Human Connection in the Time of COVID-19 Human connection has suffered quite significantly during the COVID-19 pandemic. While physical distancing is necessary for our wellbeing, restricting family presence in the ICU has been challenging. There is recent data that show the negative consequences of these policies and restrictions. Moral distress has been reported due to restrictive family visitation policies. It is also believed that patients may be spending mor...

Original Investigation November 2, 2021 Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia: The CAP-IT Randomized Clinical Trial Julia A. Bielicki, Wolfgang Stöhr, Sam Barratt, et al JAMA. 2021;326(17):1713-1724. doi:10.1001/jama.2021.17843 Abstract Importance  The optimal dose and duration of oral amoxicillin for children with community-acquired pn...

Ventilator-Associated Pneumonia in COVID-19 Patients The coronavirus has a high incidence of patients with severe acute respiratory syndrome (SARS). Many patients infected with COVID-19 need to be admitted to the ICU for invasive ventilation. They are also at a high risk of developing secondary, ventilator-associated pneumonia (VAP). This is because of breach of natural defences by invasive devices, impairment of coughing and mucociliary clearance, sedation and the imm...

Research Letter November 1, 2021 Durability of Antibody Levels After Vaccination With mRNA SARS-CoV-2 Vaccine in Individuals With or Without Prior Infection Diana Zhong, Shaoming Xiao, Amanda K. Debes, et al JAMA. Published online November 1, 2021. doi:10.1001/jama.2021.19996 Waning serum antibodies against SARS-CoV-2 have raised questions about long-term immunity. Lower antibody levels to SARS-CoV-2 spike protein are associated with breakthroug...

Precision Therapies for Heterogeneous ARDS Patients ARDS is a heterogeneous syndrome rather than a distinct disease. It is this heterogeneity that often makes it difficult to study treatments for patients with ARDS. Literature on ARDS is rife with clinical trials that do not show any mortality benefit. Recent evidence suggests different sub-phenotypes within the heterogeneous patient population. These sub-phenotypes have variable clinical responses to specific t...

Editorial October 11, 2021 Antithrombotic Therapy for Outpatients With COVID-19: Implications for Clinical Practice and Future Research Otavio Berwanger JAMA. 2021;326(17):1685-1686. doi:10.1001/jama.2021.17460 COVID-19, the infectious disease caused by the SARS-CoV-2 virus, has been associated with an inflammatory and hypercoagulable state characterized by increases in levels of D-dimers, fibrin, fibrin degradation products, and fibrinogen.1 Observa...

Safety of Enhanced Thromboprophylaxis Strategies for COVID-19 Patients COVID-19 is associated with a high incidence of thrombotic complications. The burden of thrombin complications, in particular, pulmonary embolism, remains high in patients with COVID-19, especially those requiring admission to the ICU. Data suggest an incidence of thromboembolic events between 27 to 57% in COVID-19 patients despite standard thromboprophylaxis. A review of studies including 1765 ...

Original Investigation October 11, 2021 Effect of Antithrombotic Therapy on Clinical Outcomes in Outpatients With Clinically Stable Symptomatic COVID-19: The ACTIV-4B Randomized Clinical Trial Jean M. Connors, Maria M. Brooks, Frank C. Sciurba, et al JAMA. 2021;326(17):1703-1712. doi:10.1001/jama.2021.17272 Abstract Importance  Acutely ill inpatients with COVID-19 typically receive antithrombotic therapy, although the risks and benefits of th...

Resuscitative Transesophageal Echocardiography Programme in the ED: 5 Tips for Success Over the past few years, inspired by landmark publications,1,2,3 demonstrating the feasibility, safety and clinical value of transesophageal echocardiography (TEE) performed by emergency physicians (EPs), a number of U.S. hospitals have established TEE programmes based in their emergency departments (EDs). In 2017, the American College of Emergency Physicians (ACEP) published th...

ORIGINAL ARTICLE Early Treatment for Covid-19 with SARS-CoV-2 Neutralizing Antibody Sotrovimab Anil Gupta, Yaneicy Gonzalez-Rojas, Erick Juarez, et al N Engl J Med October 27, 2021DOI: 10.1056/NEJMoa2107934 Abstract BACKGROUND Coronavirus disease 2019 (Covid-19) disproportionately results in hospitalization or death in older patients and those with underlying conditions. Sotrovimab is a pan-sarbecovirus monoclonal antibody that was designed to preve...