COVID-box Experiences of Patients and Health Care Professionals (COVID-box Project): Single-Center, Retrospective, Observational Study.

BACKGROUND: During the COVID-19 pandemic, several home monitoring programs have described the success of reducing hospital admissions, but only a few studies have investigated the experiences of patients and health care professionals. OBJECTIVE: The objective of our study was to determine patients' and health care professionals' experiences and satisfaction with employing the COVID-box. METHODS: In this single-center, retrospective, observational study, patients and health care professionals were asked to anonymously fill out multiple-choice questionnaires with questions on a 5-point or 10-point Likert scale. The themes addressed by patients were the sense of reassurance and safety, experiences with teleconsultations, their appreciation for staying at home, and the instructions for using the COVID-box. The themes addressed by health care professionals who treated patients with the COVID-box were the characteristics of the COVID-box, the technical support service and general satisfaction, and their expectations and support for this telemonitoring concept. Scores were interpreted as insufficient (≤2 or ≤5, respectively), sufficient (3 or 6-7, respectively), or good (≥4 or ≥8, respectively) on a 5-point or 10-point Likert scale. RESULTS: A total of 117 patients and 25 health care professionals filled out the questionnaires. The median score was 4 (IQR 4-5) for the sense of safety, the appreciation for staying at home, and experiences with teleconsultations, with good scores from 76.5% (88/115), 86% (56/65), and 83.6% (92/110) of the patients, respectively. Further, 74.4% (87/117) of the patients scored the home monitoring program with a score of ≥8. Health care professionals scored the COVID-box with a minimum median score of 7 (IQR 7-10) on a 10-point scale for all domains (ie, the characteristics of the COVID-box and the technical support service and general satisfaction). For the sense of safety, user-friendliness, and additional value of the COVID-box, the median scores were 8 (IQR 8-10), 8 (IQR 7-9), and 10 (IQR 8-10), respectively, with good scores from 86% (19/22), 75% (15/20), and 96% (24/25) of the health care professionals, respectively. All health care professionals (25/25, 100%) gave a score of ≥8 for supporting this home monitoring concept, with a median score of 10 (IQR 10-10). CONCLUSIONS: The positive experiences and satisfaction of involved users are key factors for the successful implementation of a novel eHealth solution. In our study, patients, as well as health care professionals, were highly satisfied with the use of the home monitoring program-the COVID-box project. Remote home monitoring may be an effective approach in cases of increased demand for hospital care and high pressure on health care systems.

Implementing a Personalized Integrated Stepped-Care Method (STIP-Method) to Prevent and Treat Neuropsychiatric Symptoms in Persons With Dementia in Nursing Homes: Protocol for a Mixed Methods Study.

BACKGROUND: Neuropsychiatric symptoms occur frequently in many nursing home residents with dementia. Despite the availability of multidisciplinary guidelines, neuropsychiatric symptoms are often inadequately managed. Three proven effective methods for managing neuropsychiatric symptoms were integrated into a single intervention method: the STIP-Method, a personalized integrated stepped-care method to prevent and treat neuropsychiatric symptoms. The STIP-Method comprises 5 phases of clinical reasoning to neuropsychiatric symptoms and 4 stepped-care interventions and is supported with a web application. OBJECTIVE: This study aims to identify the facilitators and barriers in the implementation of the STIP-Method in nursing homes. METHODS: A mixed methods design within a participatory action research was used to implement the STIP-Method in 4 facilities of 2 Dutch nursing home organizations. In total, we aimed at participation of 160-200 persons with dementia and expected an intervention fidelity of 50% or more, based on earlier studies regarding implementation of effective psychosocial interventions to manage neuropsychiatric symptoms. All involved managers and professionals were trained in the principles of the STIP-Method and in using the web application. An advisory board of professionals, managers, and informal caregivers in each facility supported the implementation during 21 months, including an intermission of 6 months due to the COVID-19 pandemic. In these 6-weekly advisory board meetings, 2 researchers stimulated the members to reflect on progress of the implementation by making use of available data from patient records and the web application. Additionally, the 2 researchers invited the members to suggest how to improve the implementation. Data analysis will involve (1) analysis of facilitators and barriers to the implementation derived from verbatim text reports of advisory board meetings to better understand the implementation process; (2) analysis of patient records in accordance with multidisciplinary guidelines to neuropsychiatric symptoms: personalized, interdisciplinary, and proactive management of neuropsychiatric symptoms; (3) evaluation of the web application in terms of usability scores; (4) pre- and postimplementation analysis of patient records and the web application to evaluate the impact of the STIP-Method, such as changes in neuropsychiatric symptoms and informal caregiver burden. RESULTS: We enrolled 328 persons with dementia. Data collection started in July 2019 and ended in December 2021. The first version of this manuscript was submitted in October 2021. The first results of data analysis are expected to be published in December 2022 and final results in June 2023. CONCLUSIONS: Our study may increase understanding of facilitators and barriers to the prevention and treatment of neuropsychiatric symptoms in nursing home residents with dementia by implementing the integrated STIP-Method. The need for well-designed implementation studies is of importance to provide nursing homes with optimal tools to prevent and treat neuropsychiatric symptoms. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34550.

