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Purpose of Study The current depart process resulted in slow work-flow and patient safety and equity concerns. The QI project aimed to improve resident satisfaction with the hospital discharge process. Methods Used The QI project was designed using the Model for Improvement. Starting April 2020, Plan-Do-Study-Act cycles included: hiring clinical team coordinators;creating standard depart instructions for diabetic ketoacidosis, pyelonephritis, seizures, croup and dehydration;uploading instructions to Powerchart;and clinician reminders to use instructions with families. Measures examined monthly, included resident satisfaction and patient readmissions. Summary of Results Resident satisfaction improved from 4.8 (February 2020) to 7.8 (August 2020) for the overall discharge process;from 5.3 to 7.9 for family education on all key points;from 6.0 to 7.7 for smooth transition of care;from 3.0 to 7.4 for no language barriers;and from 3.0 to 6.7 for no unnecessary delays, on a scale of 0/strongly disagree/ terrible to 10/strongly agree/excellent. Readmissions also trended downward. Conclusions During this QI project to address the depart process, resident satisfaction improved and readmissions declined. These results are encouraging, but should be interpreted in the context of decreased patient census due to COVID-19 and non-respiratory season, which may have decreased workload and increased education time and interpreter access. Next steps include PDSAs related to health literacy and Spanish translation.
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The COVID-19 pandemic has considerably affected global economies and societies, exacerbating existing social inequalities. This "syndemic” pandemic has placed people and communities affected by modern slavery and human trafficking at elevated risk of multiple harms. This paper uses a mix of methods–an evidence synthesis, a survivor survey, web-monitoring, and dialogue events–to explore how COVID-19 has affected the risks and pathways to harm associated with modern slavery/human trafficking in the UK and U.S. We use concepts of hazard, risk, exposure, and harm and the tools of public health risk and resilience assessment to examine how COVID-19 has amplified existing risks of harm and generated new pathways to further harm. We also use a novel complex systems approach to represent risk relationships and demonstrate how the economic shock of COVID-19 and mandated social isolation have led to negative outcomes for affected people. The paper provides policy and practice insight into interventions can be implemented across systems to minimize exploitation and how locally led intervention can offset the damaging effects of the pandemic (SDGs 5 & 16). © 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.
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This letter discusses mental health care after the COVID-19 outbreak by presenting preliminary findings from a public general hospital in Madrid. The pandemic caused by the SARS-CoV-2 poses a major challenge for national health systems around the globe. In these situations, healthcare centers are urged to adjust their structures to the demands of the outbreak in order to protect both the users and the workers. However, this emergency has no precedent in the recent history, and entire hospitals and clinics need further adaptations for which there is no previous evidence. This affects mental healthcare teams, which deal with the unknown psychological consequences of an overwhelming, global crisis. La Paz University Hospital is a public general hospital that provides healthcare to a catchment area of more than half a million people in Madrid. So far, more than 2,700 confirmed cases of SARS-CoV-2 have been attended in this hospital, which required a complete restructuring process. A few days after the outbreak, its mental health team managed to develop a COVID-19 intervention protocol that was based on its previous experience during the 2014 Ebola crisis in Madrid and on the reports that were coming from China. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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Introduction: the COVID-19 pandemic has affected different populations, of which the most vulnerable is the elderly, since in this population there are more risk factors than protective factors against a disease that has a varied symptomatology, all this has generated in the elderly a feeling of helplessness and insecurity, which can become symptoms of an anxiety disorder. Aim: to analyze the anxiety level of older adults during the COVID-19 pandemic. Methodology: it corresponds to a quantitative research design of descriptive observational and correlational cross-sectional cohort type. Results: regarding demographic variables, it was found that most of the population studied were men between 60 and 79 years of age;the older adults of Santa Rosa parish have a moderate level of anxiety;15 of the 21 symptoms evaluated by the Beck Anxiety Inventory (BAI) were presented with equal intensity in men and women. Conclusions: the most frequent symptoms were strong and accelerated heartbeat, weakening of legs, fear of the worst happening, feeling dizzy, insecurity and trembling body, all these symptoms are found in the test used (Beck Anxiety Inventory or BAI);the most frequent anxiety level was moderate anxiety. © Este es un artículo en acceso abierto.
