2020-05-02/03 DAILY UNM GLOBAL HEALTH COVID-19 BRIEFING

Executive Summary: More NM cases. Free Shiprock testing. Prison release demands. 8 state parks reopen. Higher US deaths. NY PPE case dismissed. Orthopedic Tx down. European deaths down. UK mortality factors. People leaving large cities. Ending lockdown strategies. Public mask impact. Taiwan tracing. Homeless shelter prevalence. Homeless shelter outbreak. 50-state R0. COVID-19 decades later. US county tracking site. Hospital management model. COVID-19 behavioral transformation. Practice guidelines for: cardiology, IBD surgery, and rheumatic physical inactivity. Roche antibody test approved. Abbott antibody test EU-certified. Home anosmia assessment. CVD and ACE/ARBs. Tocilizumab early evidence. Tocilizumab systematic review. WHO vaccines trial. HCQ slower viral clearance. CBC predicts severity. Kidney disease meta-analysis. Innate/adaptive immunity timing. Combating misinformation. Mental health living reviews

2020-05-05 DAILY UNM GLOBAL HEALTH COVID-19 BRIEFING

Executive Summary: NM cases. Navajo cases. NM remdesivir inaccessible. Infected prison staff. No early prison releases. Unemployment beats working. NM $97M food benefits. UNM$50M revenue loss. Meat packer testing. Fall school reopening planning. Gym/salon reopening plans. 91k absentee ballots. Santa Fe closes polling stations. NM oil/gas pollution oversight. Prisons vulnerable. WH rejects FEMA report. Schools plan reopening. Italian mafia concerns. UK overtakes Italy. Symptom tracker early warning. Ethanol for FFP2 masks. Counterfeit masks. Mask skin damage. Mutant coronavirus more contagious. Hospital contamination zones. Disease prevalence estimation. Successful control measures. Average contagious period. Genetic epidemiology. Managing healthcare resources. Exercise and fitness. Italian disease management Q&A. Practice guidelines on: bronchoscopy, sarcoidosis management, glycemic control, key laboratory tests, ACE/ARB Tx, neurosurgery, cardiac surgery. WHO: test old pneumonia samples. SW NM free testing. Diagnostic assays compared. Corticosteroid benefits. Beekeepers COVID-free? European vaccine US trials. Cytokine storm interventions. Lopinavir-ritonavir second chance. Melatonin potential Tx. 48 clinical trials. Placental infection. Cytokine severity markers. Male lungs worse. Sleep problems. IBD physician survey. Researcher career impact

Improving Recognition of Malnutrition at UNMH

Introduction: Protein calorie malnutrition is the most common form of nutritional deficiency among patients who are hospitalized in the U.S. Malnutrition is a significant indicator for severity of illness and expected mortality measures. Previous audits have shown that malnutrition at UNMH is grossly under-recognized, with 4.7% of inpatients diagnosed at discharge compared with a national inpatient malnutrition prevalence of 20-50%. To improve the ultimate coding of a diagnosis of malnutrition, an interdisciplinary process has been developed. The nurse intake malnutrition screening assessments has been updated to be more sensitive, local consensus guidelines have been developed for malnutrition diagnosis and severity classification, and a workflow was created to get from malnutrition screen to dietitian assessment, then to provider documentation (see Fig. 1) and ultimately documentation coding. To measure the impact of these changes, an audit was performed. Materials/Methods:The study population consists of all adult inpatient or short-stay patients first admitted to either 4-West or 5-West over a three-month period from 08/18/2019 to 11/18/2019. Data were pulled from Powerinsight, a database querying tool that accesses information from Powerchart, and additional fields were populated by manual chart review. Analyses were done to assess the completion of each step in the malnutrition capture process. Results: A total of 126 patients were first admitted to either 4- or 5-West during the study period. Of these, 56 patients (44%) had the initial nursing malnutrition screen completed. Of the patients with a completed malnutrition screen, 19 patients (33%) had dietitian consult orders placed. All consult orders resulted in a completed consult note. Of the patients seen by a dietitian, 8 cases of malnutrition were identified (42%), 6 of which were severe protein-calorie malnutrition. The note was forwarded to an attending physician 5 times (62.5%) and signed in each instance, but providers only used the institutionally approved verbiage in 3 cases (37.5%). In one of the 8 (12.5%) instances in which the dietitian identified malnutrition, the diagnosis did not end up on the discharge summary. Conclusions: The percentage of patients with a discharge diagnosis of malnutrition increased from around 5% up to 10% with the new process. Opportunities for improvement identified by the audit include a high proportion of patients not receiving the initial malnutrition screen and providers not signing the nutrition note with the appropriate institutionally approved addendum. Further efforts will focus on educating nurses, dietitians, and providers about the appropriate steps and ideally creating a dashboard showing where an individual patient is currently in the workflow

