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Background In vitro studies suggesting that REGEN-COV (casirivimab plus imdevimab monoclonal antibodies) had poor efficacy against Omicron-variant SARS-CoV-2 infection led to amendment of REGEN-COV’s Emergency Use Authorization to recommend use only in regions without high Omicron prevalence. REGEN-COV’s relative clinical effectiveness for Omicron is unknown. Methods and findings We conducted a retrospective cohort study of non-hospitalized adults who tested positive for SARS-CoV-2 by polymerase chain reaction at the University of Miami Health System from July 19 –November 21, 2021 (Delta period) and December 6, 2021 –January 7, 2022 (Omicron period). Subjects were stratified be REGEN-COV receipt within 72h of test positivity and by time period of infection. We constructed multivariable logistic regression models to assess the differential association of REGEN-COV receipt with hospitalization within 30 days (primary outcome) and ED presentation; all models included three exposure terms (REGEN-COV receipt, Omicron vs Delta period, interaction of REGEN-COV with time period) and potential confounders (vaccination status, vaccine boosting, cancer diagnosis). Our cohort consisted of 2,083 adults in the Delta period (213 [10.2%] received REGEN-COV) and 4,201 in the Omicron period (156 [3.7%] received REGEN-COV). Hospitalization was less common during the Omicron period than during Delta (0.9% vs 1.7%, p = 0.78) and more common for patients receiving REGEN-COV than not (5.7% vs 0.9%, p<0.001). After adjustment, we found no differential association of REGEN-COV use during Omicron vs Delta with hospitalization within 30d (adjusted odds ratio [95% confidence interval] for the interaction term: 2.31 [0.76–6.92], p = 0.13). Similarly, we found no differential association for hospitalization within 15d (2.45 [0.63–9.59], p = 0.20) or emergency department presentation within 30d (1.43 [0.57–3.51], p = 0.40) or within 15d (1.79 [0.65–4.82], p = 0.30). Conclusions Within the limitations of this study’s power to detect a difference, we identified no differential effectiveness of REGEN-COV in the context of Omicron vs Delta SARS-CoV-2 infection.

In vitro studies suggesting that REGEN-COV (casirivimab plus imdevimab monoclonal antibodies) had poor efficacy against Omicron-variant SARS-CoV-2 infection led to amendment of REGEN-COV's Emergency Use Authorization to recommend use only in regions without high Omicron prevalence. REGEN-COV's relative clinical effectiveness for Omicron is unknown. We conducted a retrospective cohort study of non-hospitalized adults who tested positive for SARS-CoV-2 by polymerase chain reaction at the University of Miami Health System from July 19 -November 21, 2021 (Delta period) and December 6, 2021 -January 7, 2022 (Omicron period). Subjects were stratified be REGEN-COV receipt within 72h of test positivity and by time period of infection. We constructed multivariable logistic regression models to assess the differential association of REGEN-COV receipt with hospitalization within 30 days (primary outcome) and ED presentation; all models included three exposure terms (REGEN-COV receipt, Omicron vs Delta period, interaction of REGEN-COV with time period) and potential confounders (vaccination status, vaccine boosting, cancer diagnosis). Our cohort consisted of 2,083 adults in the Delta period (213 [10.2%] received REGEN-COV) and 4,201 in the Omicron period (156 [3.7%] received REGEN-COV). Hospitalization was less common during the Omicron period than during Delta (0.9% vs 1.7%, p = 0.78) and more common for patients receiving REGEN-COV than not (5.7% vs 0.9%, p<0.001). After adjustment, we found no differential association of REGEN-COV use during Omicron vs Delta with hospitalization within 30d (adjusted odds ratio [95% confidence interval] for the interaction term: 2.31 [0.76-6.92], p = 0.13). Similarly, we found no differential association for hospitalization within 15d (2.45 [0.63-9.59], p = 0.20) or emergency department presentation within 30d (1.43 [0.57-3.51], p = 0.40) or within 15d (1.79 [0.65-4.82], p = 0.30). Within the limitations of this study's power to detect a difference, we identified no differential effectiveness of REGEN-COV in the context of Omicron vs Delta SARS-CoV-2 infection.