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Introduction: the COVID-19 pandemic has affected different populations, of which the most vulnerable is the elderly, since in this population there are more risk factors than protective factors against a disease that has a varied symptomatology, all this has generated in the elderly a feeling of helplessness and insecurity, which can become symptoms of an anxiety disorder. Aim: to analyze the anxiety level of older adults during the COVID-19 pandemic. Methodology: it corresponds to a quantitative research design of descriptive observational and correlational cross-sectional cohort type. Results: regarding demographic variables, it was found that most of the population studied were men between 60 and 79 years of age;the older adults of Santa Rosa parish have a moderate level of anxiety;15 of the 21 symptoms evaluated by the Beck Anxiety Inventory (BAI) were presented with equal intensity in men and women. Conclusions: the most frequent symptoms were strong and accelerated heartbeat, weakening of legs, fear of the worst happening, feeling dizzy, insecurity and trembling body, all these symptoms are found in the test used (Beck Anxiety Inventory or BAI);the most frequent anxiety level was moderate anxiety. © Este es un artículo en acceso abierto.
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Background. Cancer patients (CPs) with COVID-19 have an increased risk of adverse outcomes. In addition, CPs seem to have a lower immune response to SARS-CoV-2 vaccination. This study aimed to evaluate SARS-CoV-2 spike antibodies (anti-S Abs) following COVID-19 vaccination in CPs and healthcare workers (HCWs). Methods. We conducted a point-seroprevalence study in CPs and HCWs who received a two-dose scheme with either BNT162b2, AZD1222, or Sputnik-V vaccine. We measured anti-S Abs by quantitative immunoassay to assess humoral immune response. Besides, we quantified anti-nucleocapsid antibodies in a subgroup of individuals to determine prior infection. We compared anti-S Abs titers in both groups and stratified by vaccine type, prior infection, and clinical characteristics. We conducted a multivariate logistic regression to determine variables associated with a poor humoral response. Results. Six hundred forty-one individuals were included: 174 (27%) CPs and 467 (73%) HCWs. The median anti-S Abs titter was higher among HCWs compared to CPs (2568 U/mL vs. 1807 U/mL, p=0.002). Both CPs and HCWs with prior infection had higher anti-S Abs titter (p< 0.001). Regardless of the time since vaccination, a higher proportion of subjects with titers < 250 U/mL was observed in CPs (p< 0.001) (Fig 2). In the multivariate analysis, older age (p=0.036), AZD1222 (p=0.003), and Sputnik-V (p=0.020) were associated with lower humoral response among the entire cohort. SARS-CoV-2 spike antibody titers among cancer patients and healthcare workers. Global differences in anti-S Abs titers between CPs and HCWs groups (a) and antibody titers in CPs and HCWs groups stratified by type of received vaccine (b). Abbreviations: CP: Cancer patients, HCW: Healthcare workers. SARS-CoV-2 spike antibody titers according to time since vaccination among cancer patients and healthcare workers. Abbreviations: CP: Cancer patients, HCW: Healthcare workers. Conclusion. In this study, both CPs and HCWs showed an adequate response to vaccination;however, CPs had lower anti-S Abs titers and a faster decline over time. Based on our results, new strategies should be assessed to sustain the humoral response to vaccination and thus decrease the COVID-19 burden among the oncologic population.
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Introduction: Long-term COVID-19 effects has been recently described as persistent and prolonged symptoms after an acute and severe SARS-COV-2 (1). An important concern is that the sequelae of severe COVID-19 may suppose a substantial outpatient's burden for the specialized services in reopening pandemic phase (2). Objective(s): To describe the frequency of mental health service use in COVID-19 hospitalized patients after discharge and to estimate the costs associated to the post- discharge consultations. Method(s): We used a 1-year follow-up cohort of 1455 COVID-19 inpatients hospitalized in La Paz University Hospital of Madrid, Spain between March 16th and April 15th, 2020. Data were retrieved from Psychiatry Service (PS) electronic health records and we described the frequency of mental health reason for consultation. We used information published by the Madrid health Office to estimate the cost of initial and following appointments. Result(s): Our sample consisted of 1,455 patients admitted with a COVID-19 diagnosis between March 16th and April 15th, 2020, and then discharged. Roughly half of them were men (776, 53%), 238 (16%) had a prior history of mental health problems, and 44 (3%) died. 193 participants (13%) visited the mental health department after being discharged. The total cost was estimated in 103,581 USD, of which two-thirds corresponded to patients with prior history of mental health problems. Conclusion(s): Our results indicate that the mental health burden of severe COVID-19 inpatient s after discharge was substantial during the first year of follow-up. This generate important economic impact to mental health providers and society at large.
