortality associated with acute respiratory distress syndrome due to COVID-19; and the generation of standardized, data-driven communication tools and scripts for daily conversations with families of critically ill patients. Attendees will receive copies of said communication tools and scripts, and we will conduct case-based simulations in small groups. Afterwards, we will review lessons learned and outcomes, answer questions, and review the ways in which the strategies and tools described above are being applied in our hospital outside the context of the COVID-19 pandemic. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3333 | The Role of Palliative Care During the COVID-19 Pandemic: Perceptions and Experiences Among Critical Care Clinicians, Hospital Leaders and Spiritual Care Providers (S538) Outcomes 1. Describe ways that palliative care supported patients, families, and care providers during the COVID-19 pandemic, as identified by participants in this study 2. Identify roles that palliative care could play when it comes to responding to future public health emergencies, as described by participants in this study Original Research Background Palliative care offers a unique skill set in response to challenges posed by the COVID-19 pandemic, with expertise in advance care planning, symptom management, family communication, end-of-life care, and bereavement. However, few studies have explored palliative care's role during the pandemic and changes in perceptions and utilization of the specialty among health and spiritual care providers and hospital leaders. Research Objectives To explore the evolving utilization, perceptions, and understanding of palliative care among critical care clinicians, hospital leaders, and spiritual care providers during the pandemic. Methods We conducted a qualitative study employing in-depth interviews at a tertiary academic medical center in Boston, Massachusetts. Between August and October 2020, we interviewed 25 participants from three key informant groups: critical care physicians, hospital leaders, and spiritual care providers. Results Respondents recognized that palliative care's role increased in importance during the pandemic. Palliative care served as a bridge between providers, patients, and families, supported provider well-being, and contributed to hospital efficiency. The pandemic reinforced participants’ positive perceptions of palliative care, increased their understanding of the scope of the specialty's practice, and inspired physicians to engage more with palliative care. Respondents indicated the need for more palliative care providers and advocated for their role in bereavement support and future pandemic response. Conclusion Findings highlight rapidly evolving and increased utilization and understanding of palliative care during the COVID-19 pandemic. Implications for Research, Policy, or Practice Results suggest a need for greater investment in palliative care programs and for palliative care involvement in public health emergency preparedness and response. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3334 | Enhancing Virtual Communication Skills Among Medical Learners: A COVID-19 Telemedicine Goals of Care Standardized Encounter (QI430) Outcomes 1. Evaluate the effectiveness of a virtual communication framework to conduct goals-of-care conversations 2. Emphasize the importance of adapting a complex communication curriculum to current telemedicine needs Background The COVID-19 pandemic has forced adaptations in medicine, causing rapid growth in the use of telemedicine to continue caring for patients. Although undergraduate medical education has also been forced to adapt curriculum to a distance learning or virtual model, many providers have no formal telemedicine or COVID-19-specific goals-of-care (GOC) training. Thus, a COVID-19 GOC telemedicine curriculum was developed to provide undergraduate medical learners (UMLs) the skills necessary to facilitate advance care planning (ACP) via a virtual platform. Aim Statement Develop an effective COVID-19 GOC telemedicine curriculum. Methods UMLs were given a 2-hour virtual training session using P-T-SPIKEES, a framework for conducting difficult discussions with patients via telemedicine. Training objectives included gaining an understanding of telemedicine, ACP, and risk factors for worsening COVID-19 disease to facilitate appropriate COVID-19 GOC conversations. UMLs underwent pre/post training surveys in addition to a GOC Telemedicine Objective Structured Clinical Examination (TeleOSCE). Learner pre/post training survey responses were compared to their GOC TeleOSCE performance evaluation to gauge effectiveness of this pilot program. Results N = 83 UMLs. UMLs who experienced systemic technical problems or had incomplete data lacking either a pre, post, or TeleOSCE evaluation survey were excluded from the study. 10% of UMLs had prior telemedicine training, 50% had prior GOC training, and 0% had previously participated in a TeleOSCE. After completing the curriculum, 68% received scores of excellent or above average on their TeleOSCE performance. UML self-evaluated GOC competency increased from 33% to 89%, a 2.7-fold increase, and TeleOSCE competency increased from 22% to 90%, a 4-fold increase. Conclusions and Implications A COVID-19 GOC telemedicine curriculum using the P-T-SPIKEES framework can effectively teach UMLs the skills necessary to facilitate COVID-19-focused GOC discussions via a virtual platform. Further studies should examine the use of the P-T-SPIKEES framework throughout different institutions and in graduate medical education. