Since then, the rapid increase in the number of patients with COVID-19 associated with acute respiratory distress syndrome (ARDS) 1 and high rates of mortality 2,3 has highlighted the critical need for high-quality end-of-life care. On March 31, 2020, an eight-bed Palliative Care Unit (PCU) was established at our institution for patients with COVID-19 whose surrogates opted to not initiate or continue life-sustaining therapies. To our knowledge, this is the first report describing COVID-19 patients receiving comfort-directed care.This case series aims to describe the characteristics and palliative care needs in patients admitted to the PCU at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital to inform other clinicians caring for this population at the end of life. METHODSDeceased patients with confirmed severe acute respiratory syndrome coronavirus 2 infection by polymerase chain reaction testing of a nasopharyngeal sample, admitted to the PCU at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital between March 31, 2020, and April 10, 2020, were included.Before data collection, a waiver was obtained from the Columbia University institutional review board. Deidentified patient data were collected from the electronic medical record Epic Hyperspace and analyzed using Microsoft Excel. Laboratory testing was reviewed at PCU admission. Patient outcome data were evaluated at time of death. Due to the descriptive nature of this case series, no analysis for statistical significance was performed. RESULTSA total of 30 patients were included in this case series (mean age = 84.5 years; 53% male) (Table 1). Most patients were of Hispanic origin (20 [66.7%]), followed by white (4 [13.3%]). All 30 patients had comorbidities before hospital admission, with 70% of patients having more than one comorbidity. Twenty-four patients (80%) had metabolic abnormalities, with hypernatremia observed in 17 patients (57%). Before PCU admission, all 30 patients
Objective: This study aimed to investigate the association between dietary prebiotic intake and risk for Alzheimer’s disease (AD). Methods: This longitudinal study includes 1,837 elderly (≥65 years) participants of a multi-ethnic community-based cohort study who were dementia-free at baseline and had provided dietary information from food frequency questionnaires. Total daily intake of fructan, one of the best-known prebiotics, was calculated based on consumption frequency and fructan content per serving of 8 food items. The associations of daily fructan intake with AD risk were examined using a Cox proportional hazards model, adjusted for cohort recruitment wave, age, gender, race/ethnicity, education, daily caloric intake, and APOE genotype. Effect modification by race/ethnicity, APOE genotype, and gender was tested by including an interaction term into the Cox models, as well as by stratified analyses. Results: Among 1,837 participants (1,263 women [69%]; mean [SD] age = 76 [6.3] years), there were 391 incident AD cases during a mean follow-up of 7.5 years (13736 person-years). Each additional gram of fructan intake was associated with 24% lower risk for AD ((95% CI)=0.60-0.97; P =0.03). Additional adjusting for smoking, alcohol consumption, and comorbidity index did not change results materially. The associations were not modified by race/ethnicity, gender, and APOE genotype, although stratified analyses showed that fructan intake was significantly associated with reduced AD risk in Hispanics but not in non-Hispanic Blacks or Whites. Conclusion: Higher dietary fructan intake is associated with a reduced risk of clinical Alzheimer’s disease among older adults.
OBJECTIVES: The utility and risks to providers of performing cardiopulmonary resuscitation after in-hospital cardiac arrest in COVID-19 patients have been questioned. Additionally, there are discrepancies in reported COVID-19 in-hospital cardiac arrest survival rates. We describe outcomes after cardiopulmonary resuscitation for in-hospital cardiac arrest in two COVID-19 patient cohorts. DESIGN: Retrospective cohort study. SETTING: New York-Presbyterian Hospital/Columbia University Irving Medical Center in New York, NY. PATIENTS: Those admitted with COVID-19 between March 1, 2020, and May 31, 2020, as well as between March 1, 2021, and May 31, 2021, who received resuscitation after in-hospital cardiac arrest. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Among 103 patients with coronavirus disease 2019 who were resuscitated after in-hospital cardiac arrest in spring 2020, most self-identified as Hispanic/Latino or African American, 35 (34.0%) had return of spontaneous circulation for at least 20 minutes, and 15 (14.6%) survived to 30 days post-arrest. Compared with nonsurvivors, 30-day survivors experienced in-hospital cardiac arrest later (day 22 vs day 7; p = 0.008) and were more likely to have had an acute respiratory event preceding in-hospital cardiac arrest (93.3% vs 27.3%; p < 0.001). Among 30-day survivors, 11 (73.3%) survived to hospital discharge, at which point 8 (72.7%) had Cerebral Performance Category scores of 1 or 2. Among 26 COVID-19 patients resuscitated after in-hospital cardiac arrest in spring 2021, 15 (57.7%) had return of spontaneous circulation for at least 20 minutes, 3 (11.5%) survived to 30 days post in-hospital cardiac arrest, and 2 (7.7%) survived to hospital discharge, both with Cerebral Performance Category scores of 2 or less. Those who survived to 30 days post in-hospital cardiac arrest were younger (46.3 vs 67.8; p = 0.03), but otherwise there were no significant differences between groups. CONCLUSIONS: Patients with COVID-19 who received cardiopulmonary resuscitation after in-hospital cardiac arrest had low survival rates. Our findings additionally show return of spontaneous circulation rates in these patients may be impacted by hospital strain and that patients with in-hospital cardiac arrest preceded by acute respiratory events might be more likely to survive to 30 days, suggesting Advanced Cardiac Life Support efforts may be more successful in this subpopulation.
This a preprint and has not been peer reviewed. Data may be preliminary.
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