Nutrition Risk, Resilience and Effects of a Brief Education Intervention among Community-Dwelling Older Adults during the COVID-19 Pandemic in Alberta, Canada.

Up to two-thirds of older Canadian adults have high nutrition risk, which predisposes them to frailty, hospitalization and death. The aim of this study was to examine the effect of a brief education intervention on nutrition risk and use of adaptive strategies to promote dietary resilience among community-dwelling older adults living in Alberta, Canada, during the COVID-19 pandemic. The study design was a single-arm intervention trial with pre-post evaluation. Participants (N = 28, age 65+ years) in the study completed a survey online or via telephone. Questions included the Brief Resilience Scale (BRS), SCREEN-14, a brief poverty screen, and a World Health Organization-guided questionnaire regarding awareness and use of nutrition-related services and resources (S and R). A brief educational intervention involved raising participant awareness of available nutrition S and R. Education was offered via email or postal mail with follow-up surveys administered 3 months later. Baseline and follow-up nutrition risk scores, S and R awareness and use were compared using paired t-test. Three-quarters of participants had a high nutrition risk, but very few reported experiencing financial strain or food insecurity. Those at high nutrition risk were more likely to report eating alone, compared to those who scored as low risk. There was a significant increase in awareness of 20 S and R as a result of the educational intervention, but no change in use. The study shows increasing individual knowledge about services and resources in the community is not sufficient to change use of these services or improve nutrition risk.

Prevalence and Workplace Drivers of Burnout in Cancer Care Physicians in Ontario, Canada.

PURPOSE: Provider well-being has become the fourth pillar of the quadruple aim for providing quality care. Exacerbated by the global COVID-19 pandemic, provider well-being has become a critical issue for health care systems worldwide. We describe the prevalence and key system-level drivers of burnout in oncologists in Ontario, Canada. METHODS: This is a cross-sectional survey study conducted in November-December 2019 of practicing cancer care physicians (surgical, medical, radiation, gynecologic oncology, and hematology) in Ontario, Canada. Ontario is Canada's largest province (with a population of 14.5 million), and has a single-payer publicly funded cancer system. The primary outcome was burnout experience assessed through the Maslach Burnout Inventory. RESULTS: A total of 418 physicians completed the questionnaire (response rate was 44% among confirmed oncologists). Seventy-three percent (n = 264 of 362) of oncologists had symptoms of burnout (high emotional exhaustion and/or depersonalization scores). Significant drivers of burnout identified in multivariable regression modeling included working in a hectic or chaotic atmosphere (odds ratio [OR] = 15.5; 95% CI, 3.4 to 71.5; P < .001), feeling unappreciated on the job (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), reporting poor or marginal control over workload (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), and not being comfortable talking to peers about workplace stress (OR = 3.0; 95% CI, 1.1 to 7.9; P < .001). Older age (≥ 56 years) was associated with lower odds of burnout (OR = 0.16; 95% CI, 0.1 to 0.4; P < .001). CONCLUSION: Nearly three quarters of participants met predefined standardized criteria for burnout. This number is striking, given the known impact of burnout on provider mental health, patient safety, and quality of care, and suggests Oncologists in Ontario may be a vulnerable group that warrants attention. Health care changes being driven by the COVID-19 pandemic provide an opportunity to rebuild new systems that address drivers of burnout. Creating richer peer-to-peer and leadership engagement opportunities among early- to mid-career individuals may be a worthwhile organizational strategy.

A dynamic, D-dimer-based thromboprophylaxis strategy in patients with COVID-19

Background While Coronavirus disease 2019 (COVID-19) is associated with increased risk for venous thromboembolism (VTE) during hospitalization despite prophylactic anticoagulation, there is a lack of evidence-based guidelines for dose escalation of anticoagulation for patients hospitalized with COVID-19. Methods This single-center retrospective cohort study was part of a quality improvement program evaluating safety and efficacy of anticoagulation protocols at our large, metropolitan public hospital. We implemented a D-dimer-based guideline for dosing unfractionated heparin (UFH) or low molecular weight heparin (LMWH) in COVID-19 hospitalized patients that allowed for up-titration from standard prophylactic dosing to escalated prophylactic dosing or therapeutic dosing based on patient risk and presence of known or highly suspected VTE. Primary endpoints were International Society on Thrombosis and Haemostasis (ISTH)-defined major and clinically relevant non-major bleeding (CRNMB) events and in-hospital survival. Findings Among 262 COVID-19-infected patients hospitalized between March 15th and June 15th, 2020, 125 (73.1%) were male. Highest anticoagulation dose was: 65.3% prophylactic, 13.4% escalated prophylactic, 21.4% therapeutic. The dose was uptitrated in 83 (31.6%) patients. Bleeding events were comparable between the therapeutic (12.5%) and escalated prophylactic groups (11.4%), but significantly higher than in the prophylactic group (1.2%). In-hospital survival at 28 days was superior among patients whose anticoagulation was uptitrated to either escalated prophylactic or therapeutic (77.6%), compared to those receiving fixed prophylactic (56.7%) or fixed therapeutic (26.7%) dosing (p = 0.001). Conclusion A dynamic, D-dimer based dose escalation of anticoagulation for hospitalized patients with COVID-19 may improve in-hospital mortality without increasing fatal bleeding.

Profiling severe acute respiratory syndrome coronavirus 2 and its relevance to otolaryngologic examinations during the coronavirus disease 2019 pandemic.

PURPOSE OF REVIEW: The WHO announced the coronavirus disease 2019 (COVID-19) outbreak as a pandemic in February 2020 with over 15 million confirmed cases of COVID-19 globally to date. Otolaryngologists are at a high risk of contracting COVID-19 during this pandemic if there is inadequate and improper personal protective equipment provision, as we are dealing with diseases of the upper-aerodigestive tract and routinely engaged in aerosol-generating procedures. RECENT FINDINGS: This article discusses the background and transmission route for severe acute respiratory syndrome coronavirus 2, its viral load and temporal profile as well as precaution guidelines in outpatient and operative setting in otorhinolaryngology. SUMMARY: As it is evident that COVID-19 can be transmitted at presymptomatic or asymptomatic period of infections, it is essential to practice ear, nose, and throat surgery with high vigilance in a safe and up-to-standard protection level during the pandemic. This article provides a summary for guidelines and recommendations in otorhinolaryngology.