Heparan sulfate mimetic fucoidan restores the endothelial glycocalyx and protects against dysfunction induced by serum of COVID-19 patients in the intensive care unit.

Accumulating evidence proves that endothelial dysfunction is involved in coronavirus disease 2019 (COVID-19) progression. We previously demonstrated that the endothelial surface glycocalyx has a critical role in maintenance of vascular integrity. Here, we hypothesised that serum factors of severe COVID-19 patients affect the glycocalyx and result in endothelial dysfunction. We included blood samples of 32 COVID-19 hospitalised patients at the Leiden University Medical Center, of which 26 were hospitalised in an intensive care unit (ICU) and six on a non-ICU hospital floor; 18 of the samples were obtained from convalescent patients 6 weeks after hospital discharge, and 12 from age-matched healthy donors (control) during the first period of the outbreak. First, we determined endothelial (angiopoietin 2 (ANG2)) and glycocalyx degradation (soluble thrombomodulin (sTM) and syndecan-1 (sSDC1)) markers in plasma. In the plasma of COVID-19 patients, circulating ANG2 and sTM were elevated in patients in the ICU. Primary lung microvascular endothelial cell (HPMEC) and human glomerular microvascular endothelial cell (GEnC) cultured in the presence of these sera led to endothelial cell glycocalyx degradation, barrier disruption, inflammation and increased coagulation on the endothelial surface, significantly different compared to healthy control and non-ICU patient sera. These changes could all be restored in the presence of fucoidan. In conclusion, our data highlight the link between endothelial glycocalyx degradation, barrier failure and induction of a procoagulant surface in COVID-19 patients in ICU which could be targeted earlier in disease by the presence of heparan sulfate mimetics.

Drivers and Predictors of COVID-19 Vaccine Hesitancy in Virginia

This research uses the COVID-19 Trends and Impact Survey provided by Carnegie Mellon University in partnership with Facebook to study predictors and drivers of COVID-19 vaccine hesitancy in Virginia’s adult population. It estimates vaccine hesitancy rates at a zip code level in Virginia by applying multilevel statistical models. Our analysis identifies the demographic features of zip codes that are associated with vaccine hesitancy. It also examines the drivers of COVID-19 vaccine hesitancy across Virginia. Results show the presence of a larger percentage of Black and White population and a lower percentage of Hispanic population are predictors of higher vaccine hesitancy within a zip code in Virginia. Among these drivers, the biggest is system distrust, where individuals either do not trust the government or believe that the vaccine is not efficacious. Finally, it provides policy insights and tailored outreach programs for improving COVID-19 vaccination acceptability in different regions in Virginia. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

RESISTÊNCIA AOS CARBAPENÊMICOS EM CENTRO DE MEDICINA TROPICAL DE RONDÔNIA, NA AMAZÔNIA OCIDENTAL

Introdução/Objetivo: A resistência antimicrobiana é considerada hoje uma ameaça global pela OMS e um desafio constante na prática médica intra-hospitalar. Bactérias resistentes aos carbapenêmicos, principalmente via produção de carbapenemases, frequentemente são relacionadas a infecções graves e com limitado arsenal terapêutico. Dessa forma, objetivou-se neste estudo a caracterização de microorganismos isolados conforme o perfil de resistência aos carbapenêmicos no Centro de Medicina Tropical de Rondônia (CEMETRON). Métodos: Estudo retrospectivo no CEMETRON no primeiro semestre de 2021. Avaliação dos resultados de culturas provenientes do banco de dados não nominal do Serviço de Controle de Infecção Hospitalar. Para as análises estatísticas utilizamos o SPSS® versão 25.0. Resultados: No primeiro semestre de 2021 o CEMETRON teve 303 culturas positivas, destas, 153 bactérias Gram negativas, sendo incluídas 61 (39,9%) resistentes a pelo menos um carbapenêmico. A topografia mais prevalente foi o aspirado traqueal (52,5%), seguido por sangue (18,0%) e urina (14,8%). Em ordem de prevalência tivemos 38 (62,3%) Klebsiella pneumonie, 12 (19,7%) Acinetobacter baumannii, cinco (8,2%) Pseudomonas aeroginosa, quatro (6,6%) Escherichia coli, uma (1,6%) Burkholderia cepacia e uma (1,6%) Serratia marcescens. Das 61 culturas incluídas, 19 (31,1%) foram avaliadas quanto a presença de gene de resistências enzimática, sendo 11 Klebsiella pneumonie, seis Acinetobacter baumanni, uma Pseudomonas aeroginosa e uma Serratia marcescens. Foram detectados genes enzimáticos de resistência em seis das 19 (31,6%) bactérias testadas, sendo quatro KPC detectáveis em Klebsiella pneumonie, dois OXA-51 e um OXA-58 detectáveis em Acinetobacter baumanni. Conclusão: Nosso estudo demonstra uma grande incidência de bactérias resistentes aos carbapenêmicos, quase 40% das culturas com bactérias Gram negativas no período. Importante ressaltar que a maioria dessas culturas eram de aspirado traqueal, o que pode estar relacionado com o atual cenário da pandemia de COVID-19, onde as infecções pulmonares secundárias são as mais prevalentes em UTIs. É de fazer notar a detecção de produtores de carbapenemases de classe A e D cujas terapias envolvem o uso de novos inibidores de beta-lactamases (p. ex. ceftazidima-avibactam) que não estão disponíveis na maioria dos hospitais da rede pública, nos restando terapias com menor índice de sucesso (p. ex. polimixina) comparados a medicação de primeira escolha.

