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17 PATIENT SAFETY & OUTCOMES Researchers drawing closer to identifying potential cause, treatment for long COVID-19 symptoms By Erica Carbajal and Gabrielle Masson R ecent studies have identified changes to a nerve that may explain why some people suffer from long COVID-19, while separate findings may point to a poten- tial treatment option. e vagus nerve may play a role in why some people suffer from long COVID-19, accord- ing to a small study set to be presented April 23-26 at the European Congress of Clinical Microbiology and Infectious Diseases. Researchers from Spain performed a morpho- logical and functional evaluation of the vagus nerve — which is responsible for a variety of functions including controlling heart rate, speech, the gag reflex, moving food through the intestines and sweating — via imaging and functional tests in a cohort of 348 long COVID-19 subjects. At least 228 participants had at least one symptom suggestive of vagus nerve dysfunction. e current evaluation was performed in the first 22 subjects with VND symptoms. e study is ongoing. Researchers believe many of the symptoms connected to long COVID-19 could be linked to the effect of the virus on the vagus nerve. "In this pilot evaluation, most long COVID subjects with vagus nerve dysfunction symp- toms had a range of significant, clinically-rel- evant, structural and/or functional alter- ations in their vagus nerve, including nerve thickening, trouble swallowing and symptoms of impaired breathing," the authors wrote. "Our findings so far thus point at vagus nerve dysfunction as a central pathophysiological feature of long COVID." A separate small study presented at the Amer- ican College of Cardiology's Cardiovascular Summit Feb. 16-19 found enhanced external counterpulsation therapy, or EECP, may be a treatment option for long COVID-19 patients. e noninvasive treatment is typically used for coronary artery disease patients and involves the use of pneumatic cuffs placed on a patients calves, thighs and lower hip area. e cuffs, connected to an electrocardiograph machine, sequentially inflate and deflate, pushing blood throughout the heart and rest of the body. e study involved 50 long COVID-19 pa- tients — 30 with no history of coronary artery disease and 20 patients with the disease. e findings showed long COVID-19 symptoms such as fatigue, breathing difficulties and chest discomfort improved among both patient groups aer 15-35 hours of EECP therapy. "Emerging data shows that long COVID is a disease that impacts the health of vessels, also known as endothelial function. EECP is a disease-modifying, noninvasive therapy that has previously shown to improve endo- thelial function in controlled clinical trials," said Sachin Shah, PharmD, senior author on the study and chief scientific officer at Flow erapy, a nationwide EECP provider. "We currently believe that this is the most plausi- ble explanation for the benefits derived from EECP and the link to long COVID." Both studies have yet to be peer reviewed. n Nurse work environments affect patient outcomes, study finds By Mackenzie Bean S urgical patients treated in hospitals with good work environments for nurses are less likely to require intensive care or die, according to a study published Dec. 15 in AACN Advanced Critical Care. Researchers analyzed data on 269,764 adult Medicare patients who had general, orthopedic or vascular surgical procedures between January 2006 and October 2007 at 453 hospitals nationwide. A 2006 survey of registered nurses provided data on work environments, and an annual survey from the American Hospital Association provided data on hospital characteristics. They used logistic regression models to estimate how nurses' work environments affected the odds of patients' admission to the intensive care unit and death rates. Four things to know: 1. Patients undergoing surgery in hospitals with good nurse work environments had a 16 percent lower chance of being admitted to the ICU compared to patients in hospitals with mixed or poor nurse work environments. 2. The in-hospital and 30-day mortality rates were also 12 percent and 11 percent lower, respectively, for patients treated in hospitals with good nurse work environments. 3. Overall, patients treated in good work environments had a 15 percent lower risk of either ICU admission or death within 30 days of admission. 4. Researchers said the study is among the first to directly link nurse work environments to ICU use. The findings suggest efforts to improve nurses' work environments could help reduce ICU utilization and improve patient outcomes. n Patients treated in good work environments had a 15 percent lower risk of either ICU admission or death within 30 days of admission.