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3335 | Compassion Fatigue and Secondary Trauma During the COVID-19 Pandemic: Leading the Movement to Refashion Compassion (FR201) Outcomes 1. Define and differentiate between the components of professional quality of life, including compassion satisfaction, compassion fatigue, secondary trauma, moral injury, and burnout 2. Recognize risk factors and signs of compassion fatigue in yourself and your interprofessional colleagues 3. Identify three specific strategies that can be implemented to improve compassion satisfaction in yourself and your interprofessional team The COVID-19 pandemic has changed the world and created a shared trauma. In this context, palliative care has been called upon in unprecedented ways to provide care and to support our colleagues in spite of the evolving risks of our work environment. The uncertainty, fear, and exhaustion during the pandemic are immense and not without life-altering consequences. Compassion fatigue is a sense of emotional exhaustion that leads to decreased ability to feel compassion for others. It is sometimes referred to as secondary traumatic stress. As palliative care clinicians, we are especially prone to compassion fatigue as we bear witness to the suffering of our patients and colleagues. Symptoms of compassion fatigue mimic those of chronic stress, including social isolation, apathy, poor self-care, emotional lability, and substance use. While compassion fatigue is a pre-existing phenomenon, the events of 2020-2021 have produced a considerable impact on clinicians’ practice. Palliative care clinicians are in a prime position to support one another and colleagues through the anticipated post-COVID recovery. Preliminary research in the field indicates that resiliency programs may increase compassion satisfaction and decrease burnout. Although more interdisciplinary research is necessary, the existing data identify potential risk factors and interventions. In this session, an interprofessional team of providers will use brief didactics, case-based examples, and small group discussion to present and define the terminology relevant to compassion fatigue, including professional quality of life, compassion satisfaction, secondary trauma, moral injury, and burnout. The session will equip palliative care clinicians with the tools necessary to identify compassion fatigue while providing a framework within which providers can work to address and manage its complex sequelae. In addition, the session will allow participants to learn from each other, with a forum for sharing strategies that have been successful in their own practice. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3336 | "I Don't Want Him to Be Scared and Alone": A Mixed-Methods Examination of the Death Experience of Homebound Patients During New York City's Spring 2020 COVID-19 Surge (S556) Outcomes 1. Characterize patients in a home-based medical care (HBMC) practice who died during the spring 2020 COVID-19 surge in New York City 2. Identify health service and caregiving disruptions that occurred during the COVID-19 surge 3. Identify home-based primary and palliative care practice adaptations to maintain care for homebound patients during the COVID-19 surge Original Research Background Much COVID-19 research focuses on care in institutional settings, but less is known about the care experiences of homebound patients receiving home-based primary and palliative care in the community. Before COVID-19, these patients faced high symptom burden, multiple comorbidities, and high mortality. Research Objectives To describe characteristics and care experiences of patients in a home-based medical care (HBMC) practice who died during New York City's (NYC) spring COVID-19 surge through a mixed-methods, retrospective electronic medical record (EMR) review. Methods We analyzed EMRs for all HBMC patients who died in the initial COVID-19 wave in NYC (March 1-June 30, 2020). We developed an abstraction tool to collect service-related measures (eg, phone calls, televisits), household and clinical characteristics (eg, dementia status), and clinical notes on key disruptions including those related to family caregiving, paid caregiving, medical supplies, and hospice. Results During the study period 112 patients died, twice the practice's usual monthly deaths. Thirty percent died from confirmed or suspected COVID-19, 73% died at home, and 46% were enrolled in hospice. Medical and service disruptions included medication shortages, delayed hospice enrollment, and suspension of nursing and hospice visits due to personal protective equipment and staff shortages. Caregivers experienced difficulties with long-distance care and frustration over service disruptions. HBMC providers adapted by conducting outreach via phone and telehealth and leveraging relationships with partners such as hospice and medical equipment vendors. Hospital restrictions and fear of infection increased caregivers’ and providers’ commitment to keeping patients at home at the end of life. Conclusion Disruptions in family caregiving and health services such as hospice during COVID-19 complicated the dying experience. HBMC providers were an important bridge between caregivers and supportive community and medical resources. Implications for Research, Policy or Practice The COVID-19 pandemic exemplified how home-based primary and palliative care can be an important resource at the end of life. Targeted resources are needed to support families in managing end-of-life care. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3337 | Necessity Is the Mother of Implementation: Patient Satisfaction with Telemedicine for Palliative Care During the COVID-19 Pandemic Outcomes 1. Assess patient satisfaction with telemedicine for outpatient palliative care 2. Quantify time and resources saved by telemedicine 3. Examine patient demographic data and how they correlate to patient satisfaction with telehealth for outpatient palliative care Background Current literature on telemedicine use for palliative medicine focuses primarily on the accessibility of virtual health platforms. Information about patients’ attitudes toward using this medium is limited. Telemedicine expansion during the COVID-19 pandemic provided an opportunity to fill this knowledge gap. Aim Statement The aim of this article is to appraise the value of telemedicine for palliative outpatient care and help guide policy regarding telehealth implementation and expansion. Methods Data are presented from a cross-sectional qualitative survey conducted via telephone of 51 patients who participated in 199 telemedicine visits (mean 3.9 visits per patient) from March through December 2020 during the COVID-19 pandemic. Appointments were for established patients at both a large academic palliative clinic and a safety-net, palliative clinic. Questions measured patient satisfaction with healthcare delivery modes, barriers to care, and technological preparedness. Results Primary: All patients (100%) were either “extremely” or “somewhat” satisfied with their symptom management conducted via telemedicine. A majority of patients (65%) preferred a hybrid model with both telemedicine and in-person visits, and 14% preferred all follow-up via telehealth. Secondary: Telemedicine appointments required less time, travel, and family resources. Combined wait and appointment time for virtual visits was less than 30 minutes for 74% of patients, compared with 65% of patients spending 1 hour or more on in-person clinic days. Over half (56%) of support persons missed work to attend visits. No difference in satisfaction was detected when data were stratified by English language proficiency, internet access, and education level. Conclusions and Implications Patient satisfaction with telemedicine for palliative symptom management was similar to that for in-person clinic visits. Study was limited by selection bias; 28.42% of patients had died, 40.53% were unreachable. A larger study is needed. Telemedicine is advantageous, and preliminary data support its use. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3338 | "Tears over Zoom": Leveraging Technology Across Cultures to Enhance Resiliency in Response to the COVID-19 Pandemic (FR257) Outcomes 1. Describe challenges of burnout and resiliency that unique patient and provider populations have experienced throughout the COVID-19 pandemic 2. Engage in self-reflection on experiences with resiliency and burnout through the lens of one's own culture, patient population, and personal experiences 3. Compare and contrast advantages and challenges of leveraging technology for resiliency enhancement, communal grieving, and bidirectional learning across cultures During the global COVID-19 pandemic, palliative care providers internationally have experienced varying levels of distress and burnout in response to this crisis. When compared to the United States overall, providers working globally and in American Indian tribal nations may have experienced increased personal and professional suffering and distress due to the pandemic. The pandemic has also shone a light on inequity in healthcare and revealed how minority patients have been affected disproportionately. In response to travel and in-person gathering limitations, technology can be leveraged to enhance resiliency, decrease isolation, and mitigate burnout in providers, as well as provide a place to discuss these inequities and engage in communal grieving. These necessary adaptations during the global pandemic provided valuable lessons we can take forward in our practices. Our team leveraged Zoom and Project ECHO groups across countries and cultures, resulting in enhanced resiliency and bidirectional learning. We present our experiences and best-practices for leveraging technology to enhance resiliency across cultures using case studies of 3 different settings: Lakota Nation, the Caribbean, and Latin America. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3339 | Right There with You: Challenges for Inpatient Palliative Chaplains and Interdisciplinary Team Members During the Onset of COVID-19 (FR222) Outcomes 1. Identify ways inpatient palliative care chaplains triaged care at the onset of COVID, changed practices to adapt to evolving circumstances, and addressed professional pressures evident in this study's results 2. Identify salient coding and representative quotes to highlight data of when and where chaplains perceived encountering dimensions of burnout, components of moral distress, or aspects of moral injury while working alongside their interdisciplinary team members 3. Discuss the applicable roles and functions of inpatient care chaplains in consideration of these data in responding to the pandemic and how chaplains seek to mitigate the stressful effects of burnout, moral distress, and moral injury The National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines (4th edition) assert the chaplain to be among the core interdisciplinary team members. However, not much is known about roles and functions of the palliative chaplain, especially amid the stressors, rigors, and chaos of this pandemic's early days. Even less is known about the professional pressures experienced by inpatient palliative chaplains and how they changed practice, including the specific ways they sought to be attentive to and help address interdisciplinary staff support. Although there are some recent data concerning healthcare chaplains globally and within the profession overall during the pandemic, these findings are not explicitly focused on the specialization of palliative chaplaincy. Through the results of our qualitative research investigation, this education will highlight how inpatient palliative chaplains based in the United States changed practice and bore witness to the uncertain and harrowing conditions conducive to the negative effects of overwhelming stressors. Through this concurrent session chaplains experienced in clinical palliative care and research will draw data from their study by using semistructured interviews with 10 inpatient palliative care chaplain research participants. Data collection for this project occurred during the onset (late April to early May 2020) of COVID-19 in the United States. How palliative chaplains triaged, changed practice to adapt to an evolving context, and addressed their unique professional pressures will be described. When and where chaplains perceived their palliative team members experiencing dimensions of burnout, components of moral distress, or aspects of moral injury will also be shared through representative quotes. Last, the shifting roles and functions of inpatient palliative care chaplains due to the pandemic will lead to a discussion of this changed practice, including how it influenced chaplains helping support interdisciplinary team members. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3340 | Seeding a Revolution Post-COVID: Equipping Staff in Long-Term Care to Integrate Palliative Care (FR267) Outcomes 1. Recognize opportunities in existing long-term care workflows to assess for palliative care or hospice needs and trigger palliative care consultation 2. Describe four key palliative care services that long-term care professionals can be taught and incorporate into their own practice, including timely referral to palliative care or hospice 3. Devise strategies to improve collaborations with long-term care providers in their own communities It is estimated that the majority of people receiving long-term care services have unmet palliative care needs, and for those near the end of life, hospice care remains underused. These disparities were highlighted during the COVID-19 pandemic, and now many long-term care programs and facilities are eager to address the palliative care needs of their patients or residents and avoid unnecessary hospital transfers, but they need to understand this in a way that aligns with their own priorities and operations. Two recent initiatives have provided education, resources, and peer learning to groups of long-term care providers, to expedite the integration of palliative care in long-term care settings. One learning collaborative was led by a local health system aiming to improve outcomes for patients in their community, and one was led by a national organization to improve end-of-life experiences in Programs of All-inclusive Care for the Elderly (PACE) nationwide. Common to both efforts was targeted education, focused on proactively identifying people in need of palliative care and how to incorporate this identification into existing workflows; holding effective goals of care and advance care planning conversations; managing physical and psychosocial symptoms; and facilitating referral to palliative care specialty teams or hospice, as appropriate. Note that creating a strong identification process can be instrumental in ensuring equitable access to palliative care for all populations, especially Black, Indigenous, and other people of color. This session shares the lessons learned from these two initiatives, providing insights for both hospital-based and hospice-based palliative care programs to bolster capabilities as well as timely referrals from the long-term care organizations in their own communities. The session ends with an exercise to help attendees devise their own efforts. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3341 | "I Had Never Felt More Alone in My Life as I Did Those Eight Days." Impact of COVID-19 Visitation Restrictions on Patients and Caregivers Outcomes 1. Determine the impact of visitation restriction on caregivers and patients 2. Describe ways to improve communication and caregiver involvement to families during times of caregiver separation Original Research Background The impact of restricting hospital visitation during the COVID-19 pandemic on patients and caregivers has not been described. Research Objectives We explored how hospital visitation restrictions affected the health and experience of hospitalized patients and their caregivers. Methods We conducted a multimethod cohort study, matching adult patients (N = 100) hospitalized before the pandemic with 100 patients hospitalized after the pandemic. Matching was based on age, gender, and primary diagnosis. Based on chart abstractions, we conducted t tests estimating whether patient outcomes and medical teams’ communication with caregiver varied by status of visitor restrictions. We then conducted and analyzed semistructured interviews with a subset of patients hospitalized under visitor restrictions and their caregivers (N = 13) to understand the impact of visitation restrictions on patient and caregiver experience. Results Our chart abstraction revealed that caregivers of patients hospitalized during visitation restriction were more likely to receive no contact from medical teams (36.1% vs 16.5%; P < 0.001) and less likely to receive discharge counseling compared to those hospitalized before visitation restriction (36.5% vs 51.6%; P = 0.04). There were no significant differences in emergency department visits, rehospitalization, or death. Our qualitative analysis revealed that caregivers and patients experienced negative emotional consequences of the separation, such as anxiety, confusion, fear, and conflict with the medical team. Caregivers struggled with a lack of information about their loved ones’ overall psychological state. Although video visits were helpful, many caregivers either were not offered this option or did not have the technological literacy necessary to benefit. Conclusion Visitation restrictions during COVID were associated with lack of communication with caregivers but no significant differences in hospitalizations or ER visits. Interviews indicate that patients’ and caregivers’ unmet information needs due to lack of communication caused negative emotional consequences. Implications for Research, Policy, or Practice Future research should explore how to mediate the negative emotional sequelae of caregiver physical separation. | J Pain Symptom Manage | 2022 | CORD-19 | |
| 3342 | Practical randomly selected question exam design to address replicated and sequential questions in online examinations Examinations form part of the assessment processes that constitute the basis for benchmarking individual educational progress, and must consequently fulfill credibility, reliability, and transparency standards in order to promote learning outcomes and ensure academic integrity. A randomly selected question examination (RSQE) is considered to be an effective solution to mitigate sharing of questions between students by addressing replicated inter-examination questions that compromise examination integrity and sequential intra- examination questions that compromise examination comprehensivity. In this study, a Monte Carlo approach was used to design six examination schemes for the purpose of generating and evaluating 600 RSQEs in order to investigate the effects of RSQE design on replicated inter-examination and sequential and intra-examination questions. Results revealed that the number of randomly selected questions from the pool and the number of sub-pools inversely affected the replication and sequencing of the examination questions. Thus, by designing the RSQE in many sub-pools, in equivalence to the number of examination questions and selecting only one question from each sub-pool, and updating the sub-pools after each examination, the passing of information can be prevented, ensuring the integrity of the examinations. | N/A | 2022 | CORD-19 | |
| 3343 | Journey of organ on a chip technology and its role in future healthcare scenario Organ on a chip refers to microengineered biomimetic system which reflects structural and functional characteristics of human tissue. It involves biomaterial technology, cell biology and engineering combined together in a miniaturized platform. Several models using different organs such as lungs on a chip, liver on a chip, kidney on a chip, heart on a chip, intestine on a chip and skin on a chip have been successfully developed. Food and Drug administration (FDA) has also shown confidence in this technology and has partnered with industries/institutes which are working with this technology. In this review, the concepts and applications of Organ on a chip model in different scientific domains including disease model development, drug screening, toxicology, pathogenesis study, efficacy testing and virology is discussed. It is envisaged that amalgamation of various organs on chip modules into a unified body on chip device is of utmost importance for diagnosis and treatment, especially considering the complications due to the ongoing COVID-19 pandemic. It is expected that the market demand for developing organ on chip devices to skyrocket in the near future. | N/A | 2022 | CORD-19 | |