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Introduction: The use of technological supports in psychotherapeutic interventions has been widespread in recent years. Since the COVID-19 pandemic, the increase has been greater. The feasibility of online group interventions has been proved in previous studies. Research comparing dropout rates in group interventions with clinical population that include mindfulness training is infrequent. Objective(s): To compare the difference in dropout rates between online and face-to-face mindfulness-based group interventions. Method(s): This study was carried out in a Mental Health Unit in Colmenar Viejo (Madrid, Spain). One hundred thirty-five adult patients with anxiety disorders were included in group interventions (74 face-to-face;61 online). The group treatments were Acceptance and Commitment Therapy and a Mindfulness-based Emotional Regulation intervention, during 8 weeks, guided by two Clinical Psychology residents. A descriptive analysis of dropout rates (participants attending 3 or fewer sessions out of the total number of participants starting the intervention) was performed. Result(s): Of the 135 patients included, 8 did not participate in the interventions (5 face-to-face;3 online), which represents a 5.93% rejection rate;6.76% for the face-to-face intervention and 4.92% for the online intervention. Of the remaining sample (127 participants), a total dropout rate of 12.6% was obtained, with 8.69% in the faceto-face intervention versus 17.24% online. Conclusion(s): A higher dropout rate was obtained in online interventions compared to face-to-face, with an increase of almost double. Research on specific factors that may interfere with treatment adherence to online group interventions is needed.
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Introduction: Post-Intensive Care Syndrome (PICS) is a physical, cognitive, emotional and functional condition resulting from prolonged stays in ICU (Intensive Care Unit). In pathologies with clinical characteristics similar to SARS-CoV-2 pneumonia, most patients showed cognitive deficits after discharge from ICU. Further studies are needed on verbal working memory among PICS patients. Objective(s): To analyse the verbal working-memory performance among patients with PICS after COVID-19 infection in a Functional Rehabilitation Unit in Madrid (Spain) using the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S). Method(s): This study was conducted in the Hospital Central de la Cruz Roja, in Madrid (Spain). A sample of 17 PICS adult patients was included, with age ranging from 56 to 74 years old (mean = 68.35 years;13 males). Patients were assessed around three weeks after referral from their reference hospital. The Working Memory Test (WMT) of the SCIP-S was used as outcome. Descriptive analyses were conducted (mean and standard deviation) on standardized scores (z) based on age-adjusted general population norms. Significant impairment was set at z < -1.5. Result(s): Mean z-score on WMT was -.64 (S.D. = .60) from the total sample, with 5.9% of cases with significant impairment (mean = -1.53). Conclusion(s): These preliminary results show low probable presence of impairment on verbal working memory among PICS patients after COVID-19 infection. Longitudinal studies, with larger samples, are needed where the premorbid cognitive level is considered.
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Introduction: Post-Intensive Care Syndrome (PICS) is a physical, cognitive, emotional and functional condition resulting from prolonged stays in ICU (Intensive Care Unit). In pathologies with clinical characteristics similar to SARS-CoV-2 pneumonia, most patients showed cognitive deficits after discharge from ICU. In particular, earlier studies describe impairment on verbal learning among PICS patients. Objective(s): To analyse the delayed verbal-learning performance in patients with PICS after COVID-19 infection in a Functional Rehabilitation Unit in Madrid (Spain) using the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S). Method(s): This study was conducted in the Hospital Central de la Cruz Roja, in Madrid (Spain). A sample of 17 PICS adult patients was included, with age ranging from 56 to 74 years old (mean = 68.35 years;13 males). Patients were assessed around three weeks after referral from their reference hospital. The Verbal Learning Test-Delayed (VLT-D) of the SCIP-S was used as outcome. Descriptive analyses were conducted (mean and standard deviation) on standardized scores (z) based on age-adjusted general population norms. Significant impairment was set at z < -1.5. Result(s): Mean z-score on VLT-D was -1.02 (S.D. = .96) from the total sample, with 41.2% of cases with significant impairment (mean = -1.97;S.D. = .23). Conclusion(s): These preliminary results show the probable presence of mild-moderate impairment on delayed verbal learning in a relevant proportion of patients, which was already observed in PICS patients with other medical conditions. Longitudinal studies, with larger samples, are needed where the premorbid cognitive level is considered.
