Audit on changes in new born heart murmur follow-up pathway due to covid pandemic

AimsBackgroundHeart murmurs in a new born are common due to transition from fetal circulation to neonatal circulation. Majority of these heart murmurs disappear in few days, but they can also be a sign of underlying congenital heart disease. In UK the practice in majority of neonatal units is, heart murmur in an asymptomatic new born with normal examination and passing pulseOx, is reviewed again by middle grade after 24 hours. If the murmur is innocent (Grade 1-2/6, no signs or symptoms) then baby is brought back to neonatal clinic in 4 -6 weeks for follow-up. Due to the Covid pandemic in March 2020 our unit policy changed for all innocent murmurs to be followed up by the GP at 6 – 8 weeks.ObjectiveTo assess the outcome of change in policy of heart murmur follow-up during the pandemic.MethodsA retrospective study from March 2020 – June 2021 (15 months). Data collected of infants who had a heart murmur on routine newborn examination, using NIPE Smart data, admission notes, Badger and postnatal notes. Infants discharged for GP follow up as per revised guideline were identified, and parents of these infants were contacted to enquire about GP follow up and the outcome.ResultsDuring the audit period, 101 infants were found to have a heart murmur on routine neonatal examination.Of these 101:• 72 had resolved on middle grade review after 24 hours• 11 received inpatient ECHO before discharge.• 18 were discharged for GP review at 6-8 weeks.17 of 18 parents of these infants were contacted, with one baby excluded due to incorrect data. 16 were aware of the heart murmur at the time of discharge.17/17 (100%) patients contacted had a GP review at 6-8 weeks as planned.At this review, the murmur persisted in 4/17 (24%) infants. One of these infants was re-reviewed by the GP and subsequently resolved, and a further two infants were referred to paediatrics for ECHO. The final infant was not referred or re-reviewed, but has remained clinically well.ConclusionAll infants discharged for GP follow up were reviewed, and all have remained clinically well since discharge. Murmur had resolved in the majority of infants. Where the murmur persisted, the infant was appropriately referred or re-reviewed in the majority of cases. Asymptomatic infants with low grade (likely innocent) murmurs, we can continue to discharge home with GP follow-up.

Learning from the COVID-19 Pandemic Crisis to Overcome the Global Environmental Crisis

The COVID-19 crisis and the environmental crisis share a range of similarities. Both crises take place on a global scale and affect all aspects of our lives. However, we humans respond differently to these challenges. Here, we compare and comment on characteristics of the COVID-19 crisis and the environmental crisis, explore how far these two crises are comparable, and what we can learn from actions that have been taken against the COVID-19 crisis. We discuss how human societies are affected by the respective crises, and analyze policy makers' responses and offer pathways to better inform policy. We highlight the role of science, which significantly contributed to decision making throughout the COVID-19 crisis, but seems frequently underrepresented in the environmental crisis. We conclude that there are significant differences between the two crises in terms of perceptibility and thus communicability. While problems and solutions in the COVID-19 crisis are largely linearly correlated, the challenges of the environmental crisis are far more complex and decoupled, and thus appear much more complex and are often only perceived with difficulty by humans. Thus, tackling the environmental crisis is much more challenging than solving the COVID-19 crisis. To overcome the environmental crisis, purely technical approaches for combating symptoms are not sufficient. However, political interests are usually short-term, and do not correspond with the temporal and spatial scales of global change. There is an urgent need to improve institutionalized scientific advisory mechanisms and to empower global policy makers who are independent of local interest groups. Furthermore, we need the sound communication of complex interactions to the general public and the translation of scientific findings into action. One possibility to achieve this is to bring together natural scientists with expertise in biology, climate and geosciences and social scientists, psychologists, and, possibly, artists.

Predictors of Audio-Only Versus Video Telehealth Visits During the COVID-19 Pandemic.

BACKGROUND: Most health insurance organizations reimbursed both video and audio-only (i.e., phone) visits during the COVID-19 pandemic, but may discontinue phone visit coverage after the pandemic. The impact of discontinuing phone visit coverage on various patient subgroups is uncertain. OBJECTIVE: Identify patient subgroups that are more probable to access telehealth through phone versus video. DESIGN: Retrospective cohort. PATIENTS: All patients at a U.S. academic medical center who had an outpatient visit that was eligible for telehealth from April through June 2020. MAIN MEASURES: The marginal and cumulative effect of patient demographic, socioeconomic, and geographic characteristics on the probability of using video versus phone visits. KEY RESULTS: A total of 104,204 patients had at least one telehealth visit and 45.4% received care through phone visits only. Patient characteristics associated with lower probability of using video visits included age (average marginal effect [AME] -6.9% for every 10 years of age increase, 95%CI -7.8, -4.5), African-American (AME -10.2%, 95%CI -11.4, -7.6), need an interpreter (AME -19.3%, 95%CI -21.8, -14.4), Medicaid as primary insurance (AME -12.1%, 95%CI -13.7, -9.0), and live in a zip code with low broadband access (AME -7.2%, 95%CI -8.1, -4.8). Most patients had more than one factor which further reduced their probability of using video visits. CONCLUSIONS: Patients who are older, are African-American, require an interpreter, use Medicaid, and live in areas with low broadband access are less likely to use video visits as compared to phone. Post-pandemic policies that eliminate insurance coverage for phone visits may decrease telehealth access for patients who have one or more of these characteristics.

Outcomes of seizures, status epilepticus, and EEG findings in critically ill patient with COVID-19.

OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has a myriad of neurological manifestations and its effects on the nervous system are increasingly recognized. Seizures and status epilepticus (SE) are reported in the novel coronavirus disease (COVID-19), both new onset and worsening of existing epilepsy; however, the exact prevalence is still unknown. The primary aim of this study was to correlate the presence of seizures, status epilepticus, and specific critical care EEG patterns with patient functional outcomes in those with COVID-19. METHODS: This is a retrospective, multicenter cohort of COVID-19-positive patients in Southeast Michigan who underwent electroencephalography (EEG) from March 12th through May 15th, 2020. All patients had confirmed nasopharyngeal PCR for COVID-19. EEG patterns were characterized per 2012 ACNS critical care EEG terminology. Clinical and demographic variables were collected by medical chart review. Outcomes were divided into recovered, recovered with disability, or deceased. RESULTS: Out of the total of 4100 patients hospitalized with COVID-19, 110 patients (2.68%) had EEG during their hospitalization; 64% were male, 67% were African American with mean age of 63 years (range 20-87). The majority (70%) had severe COVID-19, were intubated, or had multi-organ failure. The median length of hospitalization was 26.5 days (IQR = 15 to 44 days). During hospitalization, of the patients who had EEG, 21.8% had new-onset seizure including 7% with status epilepticus, majority (87.5%) with no prior epilepsy. Forty-nine (45%) patients died in the hospital, 46 (42%) recovered but maintained a disability and 15 (14%) recovered without a disability. The EEG findings associated with outcomes were background slowing/attenuation (recovered 60% vs recovered/disabled 96% vs died 96%, p < 0.001) and normal (recovered 27% vs recovered/disabled 0% vs died 1%, p < 0.001). However, these findings were no longer significant after adjusting for severity of COVID-19. CONCLUSION: In this large multicenter study from Southeast Michigan, one of the early COVID-19 epicenters in the US, none of the EEG findings were significantly correlated with outcomes in critically ill COVID-19 patients. Although seizures and status epilepticus could be encountered in COVID-19, the occurrence did not correlate with the patients' functional outcome.