2020-05-20 DAILY UNM GLOBAL HEALTH COVID-19 BRIEFING

Executive Summary: NM Highlights: Governor’s update. NM case count. Governor’s response to republicans. Western Sky Community donation. Santa Feans using face coverings. NM Medicaid enrollment. NM colleges fall reopening. Rio Rancho partial reopening. NM Tourism Department cooking recipes. ABQ Meals on Wheels feeding more. US Highlights: Mexico influx California hospitals. Arkansas church outbreak. International Highlights: Estonia immunity passport rollout. South Korea school reopenings. Economics, Workforce, Supply Chain, PPE Highlights: Hydrogel patches for pressure injuries. Resuscitation with PPE. Journal of wound care PPE guidelines. Food supply chain protections. Epidemiology Highlights: Higher rates in Black communities. Superspreaders may explain propagation patterns. “Back-projection” used for analysis. Healthcare Policy Recommendations: Systems analysis of pandemic management is performed. Policy recommendations based on a nationwide psychological China survey. Practice Guidelines: COPD management FAQ and patient support resources. Testing: CRISPR rapid test. Fast and simple single tube assay. Drugs, Vaccines, Therapies, Clinical Trials: Protective immunity in macaques. DNA vaccine. Lopinavir and Ritonavir pharmacokinetics. 32 new trials. Other science: ACEI/ARB and disease severity. Cold plasma. Survey call for clinicians

2020-04-28 DAILY UNM GLOBAL HEALTH COVID-19 BRIEFING

Executive Summary: NM case update. NM antibody testing. Las Cruces essential worker screening. Small business closure inequity. More jobless benefits. Santa Fe furloughs. NM Funeral homes prepared. NM oil sector hit. State-by-state restrictions/reopenings. US testing expansion. JAMA on prisons. NY reopening focus. Farmers euthanizing animals. New Zealand success. Stockholm herd immunity. UK worst-hit in Europe. Japanese island lockdown. Spain multi-phase plan. Economic damage lockdown duration. Oil price impacts. Aerosol intubation box. Family cluster transmission. US contact tracing lacking. Chinese tracing system. Early US deaths undercounted. More poison center calls. Homeless shelter infection. Reduced coronary syndrome admissions. Italian predicted model. GIS spatial modeling. Exit strategy schemes. Reopening public buildings. Preventive health screening declines. Stress prevention on return to work. Mental health consequences. Protecting healthcare worker well-being. Mental health training lacking. Hospital toilet viral hotspot. Mobile phone tracking. Creating equitable society. Prone positioning protocol. Negative-pressure tracheostomy. Glucocorticoids adrenal insufficiency. ICU team models. Healthcare worker grief. Conducting clinical trials. UK home-care testing. Dry swabbing. ACE inhibitor benefits. 90 vaccines in development. Heparin and thrombocytopenia. 53 clinical trials registered. Respirator comparison. SARS-coV-2 genetic diversity. Transmission with temperature. Antibody dynamics. Vitamin D and severity. Immunosuppression and severity. Temporal artery thermometers low sensitivity. Digestive symptoms and hospitalization