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Tag: JAMA

  • mRNA Vaccines Significantly Reduce Severity of Delta, Omicron COVID-19 Infections

    mRNA Vaccines Significantly Reduce Severity of Delta, Omicron COVID-19 Infections

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    Newswise — People who have received two or three doses of an mRNA COVID-19 vaccine are significantly more likely to have milder illnesses if infected with the Delta or Omicron coronavirus variants than those who are unvaccinated, according to a nationwide study involving a team of University of Utah researchers.

    The study, which examined health care personnel, first responders and other frontline workers in Utah and five other states, builds on previous research that indicates mRNA vaccines provide protection against severe health outcomes associated with COVID-19 despite the variants’ increased transmissibility.

    “It’s encouraging that the mRNA vaccines hold up rather well against these variants,” said Sarang Yoon, D.O., associate professor in the Department of Family and Preventive Medicine at University of Utah Health. She is a study co-author who leads the Utah portion of the research and is part of the Rocky Mountain Center for Occupational and Environmental Health, a partnership between the University of Utah and Weber State University. “We know that breakthrough cases are more likely with Delta and Omicron than the initial strain, but the vaccines still do a good job of limiting the severity of the infection.”

    The study was published Tuesday in the Journal of the American Medical Association (JAMA). It is the latest of several peer-reviewed papers resulting from the nationwide HEROES-RECOVER project funded by the U.S. Centers for Disease Control and Prevention.

    Researchers examined 1,199 participants who developed COVID-19 infections. Of the participants, 24% were infected with Delta and 62% contracted Omicron, while 14% had the original virus strain.

    Delta highlights:

    • Participants who had received two vaccine doses were significantly less likely to be symptomatic than those who were unvaccinated (77.8% vs. 96.1%)
    • Symptomatic participants with a third dose were far less likely to experience fever or chills than those who were unvaccinated (38.5% vs. 84.9%) and experienced symptoms for an average of six fewer days (10.2 days vs. 16.4 days)

    Omicron highlights:

    • The risk of symptomatic infection was similar between participants with two vaccine doses and those who were unvaccinated, while those with three doses experienced a higher risk than the unvaccinated (88.4% vs. 79.4%)
    • Symptomatic participants with three doses were significantly less likely to experience fever or chills (51.5% vs 79%) or seek medical care (14.6% vs 24.7%) than the unvaccinated

    The authors noted that, while the study is among the largest of its kind examining COVID-19 vaccines over time and across variants, grouping participants by variant and vaccine status resulted in some combinations with relatively few people, affecting the precision of the findings. They also indicated that the study was not able to account for all factors influencing COVID-19 severity, which may skew the results. There were also results the authors characterized as “unexpected” among participants who received three doses and had symptomatic Omicron infections.

    Researchers gathered data between Dec. 14, 2020, and April 19, 2022. Participants submitted self-collected nasal swabs weekly regardless of COVID-19 symptoms, as well as at the beginning of experiencing signs of illness. Participants were excluded from the study if they had infections before the study start date, or if their infections occurred: sooner than 14 days after their second vaccine dose, sooner than seven days after their third dose or more than 149 days after their third dose.

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    Other co-authors associated with the University of Utah and Rocky Mountain Center for Occupational and Environmental Health include Kurt Hegmann, M.D.; Matthew Thiese, P.h.D; Andrew Phillips, M.D.; Jenna Praggastis, B.S.; and Matthew Bruner, B.S.

    About University of Utah Health

    University of Utah Health  provides leading-edge and compassionate care for a referral area that encompasses Idaho, Wyoming, Montana, and much of Nevada. A hub for health sciences research and education in the region, U of U Health has a $458 million research enterprise and trains the majority of Utah’s physicians and health care providers at its Colleges of Health, Nursing, and Pharmacy and Schools of Dentistry and Medicine. With more than 20,000 employees, the system includes 12 community clinics and five hospitals. U of U Health is recognized nationally as a transformative health care system and provider of world-class care.

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    University of Utah Health

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  • Increased electronic health record time associated with enhanced quality outcomes in primary care

    Increased electronic health record time associated with enhanced quality outcomes in primary care

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    In the United States, the electronic health record (EHR) has become increasingly prevalent in the day-to-day practice of physicians, with primary care physicians (PCPs) spending the most time in the EHR. Yet, the association between time spent in the EHR and quality of ambulatory care was unclear before Brigham and Women’s researchers investigated this critical intersection. In their cross-sectional study of 291 primary care physicians, the team tracked ambulatory quality measures (year-end, PCP panel-level achievement of targets for hemoglobin A1C level control, lipid management, hypertension control, diabetes screening, and breast cancer screening) and found a significant, positive relationship between EHR time and some of these measures — panel-wide hemoglobin A1C level control, hypertension control, and breast cancer screening. These associations suggest that extra time spent in the EHR may benefit certain care outcomes, particularly for doctors who spend less than half their time seeing patients.  