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Introduction: Gastrointestinal symptomatology in SARS-CoV-2 infection is a common clinical presentation, reported in up to 61% in those affected, being the presence of acute diarrhea one of the most common symptoms, reported in up to 33.7%. There are multiple theories about physiopathological mechanisms of diarrhea associated with SARS-CoV2 infection, but there is not enough evidence to attribute this symptom only to the infection without the influence of host and environment factors. Objective: Determine the associated factors with acute diarrhea in Mexican population with SARS-CoV-2 infection. Methods: A case-control cross-sectional study was performed to analyze the factors associated with acute diarrhea in patients with SARS-CoV-2. This research was carried out during the 2020-2021 in five states of Mexico. An online survey was applied to 784 patients, selected by randomized sampling of whom sociodemographic data, medical history, and symptoms related to SARSCoV- 2 infection were collected. A univariate and multivariate logistic regression analysis was performed applying a χ2 test with 95% confidence intervals to determinate the association of acute diarrhea in SARS-CoV-2 infection with other symptomatology and possible nonhost contributing factors for its presentation. Results: A total of 784 patients were analyzed with a mean age of 29 ± 8 years, predominantly female with 75.4% (591). The most frequently described symptom was fatigue in 75% (588) followed by anosmia and myalgias with 67% (525) and 65.5% (514) respectively. Acute diarrhea was present in 28.6% (321) of our population during the acute phase of SARS-CoV-2 infection. The most used drugs were acetaminophen (79.2%) and azithromycin (29.7%). The multivariate logistic regression analysis showed a statistically significant association between acute diarrhea and the use of macrolides, mainly with clarithromycin with an OR of 2.96 (95% CI of 1.26-6.95, p = 0.001) followed by azithromycin with an OR of 1.47 (95% CI 1.035-2.091, p = 0.031). In this same analysis, there was no significant association of acute diarrhea with the rest of SARS-CoV-2 infection symptoms. Discussion: This study demonstrates the association of acute diarrhea in SARS-CoV-2 infection with the concomitant use of macrolides, without finding any association with described SARS-CoV-2 viral symptoms. According to the previously mentioned, we propose that a proportion of acute diarrhea associated with SARSCoV- 2 infection may be secondary to inappropriate macrolide prescription and not due to the viral disease itself.
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A patient, diagnosed with ulcerative colitis and rheumatoid arthritis and treated with mesalazine and hydroxychloroquine, presented with symptoms of catarrh similar to those of COVID-19. The pharmacotherapeutic monitoring service (PMS) provided to the patient allowed us to associate these symptoms with a side effect of the drug taken by the patient, i.e., blood dyscrasias. The intervention, carried out to inform the doctor while the patient was symptomatic, allowed the HCP to modify the treatment by reducing the doses of the drugs used until the condition was under control.
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The tourism sector has been strongly affected by the COVID-19 health crisis. In this context, spa tourism, in the process of reconceptualizing towards wellness, faces a new scenario. The main aim is to analyze whether the behavior and needs of clients of spa tourism in Spain have undergone changes during the pandemic. The research is based on field work and a questionnaire of the spa of Archena (Murcia) to 1406 clients. The results evidence that participants have new needs and prefer spas as vacation destinations, to spend the night and receive health treatments. However, the level of economic uncertainty of many of them has increased exponentially and, although the security measures in the establishment are solid, most are not willing to assume extra economic costs. This reality can guide thermal establishments to quickly and strategically redirect their offer to a demand with new needs derived from the pandemic. In addition, it is an opportunity for spas to position themselves as a strategic tourism modality in the health crisis.
