ABSTRACT
Objective: To examine risk factors for cardiac-related postacute sequelae of SARS-CoV-2 infection (PASC) in community-dwelling adults after acute COVID-19 infection. Methods: We performed a cross-sectional analysis among adults who tested positive for COVID-19. Outcomes were self-reported cardiac-related PASC. We conducted stepwise multivariable logistic regression to assess association between the risk factors (existing cardiovascular disease (CVD), pre-existing conditions, days since positive test, COVID-19 hospitalisation, age, sex, education, income) and cardiac-related PASC. Results: In a sample of 442 persons, mean (SD) age was 45.4 (16.2) years, 71% were women, 13% were black, 46% had pre-existing conditions, 23% had cardiovascular (CV) risk factors and 4% had CVD. Prevalence of cardiac PASC was 43% and newly diagnosed cardiac conditions were 27%. The odds for cardiac-related PASC were higher among persons with underlying pre-existing conditions (adjusted OR (aOR): 2.00, 95% CI: 1.28 to 3.10) and among those who were hospitalised (aOR: 3.03, 95% CI: 1.58 to 5.83). Conclusions: More than a third of persons with COVID-19 reported cardiac-related PASC symptoms. Underlying CVD, pre-existing diseases, age and COVID-19 hospitalisation are possible risk factors for cardiac-related PASC symptoms. COVID-19 may exacerbate CV risk factors and increase risk of complications.
ABSTRACT
The COVID-19 pandemic left an unprecedented impact on the general public health, resulting in hundreds of thousands of deaths in the U.S. alone. Nationwide testing plans were initiated with drive-through being the currently dominant testing approach, which, however, exhausts personal protective equipment supplies, and is unfriendly to individuals not owning a vehicle. Walkup positive pressure testing booths are a safe alternative, whereby a health care provider situated on the inside of an enclosed and positively pressurized booth swabs a patient on the outside through chemical resistant gloves. The booths, however, are too prohibitively priced on the market to allow for nationwide deployment. To mitigate this, we present in this paper a safe, accessible, mobile, and affordable design of positive-pressure COVID-19 testing booths. The booths have successfully passed the Centers for Disease Control and Prevention and Health care Infection Control Practices Advisory Committee pressure, air exchange, and air quality requirements for positive-pressure rooms, following the guidelines for environmental infection control in health care facilities. The booths are manufactured using primarily off-the-shelf components from U.S. vendors with minimized customization, and the final bill of materials does not surpass USD 3,900. Since August 2019, five booths were deployed and used at the Johns Hopkins University School of Nursing, Baltimore City Health Department, and two community health centers in Baltimore. No health care provider was infected when using our booths, which have shown to facilitate walkup testing with decreased personal protective equipment consumption, reduced risk of infection, and enhanced accessibility to lower-income communities and nondrivers. Copyright © 2022 by ASME.
ABSTRACT
BACKGROUND: In COVID-19 pandemic, hospitals become overwhelmed with acute admissions leading to the suspension of outpatient clinics including gastroenterology and endoscopic services. Similarly available resources are channeled to combat the scourge. These diversions of resources coupled with lockdowns and fear of getting infected prevent patients from accessing routine and lifesaving gastroenterology services leading to increased gastrointestinal-related morbidity and mortality in at-risk populations. Often, there are delays in the diagnosis and early treatment of gastrointestinal cancers, and high risks of death from gastrointestinal bleeding. SUMMARY: This review discusses COVID-19 risk factors and ways and means of ensuring safe essential gastroenterology services in the setting of COVID-19 pandemic based on available evidence. Telemedicine avoids physical contacts, maximizes safety by reducing the risk of infection to both clinicians and patients, and is conducive to a lockdown, quarantine, or self-isolation environment of COVID-19. It can be used to triage critical cases requiring life-saving endoscopic procedures. The review also explores measures at derisking endoscopies being high-risk aerosol generating procedures. The emerging technology of non-contact endoscopy in the form of robotic endoscopy raises hope in this direction.
ABSTRACT
AIM: To argue that nurse practitioners have been under-utilized generally in the current global health environment, creating barriers to achieving universal health coverage and the Sustainable Development Goals. BACKGROUND: Nurse practitioners are advanced practice nurses possessing expert knowledge and leadership skills that can be optimized to narrow disparities and ensure access to high-quality health care globally. Nurses worldwide have been challenged to meet global public health needs in the context of COVID-19 (SARS-CoV-2 virus), and there are early indications that nurse practitioners are being called upon to the full extent of their capabilities in the current pandemic. SOURCES OF EVIDENCE: PubMed; Google Scholar; the International Council of Nurses; World Health Organization; United Nations; and the experiences of the authors. DISCUSSION: Several international reports, nursing and health organizations have called for continued investment in and development of nursing to improve mechanisms that promote cost-effective and universally accessible care. Expanding nurse practitioner scopes of practice across nations will leverage their clinical capacities, policy and advocacy skills, and talents to lead at all levels. CONCLUSION: Ongoing empirical data and policy change is needed to enable the full scope and strategic utilization of nurse practitioners across healthcare systems and contexts. IMPLICATIONS FOR NURSING PRACTICE, AND NURSING AND HEALTH POLICY: Widespread education regarding nurse practitioner capacities for interdisciplinary partners, policymakers and the public is needed. Policies that safely expand their roles are critical. Role titles and remuneration reflective of their scope and service are required to lead, sustain and grow the workforce internationally.