| 3344 | Influence of physical activity on well-being at times of the COVID-19 pandemic: a review Background Physical activity (PA) has been shown to be advantageous to one's health. Coronavirus disease 2019 (COVID-19) lockdown measures have reportedly led to substantial decrease of PA and to drastic reduction of well-being (WB). In light of this, the purpose of this review was to assess the impact of PA on WB during the COVID-19 pandemic. Material and Methods In May 2021, Literature search was conducted in Pubmed/Medline. The eligible publication period was one year from the search date. Results Synthesis of results from eight publications reporting on data from around 100 countries showed that PA positively influences diverse dimensions of the multivariate construct of WB, all of them relating to mental health. Young adults and women showed lowest PA concomitant with lowest self-reported WB. Conclusions Reduced PA levels resulted in lower WB levels, which might have a negative impact on mental health. Forthcoming, initiatives will be needed to facilitate PA – ideally whilst promoting joy of moving – in consideration of pandemic circumstances. By this means it will be possible to effectively promote WB and to prevent arising mental health issues. The current findings are fundamental to develop suitable approaches to improve PA in pandemic situations. | N/A | 2022 | CORD-19 | |
| 3345 | In silico ADMET, molecular docking and molecular simulation-based study of glabridin's natural and semisynthetic derivatives as potential tyrosinase inhibitors Hyper-pigmentation conditions may develop due to erroneous melanogenesis cascade which leads to excess melanin production. Recently, inhibition of tyrosinase is the main focus of investigation as it majorly contributes to melanin production. This inhibition property can be exploited in medicine, agriculture, and in cosmetics. Present study aims to find a natural and safe alternative molecule as tyrosinase inhibitor. In this study, human tyrosinase enzyme was modelled due to unavailability of its crystal structure to look into the degree of efficacy of glabridin and its 15 derivatives as tyrosinase inhibitor. Docking was performed by Autodock Vina at the catalytic core enzyme. Glabridin effects on melanoma cell lines was also elucidated by analysing cytotoxicity and effect on melanin production. Computational ADME analysis was done by SwissADME. Molecular dynamic simulation was also performed to further evaluate the interaction profile of these molecules and kojic acid (positive inhibitor) with respect to apo protein. Notably, four derivatives 5′-formylglabridin, glabridin dimer, 5′-prenyl glabridin and R-glabridin exhibited better binding affinity than glabridin. Glabridin effectively inhibited melanin production in a dose dependent manner. Among these, 5′-formylglabridin displayed highest binding affinity with docking score − 9.2 kcal/mol. Molecular properties and bioactivity analysis by Molinspiration web server and by SwissADME also presented these molecules as potential drug candidates. The study explores the understanding for the development of suitable tyrosinase inhibitor/s for the prevention of hyperpigmentation. However, a detailed in vivo study is required for glabridin derivatives to suggest these molecules as anti-melanogenic compound. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13596-022-00640-8. | N/A | 2022 | CORD-19 | |
| 3346 | Regional entrepreneurial ecosystems: learning from forest ecosystems Despite the emerging body of literature on entrepreneurial ecosystems (EEs), theoretical development is still in its infancy. In this article, we explicitly draw upon the analogy of forest ecosystems (FEs) with an EE to extrapolate the regional entrepreneurial ecosystem (REE) as an alternate conceptual framework. The REE considers a region’s socioeconomic activity and the stability of its performance as a whole, influenced by partitioned interests of economics, social arrangements, physical environment, knowledge and the technology that each contributes to the community’s industry and economic order. We contend that it is when an EE is defined by a regional dimension that it is analogous to the study of forests. In this REE analysis, neither the entrepreneur nor their firm are the unit of analysis, but it is the change and stability of the regional socioeconomic ecosystem itself that becomes the priority. Scholars, interested in the effects of entrepreneurship, can learn from ecological studies to more fully grasp the interplay between compositional, structural, and functional elements and specifically how entrepreneurs account for change dynamics. | N/A | 2022 | CORD-19 | |