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Plain language summary Achievement of elimination of HCV as a major public health threat requires focus on vulnerable populations such as people in prison. The prison population is at high risk of HCV infection but their treatment is complicated by social issues such as mental health disorders and drug use. Simple and effective treatment regimens are required to increase access to treatment and improve cure rates. This real-world analysis across Europe and Canada analyzed data from 20 prison populations. HCV-infected individuals were treated with sofosbuvir/velpatasvir, a once daily treatment which requires minimal monitoring. This regimen achieved high cure rates in the prison population despite the existence of complicating social issues. Background: People in prison are at high risk of hepatitis C virus (HCV) infection and often have a history of injection drug use and mental health disorders. Simple test-and-treat regimens which require minimal monitoring are critical. Methods: This integrated real-world analysis evaluated the effectiveness of once daily sofosbuvir/velpatasvir (SOF/VEL) in 20 prison cohorts across Europe and Canada. The primary outcome was sustained virological response (SVR) in the effectiveness population (EP), defined as patients with a valid SVR status. Secondary outcomes were reasons for not achieving SVR, adherence and time between HCV RNA diagnosis and SOF/VEL treatment. Results: Overall, 526 people in prison were included with 98.9% SVR achieved in the EP (n = 442). Cure rates were not compromised by drug use or existence of mental health disorders. Conclusion: SOF/VEL for 12 weeks is highly successful in prison settings and enables the implementation of a simple treatment algorithm in line with guideline recommendations and test-and-treat strategies.
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Media has been the business area that not only has not stopped its activity, but also has increased it due to the high demand of information by the population to inform and entertain themselves. Our main goals to address how the media, especially television, have adapted to the new situation. Specifically, the programming referring to the retransmission of the Cadiz Carnival. In 2021, television networks have had to created that content to cover the special programming of those dates. In this work we show a general overview analyzing the broadcast programming as well as the content created by networks. Through participating observation, in-depth interviews with agents involved in the making and development of the programs studied and analysis of television programming, we note that, in this occasion, creativity has emerged from the scriptwriters or program directors and not from the cultural product itself that is the Cadiz Carnival, as it has historically happened. We know that the content studied here can quickly become out of step due to its own characteristics, but since it is an exceptional event, it must be studied as a historical moment that adds to the various changes and adaptations that society has had to make because of the pandemic.
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When the World Health Organization declared COVID-19 as a public health emergency of international concern, the Spanish Ministry of Health called the health, labor, social security authorities, Labor and Social Security Inspection, National Institute of Security and Occupational Health, employers, unions, occupational risk prevention services, mutual societies and scientific societies of occupational medicine and nursing, to collaborate in the control of the transmission of SARS-CoV-2 in companies. The Occupational Health Group of the Public Health Commission of the Interterritorial Council of the National Health System, developed the Procedure for the prevention of occupational risks in the face of exposure to SARS-CoV-2, which has been updated 15 times until the date. It contains the prevention measures to be implemented in the workplaces: organizational and collective protection, personal protection, especially vulnerable worker and risk level, study and management of cases and contacts that occurred in the company, collaboration in the management of temporary disability and, more recently, reincorporation and management of vaccinated workers. As a result of these cooperation and collaboration frameworks, a series of activities were deployed in the workplace, which are described in this article.
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Background: The outcomes after COVID-19 and the associated immunosuppressive agents modification in kidney graft is unknown. We evaluated the presence of de-novo DSA and histopathologic findings in a group of kidney recipients after COVID-19 infection Methods: Kidney recipients recovered from COVID 19 infection from March 31, 2020 to December 8, 2020 in a single transplant center in Mexico were enrolled. Four weeks after COVID-19 diagnosis, DSA and kidney graft biopsy were performed. Results: A total of 20 kidney transplant recipients were enrolled. Immunosuppressive regimen was modified in 60% of patients, the most common modification was MMF reduction or withdrawn (35%). Allograft biopsy revealed that 70% had rejection;20% were classified as active chronic rejection, 15% active ABMR, 20% mixed ABMR/TCMR rejection, 10% borderline for acute TCMR and 5% acute TCMR. Among allografts diagnosed with rejection, 57% were considered as subclinical. All borderline for acute TCMR and active ABMR with dnDSA were subclinical Conclusions: The unusually high rate of acute rejections and the high number detected without allograft dysfunction in recipients recovered from COVID-19 should be an alert to others transplant centers to monitorize alloimmune response after COVID-19.