ABSTRACT
Introduction and Objectives: Limited healthcare access and resource inequities pose significant barriers to care, all of which have been amplified during the COVID-19 pandemic. DFUs represent an especially challenging medical problem to prevent and treat due to the resource intensive care required. We sought to evaluate the feasibility of multidisciplinary, mobile, DFU outreach clinics to improve access to care. Method(s): Our clinic model focused on creating mobile diabetic foot clinics staffed by volunteer clinical providers who specialize in Vascular Surgery, Diabetes, and Podiatry. We recruited volunteer healthcare providers from an academic medical center. We partnered with local community centers with established programs providing services to unhoused individuals. Result(s): Between June 2020 and August 2022, a total of 130 unhoused individuals were seen at four mobile clinics set up at different locations. Diabetic foot care was provided by volunteers from seven departments: Endocrinology/Diabetes, Vascular Surgery and Vascular Lab, Podiatry, Addiction Medicine, Smoking Cessation, and Financial. On average, 32 healthcare provider volunteers participated at each clinic. Services provided include: vitals, blood glucose, HgA1c, lipid panel testing, ankle-brachial index, podiatric exam, wound care, medical education, COVID vaccination/booster, insurance enrollment, and new socks and shoes. Of 130 unhoused patients, 29% had hypertension (38), 34% had abnormal ABI (44), and 14% had diabetes (18). Fifteen patients were further identified as high risk for developing DFU-associated amputation (12%) and were provided with ambulatory follow-ups. Conclusion(s): In our pilot experience, it is feasible to provide consistent comprehensive DFU care through mobile outreach clinics. By using the infrastructure of partner organizations and healthcare expertise of an academic center, our clinics could integrate into existing community services. [Formula presented]Copyright © 2022
ABSTRACT
Introduction: Extracorporeal membrane oxygenation (ECMO) is increasingly instituted for patients with severe circulatory or respiratory failure and as bridge to recovery or destination therapies (device implantation or organ transplantation). Morbidity and mortality for those patients is high. Hypothesis: ECMO combined with COVID isolation presents an additional set of challenges for patients, families. Objective: To test feasibility of an early, concurrent, and semi-structured palliative care intervention in improving communication, clarifying goals of care, and highlighting the experience of patients' families. Methods: IRB Approved Qualitative study using content analysis of guided, in-depth discussions with families of COVID-19 patients within 48-72 hours of being cannulated for ECMO between March-October 2020. Scripted template was developed to guide and facilitate goals of care conversations and to ensure consistent communication with family members throughout patients' disease trajectory. Patient demographics, comorbidities, clinical course, length of stay, and discharge disposition was obtained from the institution's COVID-19 Data Warehouse and analyzed using descriptive statistics Setting: Large urban academic medical center. Results: Patients were 44 ± 10 years, Hispanic or Latino 27/43 (63%), white 3 (7%), Black 8 (19%). Palliative care documentation for ECMO acknowledgement meeting was 36/43 (84%). Timely and guided communication demonstrated themes expressed by families including 1) social isolation and related grief of not being at patient's bedside;2) helping children of patients adjust to a new normal;3) coping with multiple family members suffering from COVID-19;4) importance of faith and spirituality;5) need for hope and gratitude 6) futility of prolonged ECMO stay. Survival to discharge 24/43 (56%). There was no statistical difference in hospital survival or length of stay between patients with and without documented palliative care. Conclusions: Early and ongoing palliative care intervention is feasible to support families' acknowledgment of complexity, benefits and limitations of ECMO, and it is useful in highlighting families' experiences, managing expectations and alleviating suffering.
ABSTRACT
The effect of confinement on intimate partner violence is hard to assess, partly because of usual endogeneity problems, but also because the often‐used report calls poorly measure that violence. We exploit self‐reported survey data from Argentina to study the extent to which the coronavirus pandemic quarantine had unintended consequences on intimate partner violence. The quarantine decree established clear exceptions for heterogeneous subsets of the population and, for reasons plausibly exogenous to the prevalence of intimate partner violence, only some individuals were forced to spend more time with their partners. Using this variability in exposure we find that the lockdown led to an increase between 12% and 35% in intimate partner violence, depending type of violence (emotional, physical or sexual). Given the Argentinian government imposed the full national lockdown when few people felt threatened by the virus, these effects are likely to have been triggered by the actual confinement.
ABSTRACT
The effect of confinement on intimate partner violence is hard to assess, partly because of usual endogeneity problems, but also because the often‐used report calls poorly measure that violence. We exploit self‐reported survey data from Argentina to study the extent to which the coronavirus pandemic quarantine had unintended consequences on intimate partner violence. The quarantine decree established clear exceptions for heterogeneous subsets of the population and, for reasons plausibly exogenous to the prevalence of intimate partner violence, only <italic>some</italic> individuals were forced to spend more time with their partners. Using this variability in exposure we find that the lockdown led to an increase between 12% and 35% in intimate partner violence, depending type of violence (emotional, physical or sexual). Given the Argentinian government imposed the full national lockdown when few people felt threatened by the virus, these effects are likely to have been triggered by the actual confinement. [ABSTRACT FROM AUTHOR] Copyright of Kyklos is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)