ABSTRACT
Mental health (MH) issues related to COVID-19 can arise at each of the following stages: Onset (managing fear, uncertainty, stigma) and re-emerging MH problems;Acute (managing panic, fear, delirium, isolation);Long COVID (managing the cognitive, emotional, physical sequelae of COVID-19 and differentiating from pre- COVID 'unfinished emotional business' that has arisen;and Recovery (adjusting to full recovery or a 'new normal'). This talk will address the issues seen in post-COVID-19 follow-up in relation to these stages. Consultation-liaison psychiatry's role throughout the transplant journey from assessment to post-transplant management. This has grown in importance as the range of potential recipients has grown to include people who are older, and with more evidence of the '4 Ds' (depression, disordered personality, delirium, decline in cognitive function). Several innovations to the assessment process have improved outcomes in predicting delirium, survival, and intensive care unit (ICU)/hospital stays. First, addition of frailty assessment and the effects of adding depression and cognitive capacity to the standard frailty score. While depression improves post-transplantation, cognitive function tends not to. Similarly, patients with high scores on the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) are at increased risk of adverse outcomes (delirium, poor post-transplant adherence and increased ICU/hospital stays). Findings: The implications of these findings will be discussed.
ABSTRACT
Background: As a consequence of the COVID-19 pandemic, many healthcare consultations and programs were delivered via telehealth in 2020. In March 2020, additional telehealth items were added to the Medicare Benefits Schedule (MBS). The Tele-PC Study strategically examined clinician experiences of delivering cardiovascular care via telehealth in 2020 to inform future cardiovascular care. Methods: Qualitative study conducted via individual semi-structured interviews with clinicians providing care to people with cardiovascular conditions. Interviews were recorded and transcribed verbatim and analysed using thematic analysis. An invitation to participate in the study was circulated via CSANZ, ACRA, RACGP, and Stroke Foundation and local networks, and promoted through two conference presentations and via social media (Twitter). Results: Sixteen clinicians consented to participate and completed interviews. Clinicians were from across Australia and clinical disciplines: cardiology (adult and paediatric), general practice, nursing (Registered Nurses and Nurse Practitioners), and allied health (dietetics, genetic counselling, and exercise physiology) and employed across settings: acute care, cardiovascular rehabilitation, cardiovascular transplant, community, and outpatient care. Findings identified three overarching themes: 1) environmental impacts on telehealth;2) perceived barriers and enablers to telehealth;3) understanding remote assessment and collecting physiological data. Conclusions: These qualitative data inform sustainable cardiovascular telehealth implementation and policy in Australia.
ABSTRACT
Introduction: Viral infections may trigger diabetes. Clinical data suggest infection with the pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19), may impact glucose homeostasis in patients. Notably, cases of new-onset diabetes upon SARS-CoV-2 infection have been reported. However, experimental evidence of pancreatic infection is still controversial. Aims & Methods: Here, we employ cadaveric human pancreatic islets, as well as pancreatic tissue from deceased COVID-19 patients to investigate the impact of SARS-CoV-2 on the pancreas. Results: We show that human β-cells express viral entry proteins ACE2 and TMPRSS2, making them susceptible to SARS-CoV-2 infection and replication. Our data further demonstrates that SARS-CoV-2 infects and replicates in ex vivo cultured human islets and infection. This infection is associated with morphological, transcriptional and functional changes, such as reduction of insulin-secretory granules in β-cells and impaired glucose-stimulated insulin secretion. In COVID-19 post-mortem examinations, we detected SARS-CoV-2 nucleocapsid protein in pancreatic exocrine cells, and in cells that stain positive for the β-cell marker NKX6.1 in all patients investigated. Conclusion: Taken together, our data define the human pancreas as a target of SARS-CoV-2 infection and suggest that β-cell infection might contribute to the metabolic dysregulation observed in patients with COVID- 19.