Rehabilitation post-COVID-19: cross-sectional observations using the Stanford Hall remote assessment tool.

INTRODUCTION: The multisystem COVID-19 can cause prolonged symptoms requiring rehabilitation. This study describes the creation of a remote COVID-19 rehabilitation assessment tool to allow timely triage, assessment and management. It hypotheses those with post-COVID-19 syndrome, potentially without laboratory confirmation and irrespective of initial disease severity, will have significant rehabilitation needs. METHODS: Cross-sectional study of consecutive patients referred by general practitioners (April-November 2020). Primary outcomes were presence/absence of anticipated sequelae. Binary logistic regression was used to test association between acute presentation and post-COVID-19 symptomatology. RESULTS: 155 patients (n=127 men, n=28 women, median age 39 years, median 13 weeks post-illness) were assessed using the tool. Acute symptoms were most commonly shortness of breath (SOB) (74.2%), fever (73.5%), fatigue (70.3%) and cough (64.5%); and post-acutely, SOB (76.7%), fatigue (70.3%), cough (57.4%) and anxiety/mood disturbance (39.4%). Individuals with a confirmed diagnosis of COVID-19 were 69% and 63% less likely to have anxiety/mood disturbance and pain, respectively, at 3 months. CONCLUSIONS: Rehabilitation assessment should be offered to all patients suffering post-COVID-19 symptoms, not only those with laboratory confirmation and considered independently from acute illness severity. This tool offers a structure for a remote assessment. Post-COVID-19 programmes should include SOB, fatigue and mood disturbance management.

Application of machine learning approaches to predict the impact of ambient air pollution on outpatient visits for acute respiratory infections

With a remarkable increase in industrialization among fast-developing countries, air pollution is rising at an alarming rate and has become a public health concern. The study aims to examine the effect of air pollution on patient's hospital visits for respiratory diseases, particularly Acute Respiratory Infections (ARI). Outpatient hospital visits, air pollution and meteorological parameters were collected from March 2018 to October 2021. Eight machine learning algorithms (Random Forest model, K-Nearest Neighbors regression model, Linear regression model, LASSO regression model, Decision Tree Regressor, Support Vector Regression, X.G. Boost and Deep Neural Network with 5-layers) were applied for the analysis of daily air pollutants and outpatient visits for ARI. The evaluation was done by using 5-cross-fold confirmations. The data was randomly divided into test and training data sets at a scale of 1:2, respectively. Results show that among the studied eight machine learning models, the Random Forest model has given the best performance with R2 = 0.606, 0.608 without lag and 1-day lag respectively on ARI patients and R2 = 0.872, 0.871 without lag and 1-day lag respectively on total patients. All eight models did not perform well with the lag effect on the ARI patient dataset but performed better on the total patient dataset. Thus, the study did not find any significant association between ARI patients and ambient air pollution due to the intermittent availability of data during the COVID-19 period. This study gives insight into developing machine learning programs for risk prediction that can be used to predict analytics for several other diseases apart from ARI, such as heart disease and other respiratory diseases. © 2022 Elsevier B.V.

Changing characteristics of post-COVID-19 syndrome: Cross-sectional findings from 458 consultations using the Stanford Hall remote rehabilitation assessment tool.

BACKGROUND: In the UK, there have been multiple waves of COVID-19, with a five-tier alert system created to describe the transmission rate and appropriate restrictions. While acute mortality decreased, there continued to be a significant morbidity, with individuals suffering from persistent, life-restricting symptoms for months to years afterwards. A remote rehabilitation tool was created at the Defence Medical Rehabilitation Centre (DMRC) Stanford Hall to assess post-COVID-19 symptoms and their impact on the UK military.This study aims to understand changes in post-COVID-19 syndrome between wave 1 and wave 2, identify interactions between alert level and symptoms and investigate any predictive nature of acute symptoms for postacute symptomology in a young, physically active population. METHODS: Cross-sectional study of 458 consecutive remote rehabilitation assessments performed at DMRC Stanford Hall between 2 April 2020 and 29 July 2021. Consultations were coded, anonymised, and statistical analysis was performed to determine associations between acute and postacute symptoms, and between symptoms, alert levels and waves. RESULTS: 435 assessments were eligible; 174 in wave 1 and 261 in wave 2. Post-COVID-19 syndrome prevalence reduced from 43% to 2% between the waves. Acutely, widespread pain was more prevalent in wave 2 (p<0.001). Postacutely, there was increased anxiety (p=0.10) in wave 1 and increased sleep disturbance (p<0.001), memory/concentration issues (p<0.001) and shortness of breath/cough (p=0.017) in wave 2. Increasing alert level was associated with increased postacute symptom prevalence (p=0.046), with sleep disturbance increasing at higher alert level (p=0.016). Acute symptoms, including fatigue, sleep disturbance and myalgia, were associated with multiple postacute symptoms. CONCLUSIONS: This study reports the overall prevalence and symptom burden in the UK military in the first two waves of COVID-19. By reporting differences in COVID-19 in different waves and alert level, this study highlights the importance of careful assessment and contextual understanding of acute and postacute illnesses for individual management plans.