e-Learning and Web-Based Tools for Psychosocial Interventions Addressing Neuropsychiatric Symptoms of Dementia During the COVID-19 Pandemic in Tokyo, Japan: Quasi-Experimental Study.

BACKGROUND: Concern has been raised that the COVID-19 pandemic and consequent social distancing measures may increase neuropsychiatric symptoms in people with dementia. Thus, we developed and delivered an e-learning training course to professional caregivers on using a web-based tool for psychosocial interventions for people with dementia. OBJECTIVE: The aim of our study was to evaluate the feasibility and efficacy of an e-learning course in combination with a web-based tool in addressing neuropsychiatric symptoms of dementia. METHODS: A quasi-experimental design was used in Tokyo, Japan. The e-learning course was delivered three times to professional caregivers between July and December 2020. Caregivers who completed the course assessed the level of neuropsychiatric symptoms in people with dementia using the total score from the Neuropsychiatric Inventory (NPI) via a web-based tool. The primary outcome measures were the number of caregivers who implemented follow-up NPI evaluations by March 2021 and the change in NPI scores from baseline to their most recent follow-up evaluations. As a control group, information was also obtained from professional caregivers who completed a face-to-face training course using the same web-based tool between July 2019 and March 2020. RESULTS: A total of 268 caregivers completed the e-learning course in 2020. Of the 268 caregivers, 56 (20.9%) underwent follow-up evaluations with 63 persons with dementia. The average NPI score was significantly reduced from baseline (mean 20.4, SD 16.2) to the most recent follow-up evaluations (mean 14.3, SD 13.4). The effect size was assumed to be medium (Cohen drm [repeated measures]=0.40). The control group consisted of 252 caregivers who completed a face-to-face training course. Of the 252 caregivers, 114 (45.2%) underwent follow-up evaluations. Compared to the control group, caregivers who completed the e-learning course were significantly less likely to implement follow-up evaluations (χ21=52.0, P<.001). The change in NPI scores did not differ according to the type of training course (baseline-adjusted difference=-0.61, P=.69). CONCLUSIONS: The replacement of face-to-face training with e-learning may have provided professionals with an opportunity to participate in the dementia behavior analysis and support enhancement (DEMBASE) program who may not have participated in the program otherwise. Although the program showed equal efficacy in terms of the two training courses, the feasibility was suboptimal with lower implementation levels for those receiving e-learning training. Thus, further strategies should be developed to improve feasibility by providing motivational triggers for implementation and technical support for care professionals. Using online communities in the program should also be investigated.

HEPATIC CHANGES BY SARS-COV 2 IN PATIENTS OF THE INTENSIVE CARE UNIT OF THE TROPICAL MEDICINE CENTER IN RONDÔNIA

Introduction: Coronavirus (SARS-CoV2) infection occurs through the receptor's angiotensin converting enzyme 2, present in the pulmonary, biliary, and hepatic epithelial cells. Therefore, the liver is a potential target for infection. Objectives: To analyze liver changes resulting from Sars-Cov-2 infection in patients admitted to the Intensive Care Unit of the Rondônia Tropical Medicine Center (CEMETRON). Methods: Patients admitted between April and August 2020 in the CEMETRON ICU were included in the study. Project approved by the Research Ethics Committee. For statistical analysis, the SPSS® program was used. Results: 307 patients were admitted to the CEMETRON ICU. 81 (26.4%) non-COVID and 226 (73.6%) diagnosed with COVID. Among the 226 tested positive for COVID, 52.3% and 54.3% had, respectively, an increase in ALT and AST up to three times the upper limit of normal (40-120U/L). Non-COVID patients showed this increase in 20.8% for ALT and 33.3% for AST, being statistically significant (p: <0.005 for both). Transaminases above 120U/L had no statistically significant difference between the two groups. Regarding liver function assessed through bilirubin, albumin and platelets, there was no statistically significant difference in any of the variables (p: 0.93 p: 0.45 p: 0.599 respectively). The means varied within the normal range, except for both groups there was a tendency towards hypoalbuminemia (3.1 g / dL). Conclusion: Patients with COVID evolved in more than 50% of the cases with changes in liver enzymes, showing that despite the inflammation, liver function was not directly affected. We associate hypoalbuminemia more with basal malnutrition than with hepatic impairment.