Challenges in Communication about COVID Medical Risks: A Speculative Educational Template

Recent descriptions of the pandemic's effect in medical offices and hospitals depict unprecedented scenarios. The impact of COVID-19 on individuals sick enough to seek professional healthcare highlights the importance of communication skills. We propose an educational framework for pre-service and in-service healthcare professionals to improve communication skills during this crisis. Clinicians need to be mindful that the perception of the seriousness of the consequences of treatment vary greatly between individual patients and families. The four-quadrant scheme we offer is a way to help providers prepare to speak effectively about medical choices related to COVID. While most situations demand more than one type of communication competency, the focus here is on what might be advisable as the primary or "lead” skill. One of the most important elements in managing COVID-19 is to empower patients with appropriate information and emotional support. Additionally, we hope this model will inspire health professions faculty to think in new ways about teaching and coaching options in the practice-based learning of communication skills. © 2023 Helen Meldrum & Mary Hardy.

D-dimer testing: A narrative review.

D-dimer containing species are soluble fibrin degradation products derived from plasmin-mediated degradation of cross-linked fibrin, i.e., 'D-dimer'. D-dimer can hence be considered a biomarker of in vivo activation of both coagulation and fibrinolysis, the leading clinical application in daily practice of which is ruling out venous thromboembolism (VTE). D-dimer has been further evaluated for assessing the risk of VTE recurrence and helping define optimal duration of anticoagulation treatment in VTE, for diagnosing disseminated intravascular coagulation (DIC), and for screening those at enhanced risk of VTE. D-dimer assays should however be performed as intended by regulatory agencies, as their use outside these indications might make them a laboratory-developed test (LDT). This narrative review is aimed at: (1) reviewing the definition of D-dimer, (2) discussing preanalytical variables affecting D-dimer measurement, (3) reviewing and comparing the assays performance and some postanalytical variables (e.g., different units and age-adjusted cutoffs), and (4) discussing the interest of D-dimer measurement across different clinical settings, including pregnancy, cancer, and coronavirus disease 2019 (COVID-19).

Gender Differences in Informal Labor-Market Resilience

This paper reports on the universe of garment-making-firm owners in a Ghanaian district capital during the COVID-19 crisis. By July 2020, 80 percent of both male- and female-owned firms were operational. However, pre-pandemic data show that selection into persistent closure differs by gender. Consistent with a "cleansing effect" of recessions and highlighting the presence of marginal female entrepreneurs, female-owned firms that remain closed past the spring lockdown are negatively selected on pre-pandemic sales. The pre-pandemic sales distributions of female survivors and non-survivors are significantly different from each other. Female owners of non-operational firms exit to non-employment and experience large decreases in overall earnings. In contrast, persistently closed male-owned firms are not selected on pre-pandemic firm characteristics. Instead, male non-survivors are 36 percentage points more likely than male survivors to have another income-generating activity prior to the crisis. Male owners of persistently closed firms fully compensate for revenue losses in their core businesses with earnings from these alternative income-generating activities. Taken together, the evidence is most consistent with differential underlying occupational choice fundamentals for self-employed men and women in this context.

Physiotherapy & Psychosocial Rehabilitation in Postcovid & Postconflict Era: New Roles with same Staff? (dispatch)

Waves of COVID-19 have been managed successfully within US, EU, Southeast Asia and Latin America, however, South Asia and Sub-saharan Africa still suffer new variants and EU fights with UK and United States of ,,new waves of old disease", postcovide or long covide syndrome. The aim of this communication and research is to prepare our auditors for the size and extent of postcovid systems and the importance of non-doctors and non-medicine experts in management of its consequences.

Service improvement project: Gestational diabetes, nutrition & lifestyle

Aims: Gestational diabetes group education was delivered face to face prior to the covid-19 pandemic. An online workshop was set up in September 2020 to deliver remote group training on diet and lifestyle for blood glucose management in pregnancy. This created a safe, supportive environment to deliver education to patients and allowed efficient use of staffing during the pandemic response. Methods: An Eventbrite page for gestational diabetes workshop was set up and a presentation with additional resources created. A midwife referral system was created from two hospital sites and participants recruited weekly. Sessions were delivered online via Microsoft Teams and emails with resources sent to patients after the workshop. Data was collected on Excel regarding attendance and a follow up questionnaire via Survey Monkey. Results: Twenty six online workshops over eight months (November 2020-June 2021) had a total of 166 patient bookings. There was equal distribution across the two sites and an attendance rate of 59%. Forty patients completed the Survey Monkey questionnaire where it was found that 100% enjoyed and would recommend the session;47.5% strongly agree and 52.5% agree that they have a good understanding of Gestational Diabetes and how to manage it and 40% strongly agree, 57.5% agree and 2.5% neither agree/disagree with being confident to manage Gestational diabetes with diet and exercise. Conclusion: Virtual group workshops are an effective way to educate gestational diabetes patients on their diet and lifestyle to manage their blood glucose.

Chronic Post-Covid-19 Syndrome - a Variety of the Chronic Fatigue Disease?