Background Telemedicine use increased with the Covid-19 pandemic. The impact of telemedicine on resource use in pulmonary clinics is unknown. Methods This retrospective cohort study identified adults with pulmonary clinic visits at the University of Miami Hospital and Clinics (January 2018-December 2021). The primary exposure was telemedicine versus in-person visits. Standard statistics were used to describe the cohort and compare patients stratified by visit type. Multivariable logistic regression models evaluated the association of telemedicine with resource use (primarily, computed tomography [CT] orders placed within 7 days of visit). Results 21,744 clinic visits were included: 5,480 (25.2%) telemedicine and 16,264 (74.8%) in-person. In both, the majority were < 65-years-old, female, and identified as Hispanic white. Patients seen with telemedicine had increased odds of having CT scans ordered within 7 days (adjusted odds ratio [aOR] 1.34, [95% confidence interval 1.04–1.74]); and decreased odds of chest x-rays (aOR 0.37 [0.23–0.57]). Telemedicine increased odds of contact of any kind with our healthcare system within 30-days (aOR 1.56 [1.29–1.88]) and 90-days (aOR 1.39 [1.17–1.64]). Specifically, telemedicine visits had decreased odds of emergency department visits and hospitalizations (30 days: aOR 0.54 [0.38–0.76]; 90 days: aOR 0.68 [0.52–0.89]), but increased odds of phone calls and electronic health record inbox messages (30 days: aOR 3.44 [2.73–4.35]; 90 days: aOR 3.58 [2.95–4.35]). Conclusions Telemedicine was associated with an increased odds of chest CT order with a concomitant decreased odds of chest x-ray order. Increased contact with the healthcare system with telemedicine may represent a larger time burden for outpatient clinicians.

ObjectivesWe describe a hospital’s implementation of predictive models to optimise emergency response to the COVID-19 pandemic.MethodsWe were tasked to construct and evaluate COVID-19 driven predictive models to identify possible planning and resource utilisation scenarios. We used system dynamics to derive a series of chain susceptible, infected and recovered (SIR) models. We then built a discrete event simulation using the system dynamics output and bootstrapped electronic medical record data to approximate the weekly effect of tuning surgical volume on hospital census. We evaluated performance via a model fit assessment and cross-model comparison.ResultsWe outlined the design and implementation of predictive models to support management decision making around areas impacted by COVID-19. The fit assessments indicated the models were most useful after 30 days from onset of local cases. We found our subreports were most accurate up to 7 days after model run.DiscusssionOur model allowed us to shape our health system’s executive policy response to implement a ‘hospital within a hospital’—one for patients with COVID-19 within a hospital able to care for the regular non-COVID-19 population. The surgical schedule is modified according to models that predict the number of new patients with Covid-19 who require admission. This enabled our hospital to coordinate resources to continue to support the community at large. Challenges included the need to frequently adjust or create new models to meet rapidly evolving requirements, communication, and adoption, and to coordinate the needs of multiple stakeholders. The model we created can be adapted to other health systems, provide a mechanism to predict local peaks in cases and inform hospital leadership regarding bed allocation, surgical volumes, staffing, and supplies one for COVID-19 patients within a hospital able to care for the regular non-COVID-19 population.ConclusionPredictive models are essential tools in supporting decision making when coordinating clinical operations during a pandemic.

Objective:Assess turnaround time (TAT) and cost-benefit of on-site C. auris screening and its impact on length of stay (LOS) and costs compared to reference laboratories.Design:Before-and-after retrospective cohort study.Setting:Large-tertiary medical center.Methods:We validated an on-site polymerase chain reaction-based testing platform for C. auris and retrospectively reviewed hospitalized adults who screened negative before and after platform implementation. We constructed multivariable models to assess the association of screening negative with hospital LOS/cost in the pre and postimplementation periods. We adjusted for confounders such as demographics and indwelling device use, and compared TATs for all samples tested.Results:The sensitivity and specificity of the testing platform were 100% and 98.11%, respectively, compared to send-out testing. The clinical cohort included 287 adults in the pre and 1,266 postimplementation period. The TAT was reduced by more than 2 days (3 (interquartile range (IQR): 2.0, 7.0) vs 0.42 (IQR: 0.24, 0.81), p < 0.001). Median LOS was significantly lower in the postimplementation period; however, this was no longer evident after adjustment. In relation to total cost, the time period had an effect of $6,965 (95% CI: −$481, $14,412); p = 0.067) on reducing the cost. The median adjusted total cost per patient was $7,045 (IQR: $3,805, $13,924) less in the post vs the preimplementation period.Conclusions:Our assessment did not find a statistically significant change in LOS, nevertheless, on-site testing was not cost-prohibitive for the institution. The value of on-site testing may be supported if an institutional C. auris reduction strategy emphasizes faster TATs.