    “Although increased EHR time is associated with burnout, it may represent a level of thoroughness or communication that enhances certain outcomes,” said lead author Lisa Rotenstein, MD, MBA, of the Primary Care Center of Excellence at the Brigham. “It may be useful for future studies to characterize payment models, workflows, and technologies that enable high-quality ambulatory care delivery while minimizing EHR burden.”

    Read more in JAMA Network Open.

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    Brigham and Women’s Hospital

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  • Vaccination status, mortality among intubated patients with COVID-19–related acute respiratory distress syndrome

    Vaccination status, mortality among intubated patients with COVID-19–related acute respiratory distress syndrome

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    About The Study: Full vaccination status compared with controls was associated with lower mortality among critically ill patients who required invasive mechanical ventilation owing to COVID-19–related acute respiratory distress syndrome in this study including 265 patients. These results may inform discussions with families about prognosis.

    Authors: Ilias I. Siempos, M.D., D.Sc., of the National and Kapodistrian University of Athens Medical School in Athens, Greece, is the corresponding author.

    To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/  

    (doi:10.1001/jamanetworkopen.2022.35219)

    Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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    Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2022.35219?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=100722

    About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

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    JAMA – Journal of the American Medical Association

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  • Study casts doubt on routine use of anesthesiologists in cataract surgery

    Study casts doubt on routine use of anesthesiologists in cataract surgery

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    Newswise — Ophthalmologists may be able to safely cut back on having anesthesiologists or nurse anesthetists routinely at bedside during cataract surgery, which accounts for more than two million surgeries per year in the U.S., according to a study publishing Oct. 3 in JAMA Internal Medicine

    A team of researchers from UC San Francisco examined Medicare claims for 36,652 patients who had cataract surgery in 2017 and found the use of anesthesia care was substantially higher for cataract surgery when compared to patients undergoing other elective, low-risk outpatient procedures—such as cardiac catheterization or screening colonoscopy. However, they found that these patients experienced fewer systemic complications—such as myocardial infarction or stroke—than did patients undergoing the other low-risk procedures.  These results held true even in cases where anesthesia experts were not present for the cataract surgery, suggesting that for many cataract patients, it may be reasonable to consider doing the procedure without routine anesthesia support.

    “It’s important to note we only looked at systemic complications and not ophthalmologic outcomes from the procedure,” noted senior study author Catherine Chen, MD, MPH, UCSF associate professor in  Anesthesia and Perioperative Care and researcher at the Philip R. Lee Institute for Health Policy Studies. “We are evaluating those next, but it would be premature to say we should change practice now based on this study. Hopefully we can get a conversation going, though.” 

    Some type of anesthetic and possibly sedation is needed for cataract surgery, Chen noted, but the question is who should be present for administration and intraoperative monitoring of these patients. In the past, cataract surgery carried a much higher risk of complications, which helps explain the historic and legacy use of anesthesiologists and/or certified registered nurse anesthetists (CRNA). 

     “The risk of the procedure itself used to require general anesthesia with paralysis and inpatient admission. Over time, ophthalmologists improved their technique so it [cataract surgery] is much safer and can be done on an outpatient basis,” said Chen. “Often the patient just needs a topical anesthetic such as numbing drops in the eyeball, and, at UCSF anyway, a little fentanyl and midazolam, which are agents a sedation nurse can administer safely.”

    A Question of Resources

    The study found that, for cataract surgery, 90% of U.S. Medicare patients have an anesthesia provider at the bedside compared to a range of <1% to 70% at bedside for other low-risk elective procedures. In contrast, fewer cataract surgery patients experienced systemic complications within seven days (7.7%) than patients undergoing other low-risk procedures (range, 13% to 52%).  

    Approximately 6% of ophthalmologists never used anesthesia providers, 77% always used anesthesia providers, and 17% used them for only a subset of patients. Patients of those ophthalmologists who never used anesthesia providers had a 7.4% rate of systemic complications. 

    There is no specific guidance from professional associations on whether to include an anesthesia expert during cataract surgery, but other countries do not routinely use them, to no ill effect, Chen noted. 

    With U.S. anesthesiologists being asked to staff an increasing number of non-OR procedures, such as endoscopic or interventional radiology procedures where patients tend to be much sicker and the procedure potentially more invasive, there often aren’t enough of these specialists go around, Chen said. 

    “Add to this a general shortage of anesthesiologists since COVID, and it’s clear we need to ensure staff resources are used efficiently,” said Chen.

    In an upcoming study, Chen and her colleagues will look at both systemic and ophthalmologic outcomes stratified by whether patients received care from an anesthesia provider during cataract surgery. While the current study used a sample of 5% of Medicare claims, the upcoming study will use 20% of claims. 

    “It’s certainly possible that by having an anesthesiologist there, the patients are calmer and possibly less likely to move, and so the ophthalmologic outcomes could be better—so we are working on those studies now,” Chen said. “Where I think where we could end up, when the results are in, is that instead of automatically defaulting to include an anesthesiologist, we stratify patients by risk so that their level of sedation and anesthesia support matches their likelihood of complications.”

    Co-authors and funding: Please see paper for additional co-authors and funding disclosures.

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    University of California, San Francisco (UCSF)

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