| 3347 | HiveRel: hexagons visualization for relationship-based knowledge acquisition The growing abundance in complex network data models is constantly increasing the challenges for non-expert users who perform an effective exploratory search in large data collections. In such domains, users search for entities related to a topic of interest and acquire knowledge by investigating the relationships between these entities. Designers, in turn, are challenged by the need to provide tools that enable convenient search and exploration to facilitate productive performance on the task. For this purpose, we introduce HiveRel, a search system that presents search results as tiled hexagons on a map-like surface with center-out relevance ordering and allows on-demand display of relationships between search results. HiveRel’s user interface is based on theoretical principles that reflect how users acquire knowledge through relationships. For the search mechanism, we provide a set of information retrieval definitions leading to the formalization of the Maximal n-Bounded Exploration Subgraph problem and present an implementation of a greedy heuristic algorithm that provides non-optimal solutions to this problem. We develop a proof of concept version of HiveRel. We evaluate it in two user studies that compare users’ performance using HiveRel to standard web search over a range of search knowledge acquisition tasks and two different domains. The results indicate that despite the lack of familiarity with the new system, users were generally more accurate and as fast using HiveRel, and provided positive evaluations for the search experience. | N/A | 2022 | CORD-19 | |
| 3348 | A Low-Cost Bidirectional People Counter Device for Assisting Social Distancing Monitoring for COVID-19 Accurately estimating the number of people is a useful information to monitor the occupancy level of spaces due to the COVID-19 pandemic in order to keep social distancing. Automated counters are responsible for accurately counting people movement. This paper proposes a cost-effective automatic counting system based on a microcontroller through an infrared sensor integration to monitor occupancy of indoor spaces. In order to evaluate the proposed system in real-world scenarios, experiments were carried out at the main campus of the University of Campinas—Brazil. For the first case, two prototypes were installed at both the front and rear door of a bus in order to count the number of passengers boarding and alighting on the vehicle during its operation. In the second case, three prototypes were installed in the university restaurant ticket gates in order to count the number of people entering during lunchtime. Experimental results showed an accuracy of 91.45% and 98.65% for Cases 1 and 2, respectively. The results are promising, showing that the device has potential to be used for different proposes, such as controlling access to public and indoor spaces, public transportation planning, occupancy monitoring, and security system. | N/A | 2022 | CORD-19 | |
| 3349 | Antimicrobial and antiviral activity of selenium sulphide nanoparticles synthesised in extracts from spices in natural deep eutectic solvents (NDES) Selenium sulphide is a well-known bioactive chemical, but its preparation in nanometric form stabilised in water has not been widely reported. In the article, extracts of cinnamon, curcumin, and pepper obtained using natural deep eutectic solvents (NDES) were used to obtain stable selenium sulphide nanoparticles. The analysis confirmed that selenium sulphide nanoparticles with an average crystallite size of 28–44 nm and a particle size of approximately 500 nm were successfully synthesised. The use of NDES stabilised the SeS2 nanoparticles and increased their bioactivity towards microorganisms. The obtained systems revealed high biocidal and antiviral activity against S. aureus, E. coli, P. aeruginosa, and C. albicans strains, Human influenza virus A/H1N1, and Betacoronavirus 1 (Human coronavirus HCoV-OC43). The SeS2 nanoparticles obtained in the NDES extract of curcuma strongly inhibited the growth of pathogenic fungi and bacteria with minimum biocidal concentration (MBC) values of 117.2, 117.2, 117.2, and 468.8 mg/dm3 against E. coli, P. aeruginosa, S. aureus, and C. albicans, respectively. The suspensions containing selenium sulphide nanoparticles stabilised by spice extracts were also highly active against influenza viruses and B-coronavirus, showing a reduction of over 99%. | N/A | 2022 | CORD-19 | |
| 3350 | Learning science with YouTube videos and the impacts of Covid-19 This study investigates student and teacher use of online instructional YouTube chemistry videos in the context of the Covid-19 pandemic. Data were collected from a global sample of students (n = 1147) subscribed to the first author’s popular chemistry education YouTube channel. Participants were in secondary school or college and reported having learned science in a variety of contexts including completely online, blended, or completely in-person. The data collection instrument, an online questionnaire, was designed to detect both quantitative and qualitative changes in the use of instructional video. In addition, statistics for the overall YouTube chemistry education channel for 2018 through 2021 were compiled to provide evidence of video viewing trends with a large sample (98.6 million video views) over a timeframe encompassing before and during the Covid-19 pandemic. Findings indicate that students’ personal use of video for learning science increased substantially during the pandemic. However, for the majority of teachers, the use of video to support online learning during the pandemic either remained the same or declined. Post-pandemic, students plan to continue using science videos for learning and want teachers to do the same. | N/A | 2022 | CORD-19 |
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(3) Currently tweets of June 23rd to June 29th 2022 have been considered.