MEETING THE DEMANDS OF EMPLOYMENT: THE IMPACT AND REHABILITATION OF CHRONIC PAIN AND FATIGUE IN THE UK ARMED FORCES

Background/Aims The growing prevalence of chronic pain and the recent influx of postviral fatigue (due to COVID-19) will limit the working output of the UK population. As such presentations become more common, the ability of the working population to meet the demands of their employment will depend on the effective management of chronic pain and fatigue. We investigated the working ability and outcomes of UK military personnel two years after rehabilitation for persistent pain or fatigue. Methods We collected the health data of 35 personnel presenting with primary persistent pain, fibromyalgia, or persistent fatigue during admission to the 2-week Specialist Rehabilitation Course at DMRC between November 2018 to December 2019. Participants scored their current ability to work and the work-related impact of their symptoms by completing a follow-up survey. This group also evaluated the efficacy of 14 evidence-based rehabilitation tools provided during their rehabilitation programme based on how they improved their ability to work. Results 88.2% of attendees had a history of mental health issues, whilst 82.4% had other medical comorbidities. Royal Air Force (RAF) personnel predominantly presented with fatigue rather than pain;this subgroup left the armed forces two years earlier than the service average. 62.9% of attendees responded to our survey. 63.6% of respondents no longer served in the military two years after their initial admission to the rehabilitation course. All current military personnel reported either 'good' or 'very good' symptom management and as a cohort reported better work outcomes than those who had left the military. Respondents reported mindfulness, activity pacing and education about symptoms as the most effective strategies for improving work capability. Those who found these strategies most useful had the best outcomes. 7 of the 8 retained military personnel found at least two of these strategies useful for improving their work ability compared to 4 of the 14 military leavers. Conclusion Poor working ability due to persistent pain or fatigue was not compatible with sustained military employment. Yet, the tools provided at DMRC improved the ability to work for those remaining in the military. Military personnel with persistent pain and fatigue benefitted most from mindfulness, activity pacing and education. Response to these specific strategies corresponded with both continued military service and better work capabilities. These findings are consistent with the recent literature regarding the efficacy of these rehabilitation strategies for persistent pain and fatigue. The occupational outcomes of military personnel in this study may be comparable to that of civilian populations;specifically sectors with similar demands or mental health risks as the armed forces.

Challenging COVID-19 and its outbreak in Pakistan and across the borders

The pandemic of COVID-19 has covered almost all the globe, due to the rapid transmission of the virus. Drastic effects have been observed in Europe 1707946 confirmed cases and 155552 deaths in America, there are 1655378 confirmed cases and 98723 deaths, in Eastern Mediterranean 255728 confirmed cases 8878 deaths, Western Pacific 159662 confirmed cases and 6470 deaths, in South-East Asia 95314 confirmed cases and 3356 deaths and in Africa 42626 cases are confirmed and 1369 deaths. New cases are being reported meanwhile government has increased its testing capacity to more than 10000 per day and up to date, 283,517 total tests for corona has been performed and 30,062 confirmed cases are reported with 659 deaths however 8,063 patients get recovered which is a hopeful situation as compared to the international scenario. Pakistan has only travel history and there was no evidence of any natural outbreak and the first case was reported quite late as compared to the globe hence its spread was not as violent as that of other countries. The timely lockdown has shown its positive results and fewer cases are reported as were expected despite the rapid transmission.

Pakistani perspective, preparation and response to COVID-19: A review

The recent 2020 emerging infection of COVID-19 was initiated from Wuhan China. At first, it spread around China and now reached more than 213 countries around the globe including Pakistan. The nurses and doctors play an important role before and during the pandemics, nursing plays a leading role in preparation for the outbreak. The clinical symptoms of COVID-19 are very similar to respiratory diseases. Every day the number of laboratory-confirmed cases associated with deaths increasing regularly in different countries around the world. Natural infections of coronavirus are seven (229E, NL63, OC43, HKUI, SARS, MERS and COVID-19). Out of seven four are mild upper respiratory infection, and SARS-CoV, MERS-CoV and COVID-19 are known for their high mortality rate. Among them, COVID-19 is an emerging viral infection responsible for pandemics. Fortunately, the mortality rate of COVID-19 is low as compared to SARS and MERS, the majority of cases are recovered in almost all the countries. The death rate toll of COVID-19 is high even after its mortality because COVID-19 causes a pandemic, while the other can't. Currently, COVID-19 influenced a large segment of the world population, which let to public health emergencies around the world, and an international concern, putting all the health organizations to high alert. The present review is on preparation, response, general continent, virology, epidemiology, clinical presentations, diagnosis, treatment and control of COVID-19 regarding Pakistan.