Introduction: Several viral diseases after cure may proceed to Chronic fatigue disease or syndrome (CFS) known years or decades as late consequence of e.g. Infectious mononucleosis or other EBV and CMV infection. Methods: Here we present current occurence patophysiology and consequences of chronic fatigue syndrom caused by coronaviruses (chronic postcovid syndrom). Results: After millions with Covid-19 have been cured, this good news has to be taken with caution, such as a new entity similar to chronic fatigue syndrome have occurred and is named similarly as, chronic fatigue-as chronic postcovid syndrome. © 2021. All Rights Reserved.

Influence of C-reactive protein on thrombin generation assay

Background : C-reactive protein (CRP) is an acute phase reactant plasma protein considered as biomarker representative of the burden of inflammation also linked to the development of prothrombotic states. In moderate to severe COVID-19 patients, persistent elevated levels of CRP were observed contributing to the risk of venous thromboembolic events. CRP is known to artefactually interfere with certain coagulation assays. As the use of global coagulation test like thrombin generation assay (TGA) may be relevant to characterize the evolution of the disease or identify its severity, it is interesting to investigate the impact of CRP on TGA. Aims : This study aimed to assess how CRP impacts TGA on the automated ST Genesia system, using the STG-ThromboScreen-TM as triggering reagent. A comparison with the Calibrated Automated Thrombogram (CAT) system was performed. Methods : Normal pooled plasma (NPP) constituted of 50 healthy individuals was used as the matrix. Human CRP (Merk, Germany) was spiked in NPP at five relevant plasma concentrations (0 [=Phosphate buffer saline], 50, 100, 200 and 350 mg/L). Both TGA methods were performed in duplicate and assessed by 3 independent runs. Results : Based on mean values, no statistically significant difference was observed between the five tested concentrations ( P -value >0.05), regardless of the platform used. On the other hand, the comparison between both analyzers showed significant differences for lag-time and time-to-peak, which were significantly higher when TGA was performed on the CAT system. These differences are possibly associated with the specific algorithm of each platform. Conclusions : This study demonstrated that CRP levels up to 350 mg/L did not impact significantly thrombin generation performed either on CAT or on ST Genesia system. Therefore, TGA could be an efficient test to assess the hemostatic function of patients with elevated CRP, like those in sepsis and suffering from chronic or acute inflammatory conditions, such as COVID-19.

Is viscoelastometric testing a good tool to assess hemostasis of COVID-19 patients?

Background : Infection by SARS-CoV-2 is associated with a high risk of thrombosis. The laboratory documentation of hypercoagulability and impaired fibrinolysis remains a challenge. Aims : Our main aim was to assess the potential usefulness of viscoelastometric testing (VET) to predict thrombotic events in COVID-19 patients according to the literature. Our secondary aims were: (i) to analyze the impact of anticoagulation and the methods used to neutralize heparin, (ii) to see whether maximal clot mechanical strength brings more information than Clauss fibrinogen, and (iii) to point out results from studies with enhanced fibrinolysis modified tests. Methods : We performed a systematic search in PubMed and Scopus databases, until December 31st, 2020 (Figure 1). VETs methods and parameters, as well as patients ' features and outcomes were extracted. Results : VET was performed for 1063 patients (893 ICU and 170 non-ICU, n = 44 studies). There was a huge heterogeneity concerning study design, the VET device (ROTEM, TEG, Quantra and ClotPro) and reagents (with non-systematic use of heparin neutralization by heparinase and/or polybrene), timing of assay, and definition of hypercoagulable state. The common findings were an increased clot mechanical strength mainly due to an excessive fibrinogen component with impaired to absent fibrinolysis, more conspicuous in the presence of an added plasminogen activator. This profile was associated with an uncontrolled thrombin generation despite a standard thromboprophylaxis. However, only 4 studies out of 16 that addressed this point found an association of VETs with thrombotic events. Functional fibrinogen assessed by VET showed a variable correlation with Clauss fibrinogen. Abnormal VET pattern tended to normalization after an enhancement in thromboprophylaxis. Notably, only 4 studies out of 25 using ROTEM reported data where heparin is neutralized by heparinase (HEPTEM). Conclusions : The heterogeneity among VET studies and small sample sizes do not permit to point out an association between the illdefined hypercoagulable state and thrombotic events.

Management of the thrombotic risk associated with COVID-19: guidance for the hemostasis laboratory.

Coronavirus disease 2019 (COVID-19) is associated with extreme inflammatory response, disordered hemostasis and high thrombotic risk. A high incidence of thromboembolic events has been reported despite thromboprophylaxis, raising the question of a more effective anticoagulation. First-line hemostasis tests such as activated partial thromboplastin time, prothrombin time, fibrinogen and D-dimers are proposed for assessing thrombotic risk and monitoring hemostasis, but are vulnerable to many drawbacks affecting their reliability and clinical relevance. Specialized hemostasis-related tests (soluble fibrin complexes, tests assessing fibrinolytic capacity, viscoelastic tests, thrombin generation) may have an interest to assess the thrombotic risk associated with COVID-19. Another challenge for the hemostasis laboratory is the monitoring of heparin treatment, especially unfractionated heparin in the setting of an extreme inflammatory response. This review aimed at evaluating the role of hemostasis tests in the management of COVID-19 and discussing their main limitations.