PurposeClinician–patient language concordance improves patient outcomes in non-intensive care unit (ICU) settings. We sought to assess the association of ICU nurse–patient language concordance with delirium-related outcomes.MethodsWe conducted a retrospective cohort study of adult English- or Spanish-speaking mechanically ventilated ICU patients admitted to ICUs at the University of Miami Hospital and Clinics (January 2021–September 2022). Our primary exposure was nurse–patient language concordance on each shift. We used mixed-effects multivariable regression to evaluate the association of language concordance with the primary outcome of restraint use, and secondary outcomes of agitation and identification of delirium, during each shift (with patient as a random effect).ResultsOur cohort included 4326 shifts (3380 [78.1%] with language concordance) from 548 patients and 157 nurses. Spanish language was preferred by 269 (49.1%) of patients. English-speaking patients tended to be younger (65 [53, 75] vs 73 [61, 83], p < 0.001) and of non-Hispanic ethnicity (55.5% vs 7.1%, p < 0.001). English-speakers had restraints ordered on fewer of their included shifts (0 [0, 3] vs 1 [0, 3], p = 0.005). After adjustment, the odds of restraint use on shifts with language concordance was significantly lower (odds ratio [OR, 95% confidence interval [CI]]: 0.50 [0.39–0.63], p < 0.001). Agitation (18.6% vs 25.2%; OR [95% CI]: 0.71 [0.55–0.92], p = 0.009) and delirium identification (34.5% vs 41.3%; OR [95% CI]: 0.54 [0.34–0.88], p = 0.014) were also less common.ConclusionsWe identified a twofold reduction in the odds of restraint use among mechanically ventilated patients for language concordant nurse–patient dyads. Ensuring nurse–patient language concordance may improve ICU delirium, agitation, and restraint use.

This research delves into the primary factors driving athletes, specifically master swimmers, to Qatar for competitive sports events. Employing a discrete choice survey methodology, hypothetical event packages were crafted to mimic athletes' decision-making processes in selecting their travel options. Data collection was conducted through face-to-face interviews administered to 175 individuals experienced in aquatics. Structural equation modeling (SEM) with SmartPLS software was utilized to explore the relationship between travel motivations and two key outcomes: the intention to visit Qatar and overall satisfaction with the Masters Aquatics Championship 2024, as well as the mediating influence of satisfaction. The findings underscored the significant impact of motivators such as the pursuit of stimulation, novelty, and escapism on both athletes' intent to visit Qatar and their satisfaction with the event. Conversely, motivations tied to competitive social status and the desire for victory exhibited varying levels of influence, with the latter exerting a lesser impact on travel intentions.

This research delves into the primary factors driving athletes, specifically master swimmers, to Qatar for competitive sports events. Employing a discrete choice survey methodology, hypothetical event packages were crafted to mimic athletes' decision-making processes in selecting their travel options. Data collection was conducted through face-to-face interviews administered to 175 individuals experienced in aquatics. Structural equation modeling (SEM) with SmartPLS software was utilized to explore the relationship between travel motivations and two key outcomes: the intention to visit Qatar and overall satisfaction with the Masters Aquatics Championship 2024, as well as the mediating influence of satisfaction. The findings underscored the significant impact of motivators such as the pursuit of stimulation, novelty, and escapism on both athletes' intent to visit Qatar and their satisfaction with the event. Conversely, motivations tied to competitive social status and the desire for victory exhibited varying levels of influence, with the latter exerting a lesser impact on travel intentions.

This research delves into the primary factors driving athletes, specifically master swimmers, to Qatar for competitive sports events. Employing a discrete choice survey methodology, hypothetical event packages were crafted to mimic athletes' decision-making processes in selecting their travel options. Data collection was conducted through face-to-face interviews administered to 175 individuals experienced in aquatics. Structural Equation Modelling (SEM) with Smart-PLS software was utilized to explore the relationship between travel motivations and two key outcomes: the intention to visit Qatar and overall satisfaction with the Masters Aquatics Championship 2024, as well as the mediating influence of satisfaction. The findings underscored the significant impact of motivators such as the pursuit of stimulation, novelty, and escapism on both athletes' intent to visit Qatar and their satisfaction with the event. Conversely, motivations tied to competitive social status and the desire for victory exhibited varying levels of influence, with the latter exerting a lesser impact on travel intentions.

We established a surveillance program to evaluate persistence of C. auris colonization among hospitalized patients. Overall, 17 patients (34%) had ≥1 negative result followed by a positive test, and 7 (41%) of these patients had ≥2 consecutive negative tests.